PEDIATRIC AUDIOLOGY

Diagnostic ABR is a specialized test for newborns, infants, children or adults that measures how well sound travels from the ear to the level of the brainstem.  Three to four electrodes are placed on your child’s head and behind their ears which allows us to record and track the brain’s response to different sounds.  After the electrodes are placed, we utilize an insert earphone that plays a variety of low, middle and high pitch sounds into your child’s ear and then record how your child’s brain responds to these sounds while your child is sleeping or relaxed.   Typically, we present sounds at a louder level so that we can rule out any auditory neuropathies, and then the sounds are gradually decreased in intensity to the softest level we see a response in order to obtain an estimate of the threshold levels your child hears.   The audiologist will look for certain neurological “markers” as your child’s hearing nerves respond to the sounds being presented. The softest intensity or loudness level at which these markers appear roughly corresponds to the child’s hearing level in that frequency range or pitch. Each ear is tested independently of the other ear and ear specific results are obtained.  By reading a computer printout of your child’s responses and interpreting these markers, the audiologist can determine if your child has a hearing problem.  If a hearing loss is identified, the audiologist can then tell you the type and extent of the hearing loss.

At Beyond Limits, we perform ABR testing for patients birth to 21 years of age. ABR testing does not require the patient to respond as the results are recorded utilizing electrodes placed on your child’s head which makes this an excellent measure of hearing for newborns as well as children and young adults who are too young or are not able to cooperate for traditional audiological testing.  It is important to note that the test is completely painless and most infants and newborns sleep (un-sedated) right through the evaluation.  For older children and young adults, the test can be performed while they are relaxed, watching a movie, playing on a hand-held device, reading a book, etc.

While most local facilities will only test babies un-sedated up to 3 months of age, in most cases, our state of the art equipment allows us to test un-sedated with no age restrictions.

HOW TO PREPARE FOR YOUR CHILD’S ABR APPOINTMENT

For newborns, the ABR appointment can take anywhere from 30 min to 3 hours which depends on how relaxed your baby is, the results we are obtaining, if we need to break for a feeding or diaper change, etc.  Although it may not take this long, when scheduling we ask that you plan for a 3-hour appointment and ask that you do not bring other children to this appointment unless they have a care taker who can watch them in our waiting room.   It is very important for the baby to sleep or rest comfortably during the entire test.  The best way to prepare for the test is to keep the baby hungry and tired prior to your appointment.  Try to keep your baby awake and hold the feeding right before your appointment until the time the Audiologist is ready to begin the test.   If possible, try to keep your baby awake during the drive to our office.   It is recommended that you bring a blanket, pacifier, or anything that provides comfort to your baby while sleeping.  The goal is for the baby to sleep for 2-3 hours as soundly as possible, the better your baby sleeps the faster and more accurately the ABR testing can be completed.

For children who are past the napping age, have developmental disabilities, or other reasons ABR testing needs to be performed, we ask that you bring books to read to them, an IPad or hand- held gaming system they can play on, a hand-held device to watch movies or their favorite show, or anything that will keep them distracted, yet quiet, in order for us to perform the test.

Automated Auditory Brainstem Response (AABR) is a painless pass or refer test used to screen the hearing of newborns.  In Georgia, it is mandated that all newborns are screened for hearing loss before they leave the hospital and if they do not pass the screening, they are required to have a second screening performed within 2-4 weeks at an outpatient clinic.  Most birthing hospitals utilize AABR and/or Otoacoustic Emissions (OAE). After two attempts of AABR and/or OAE testing that result in a refer, the State of Georgia requires the infant have a diagnostic ABR to performed in order to establish hearing threshold levels.  The initial method of testing is the testing that will need to be repeated.  For example, if an AABR is performed initially, follow up testing needs to include AABR at a minimum.  If OAE  is performed then follow up testing requires OAE at a minimum.    It is important to note that referring on AABR or OAE testing does NOT mean that your child has a confirmed hearing loss.  It simply means that further diagnostic testing is required in order to rule out a hearing loss and establish hearing threshold levels.

To perform an AABR, electrodes are placed on your baby’s forehead, and behind their ears.  A probe is then placed into the ear and delivers a sound that is presented at a constant level, typically in the range of 1000-4000 Hz which are the frequencies thought to be the most important for speech and language.  Unlike diagnostic ABR testing, testing is not frequency specific and there is no interpretation possible of the results. The results are simply a pass or a refer. Each ear is tested independently of the other ear and ear specific results are obtained. A second refer result must be followed up with a diagnostic Auditory Brainstem Response (ABR) test.  Often, a patient will pass one ear and refer the other ear.  It is imperative that BOTH ears are re-evaluated when this occurs.

