The audiologic assessment of the young pediatric patient: the clinic.

Abstract

ue to the increasing number of newborn D hearing screening programs, infants are being referred for audiologic assessment and diagnosed with hearing loss at very young ages. Early diagnosis of hearing loss necessitates early initiation of habilitation including the fitting of amplification. Providing appropriate amplification is dependent on having a reliable definition of the child’s hearing loss. The assessment process is therefore tantamount to the habilitation and hearing aid fitting process. Unlike most adults whose hearing loss can be defined in one clinic visit, children often require repeated visits before the configuration and degree of hearing loss is defined. Audiologic assessment in children is often a challenging, time-intensive and ongoing process, particularly when assessing the very young infant. Infants and young children do not possess the breadth of responses that adults do, requiring modifications of behavioral audiologic techniques. In addition, there is sometimes the need for electrophysiologic tests to provide a baseline estimate of auditory function until complete behavioral audiologic findings can be obtained. However, complete behavioral audiologic information is not necessary before the hearing aid fitting and early intervention processes can begin. Valuable time should not be wasted waiting for complete information. Rather, the amplification process should be initiated with refinements and adjustments of the hearing aid fitting occurring as more and more precise information is obtained. Both behavioral and electrophysiologic tests are used in the audiologic assessment of the very young pediatric patient. Behavioral tests usually are thought of as subjective and the electrophysiologic reliance or non-reliance on patient participation, respectively. At very young ages, the electrophysiologic test findings often predominate in the decision making about the management of the child with a hearing loss, but for older children it is generally the behavioral audiologic finding: on which management decisions are made. These two types of tests, however, provide information on different aspects of the child’s auditory function, and cannot serve as perfect substitutes for each other. What follows are brief descriptions of the behavioral and electrophysiologic tests that are appropriate for the young pediatric patient. It should be highlighted that behavioral audiologic testing of the young child can yield reliable results if proper procedures are followed during the test session.