New-borns and children of any age can have a hearing test, and our oldest patient is a spunky 104 year old. Our hearing tests are conducted in professionally constructed gold-standard sound-proof and sound-treated rooms, by professional audiologists who are specialised for kids and adults.
Otoscopic Ear Examination
The Ear Nose Throat Specialist/ENT Doctor will first take a history from the caregiver, and examine the child with an otoscope. The condition of the ear canal and ear drum has to be noted prior to hearing tests, as it can affect the results of the hearing test. Sometimes, ear infections need to be treated before a hearing test, so that accurate hearing test results can be obtained.
If there is wax or infective debri blocking the ear canal and ear drum, the ENT doctor will remove the wax or debri micro-instruments and under light microscopic visualisation. Most children tolerate this procedure well if it is done in a calm and professional environment, with the caregiver helping to hug and steady the child.
New Born/ Infant Hearing Tests
- Universal Newborn Hearing Screening (UNHS) Test
The tests are done soon after birth, usually before the baby leaves the hospital. These tests are only for screening purposes, with a pass/ fail result. Mild hearing loss and auditory neuropathy hearing loss may be missed. They may also be affected by the small ear canals, or middle ear fluid in babies. Definitive hearing tests must be done if there is a suspicion of hearing reduction from the perinatal or family history.
- Behavioral Observation Assessment (BOA) Hearing Test
These tests are conducted by a specially trained audiologist who observes a child’s body and head responses to sounds, including cessation of activity, body movement, eye widening, eye opening, or change in sucking rate.
- Auditory Brainstem Response (ABR) & Brainstem Evoked Response Audiometry (BERA) Hearing Tests
These specialised electrophysiologic neurodiagnostic tests are especially important when the child is not able to cooperate with hearing tests yet, or definitive gold-standard hearing tests when awake hearing tests are not conclusive, or when it is important not to miss central/ brainstem or auditory neuropathy/ dys-synchrony causes of hearing loss.
A series of clicks or tones are presented, and non-invasive sticker electrodes are placed on the child’s head to detect the response. Sound transmission in the auditory hearing nervous system is picked up as waveforms on the computer program, and compared to normal hearing waveforms.
An experienced paediatric audiologist is needed to interpret the waveforms accurately. We have the child under natural sleep usually if they are under 6 months of age. In older children, we will administer syrup sedation so that the child is asleep but still breathing on his/ her own.
Otoacoustic Emission (OAE) Hearing Test
This does not cause discomfort, and takes less than 5 minutes. The audiologist will place a small earphone that delivers sounds into your child’s ears. The cochlear/ inner ear will normally have otoacoustic emissions responses if there is normal hearing or even a mild hearing loss. OAEs are lost if there is middle ear infection or more than a mild hearing loss.
Tympanometry Test
This test allows the audiologist to measure the movement of the eardrum which can help determine how the child’s or adult’s middle ear is functioning. The audiologist places a soft probe at the at the opening of the ear canal, and a small puff of air is delivered gently and sound delivered to the ear drum at the same time. This measures how flexible the eardrum is. If there is fluid in the middle ear, a perforated ear drum, or negative middle ear pressure related to nasal conditions, the tympanometry will show abnormal readings.
Visual Reinforcement Audiometry (VRA) Hearing Test
This is for children between 6 to 30 months old, infants to toddlers who can sit up with some support. Sounds will be delivered through calibrated speakers marked out at fixed distances or through ear phones. The audiologist will condition the child to look towards either an animated video or toy when a sound at certain frequency or volume is presented. This is akin to a visual reward, and the child is happy to respond to the sound.
Play Audiometry (PA) Hearing Test
This is for children between 30 months to 4-5 years old usually. Sounds will be delivered through headphones, and the child tries to finish a game during the test, advancing through the game each time he/ she responds to a sound. For example, they may complete a puzzle, or build with blocks. Many children enjoy this, with some refusing to leave! We are often able to work also with children who may have attention disorders or autism spectrum disorders too.
Pure Tone Audiometry (PTA) Hearing Test
This is usually for school aged children over 4 -5 years old and adults. Your child will raise his/ her hand in response to sounds delivered via headphones. The audiologist plots the hearing thresholds for both ears across low to high pitch frequencies, and from low to high volumes of sounds. For certain conditions, we are able to test to high frequencies up to 12 kHz, beyond the usual speech range. Some patients with tinnitus and high frequency hearing loss have only hearing loss beyond the 6 to 8kHz ranges that are usually tested.
Bone conduction (BC) Hearing test
For both children and adults, we carry out the tests additionally with a small vibrating device placed behind the ear for specific cases. This delivers the sound through the bones of the head and directly to the inner ear. It is important to distinguish between whether it is a conductive hearing loss that is related to the external and middle ear disorders, of if it is sensorineural hearing loss. This is needed to guide further investigations and clinch a correct diagnosis.
Speech Hearing Test
This determines how well the older child or adult can recognise the words that they hear through the headphones. Words are used, instead of just sounds. Speech hearing test is done in both quiet, and also in a noisy background generated. This is important as many patients have trouble hearing if there is background noise, but not when it is quiet. When the results are compared to the PTA test, specific types of hearing loss can be identified.
Auditory Brainstem Response (ABR) & Brainstem Evoked Response Audiometry (BERA) Hearing Tests
These specialised electrophysiologic neurodiagnostic tests are especially important when the adult is not able to cooperate with awake subjective hearing tests, when more unusual causes like an auditory neuropathy/ dys-synchrony or malingering is suspected.
A series of clicks or tones are presented, and non-invasive sticker electrodes are placed on the child’s head to detect the response. Sound transmission in the auditory hearing nervous system is picked up as waveforms on the computer program, and compared to normal hearing waveforms.
An experienced audiologist is needed to interpret the waveforms accurately. Adults can do the test without sedation, lying quietly or sleeping during the test in a dark room.
Children and adults with CAPD find it hard to understand what others are saying. Many CAPD diagnoses in adults may also have been missed, as APD is not well understood amongst even the medical fraternity.
The brain finds it hard to distinguish differences in speech, despite a normal hearing test and normal intelligence. Specialised CAPD tests are needed, with the diagnosis often missed as CAPD tests are not commonly available due to the challenge of interpreting the results and the time and subspecialty commitment needed for the testing.
Our audiologists will use specialised CAPD listening tests and word lists, over two 90 minute sessions, to document how well the patient can identify the words. Children are tested from 7 ears old, as their hearing and language skills are then sufficient for comparisons to normative data. Our audiologists will also identify if other issues like attention deficit, working memory and receptive language issues are the underlying problems, and not CAPD. We then refer to multidisciplinary colleagues to manage these issues. Sometimes, CAPD and these other issues can also co-exist, making CAPD a challenging condition to diagnose correctly.