If your baby referred in the hospital and this will be the first re-screen, please call and schedule an AABR and OAE appointment.  If your baby referred on the outpatient re-screen, please call to schedule a diagnostic ABR.   We can be reached by calling 770-917-5737 to schedule any appointment or if you have any questions.  We are here to help you!

This test checks the hearing pathway from the outside world to the cochlea, the hearing part of the inner ear. During OAE testing, a small probe is placed in the ear canal that delivers a sound to the cochlea in order to stimulate the outer hair cells of the cochlea. In a healthy functioning ear, the hair cells vibrate when stimulated by sound. When they vibrate, they actually produce a very slight sound, not audible to us, in response to the sound administered to the ear. It is basically like an echo. In OAE testing, the probe that produces the initial stimulus sound is able to detect the sound produced by the hair cells, or the otoacoustic emission. Unlike a AABR or diagnostic ABR, OAE testing does not test cochlear/auditory nerve integrity or any of the pathways from the nerve to the brain.  OAE testing only tests at the level of the cochlea.

At Beyond Limits, we often utilize OAE in conjunction with AABR, ABR, VRA, or traditional audiometry to fully assess the entire auditory system and the hearing abilities of our patients. OAE’s are also a very useful to obtain ear specific information for children who will not tolerate insert earphones in the sound booth.

If your baby referred in the hospital and this will be the first re-screen, please call and schedule an AABR and OAE appointment.  If your baby referred on the outpatient re-screen, please call to schedule a diagnostic ABR.   We can be reached at  770-917-5737 to schedule any appointment or if you have any questions.  We are here to help you!

The type of test utilized for a comprehensive audiological evaluation depends on the developmental age, not the chronological age of your child, and how cooperative your child is. There is no set test per age and we test based on the needs of your child. Typically, Visual Reinforcement Audiometry starts at about 6 months developmental age and is utilized to about 3 years of age. At approximately 3 years developmental age we try to start with Conditioned Play Audiometry and at about 5 years of age we start with Traditional Audiometry. Every child is different and we always take into account the specific needs of your child.   Our audiologists are pediatric trained to perform the following audiological testing:

Visual Reinforcement Audiometry (VRA):

VRA is performed on children starting at 6 months of age AND when they can hold their head up on their own and turn to sounds to about 3 years of age. VRA testing is performed in a sound booth. A speech awareness threshold is obtained and then sounds are typically presented for 500-4000 Hz through the speakers in the sound booth or utilizing insert ear phones and the child responds by turning his/her head to the sound. The audiologist then lights up a toy as a positive reinforcement to responding to the sound. The child learns to turn to the sounds when they hear them and the toy lights up in response. VRA provides ear specific information only if the child will tolerate the insert earphones. If earphones cannot be utilized, information for the better ear is obtained. Frequency Specific information is typically obtained. We try to incorporate OAE testing for ear specific information if the child’s tolerance level will allow.

Conditioned Play Audiometry:

This testing is performed in a sound booth, typically utilizing insert earphones on children 2-3 years of age to about 5 years of age. The audiologist utilizes game activities with the child every time a sound is hear. For example, the child drops a block in a bucket every time he/she hears a sound. Conditioned Play Audiometry allows for ear specific information if insert earphones are utilized. The goal is to obtain ear specific and frequency specific information for at least 500-4000 HZ and further frequencies if the child is cooperative. We try to incorporate OAE testing for ear specific information if the child’s tolerance level will allow.

Traditional Audiometry:

Typically this type of testing can be performed on children 5+ years of age. Insert earphones are utilized and the child raises their hand or pushes a button when they hear a sound. Ear specific and frequency specific information is obtained this way. This may remind you of when you would take hearing tests in school. If a hearing loss is found, we utilize OAE testing to help confirm the diagnosis.

EFT Measures whether the Eustachian Tube is equalizing the pressure of the middle ear with the pressure outside the middle ear.

Tympanometry tests how well your eardrum moves. It will show if your eardrum moves the correct way, is too stiff, moves too much, or has a hole in it. This can help the audiologist know if you have middle ear fluid, a hole in the eardrum, or wax in your ear canal. The test can help determine if a child has an ear infection.  Tympanometry can also assist in determining if any previously placed tube in the eardrum is open.

Acoustic reflexes are involuntary muscle contractions that occur in the middle ear in response to high-intensity sound stimuli. Acoustic reflexes help to diagnose the overall hearing health of your child.

EDHI is a program that ensures that all babies born in Georgia are screened for hearing loss at birth. 

Per the American Speech Language and Hearing Association, “Early Hearing Detection and Intervention (EHDI) refers to the practice of screening every newborn for hearing loss prior to hospital discharge. Infants not passing the screening receive diagnostic evaluation before three months of age and, when necessary, are enrolled in early intervention programs by six months of age. All 50 states and the District of Columbia have Early Hearing Detection and Intervention (EHDI) laws or voluntary compliance programs that screen hearing.”

What is newborn hearing screening?

Newborn hearing screening is screening for potential hearing loss.  All babies should be screened for hearing loss before 1 month of age as mandated by the state of Georgia.  The screening is typically done before the baby leaves the birthing facility.  If a baby refers in the birthing hospital or is not tested prior to discharge, the state of Georgia requires an outpatient re-screen.

Why screen for hearing loss in newborns?

More than half of babies born with hearing problems are otherwise healthy and have no family history of hearing loss.  If your baby has a hearing loss, you can still help your baby develop language skills. The sooner you act, the better the outcome.  Screening for hearing loss as early as possible is important to your baby because:

• Early screening allows for early treatment, if hearing loss is detected
• Early treatment can provide earlier sound stimulation for your baby’s brain

How are hearing screenings done?

There are two types of hearing screenings for infants.  Both are quick and safe and your baby will most likely sleep through both tests.

• Automated Auditory Brainstem Response (AABR) tests the baby’s ability to hear soft sounds through earphones. Electrodes are placed on the baby’s skin, which measures responses to sound at the level of the brainstem.
• Otoacoustic Emissions (OAE) measures an “echo” response to sound from the ear directly.

If your baby refers the hospital hearing screen, most likely you will hear “it’s probably fluid”.  This might be true however a hearing loss is also a real possibility.  An untreated hearing problem can significantly limit your child’s speech and language development and future educational potential.  This is why the hearing screening program is mandated across the United States and other countries.  You cannot “see” a hearing loss.  Not all kids are deaf.  Some infants with hearing loss may startle to sounds but will have difficulty hearing your voice.  The follow up screening is painless and fairly quick.  The younger the infant, the easier it is to complete the test since they have a strong sleeping schedule.  Don’t delay.

If your baby referred in the hospital and this will be the first re-screen, please call and schedule an AABR and OAE appointment.  If your baby referred on the outpatient re-screen, please call to schedule a diagnostic ABR.   We can be reached at  770-917-5737 to schedule any appointment or if you have any questions.  We are here to help you!

Our audiologists can make impressions of your child’s ear(s) for:

• Swim molds for water protection
• iPod, MP3, and Bluetooth
• Noise protection

A Beyond Limits pediatric audiologist will immediately provide you with the results of your infant/child’s hearing evaluation.   Our audiologists will work with you as the parent or caregiver and will support you as you make decisions regarding your child’s hearing health.  If diagnosed with a hearing loss, the pediatric audiologist will make appropriate referrals and will provide you with a wide variety of educational materials and parental support as your family goes through this transition.  We are here for you every step of the way in ensuring optimal results and outcome for your child.

Prior to any speech and language evaluation or therapy, a hearing loss should always be ruled out as hearing loss can cause delays in the development of receptive and expressive communication skills (speech and language). At Beyond Limits, we provide hearing screenings and evaluations for children in need of speech and language therapy for several reasons:

• Often a child with a hearing loss will still respond to sound but have delayed speech and the underlying issue of hearing loss needs to be identified.
• If a hearing loss is present, appropriate interventions need to be made so that speech and language therapy can be effective.
• If a child cannot hear sounds correctly, they cannot produce them correctly.
• Hearing loss can cause delays in the development of receptive and expressive communication skills (speech and language).
• Vocabulary develops more slowly in children who have hearing loss.
• Children with hearing loss have difficulty understanding words with multiple meanings. For example, the word bank can mean the edge of a stream or a place where we put money.  This can have significant impact on their language development.