Hearing testing in children

Reading Time: 10 mins
by Constanze Schmuck

Performing objective and subjective test methods on children including BOA, OAE, ABR and VRA

Performing hearing tests with children is a challenging but rewarding task. The child needs to feel comfortable with you as an examiner, the test arrangement, and the test process itself. 

It’s also important to note that the choice of which behavioural test technique to use should be adjusted to the child’s development level rather than their physical age. Over the years, different test tactics have been developed to ensure reliable and persistent responses from children. Here we'll explore the most common tests and suggest protocols to perform successful audiometry in children:


Children less than 6 months of age

It is not easy to perform tone audiometry on very young children (younger than 6 months) as their co-operation can be limited. Behavioural Observation Audiometry (BOA) can be performed but requires more than one clinician and very experienced personnel. The benefit is that BOA is easily to overserve by the parents, and when successful, BOA allows you to measure the child’s Minimal Response Level (MRL).

It’s important to note that behavioural observation alone is not adequate for the hearing aid fitting process in children of such a young age.

Objective measurements which do not require any co-operation of the infant include tympanometry, OAE, ABR and ASSR measurements. Depending on the child, it might be required to sedate the infant when the test time is longer than a few minutes. 


BOA test protocol suggestion

  • Ensure the baby is resting comfortably in the parent’s arms or an infant seat
  • Start breast feeding, nursing with a bottle (it therefore might be beneficial for the baby to be hungry but not upset) or offer a pacifier.  If the child rejects this, present something of interest in the form of a toy without distracting the child too much
  • Observe the child while presenting a loud sound you think the child will hear. Their response might be to start or stop sucking and/or their eyes begin to blink or widen
  • Responses should be observed two-three times to be considered consistent
  • Decrease the test level and repeat the procedure.  


Children from 5 to 6 months of age

The older children become, the better they can be conditioned to a certain test procedure. In children older than five to six months but below three years, Visual Reinforcement Audiometry (VRA) measure the head turn response of the child to a certain sound presented via loudspeaker(s). 

VRA is mostly performed with animated toys hidden and only made visible during the sound presentation. VRA is a deviation of a technique called Condition Orientation Reflex (COR), where the rewarding of the child with an animated toy is not given and the child must localize the sound source themselves.


VRA test protocol suggestion

  • Ensure the child is seated comfortably on the parent’s lap or an infant seat
  • Position the child towards you. When working with an assistant, ensure the child is focused towards you
  • When the child is unfamiliar with VRA tests, play a loud sound and perform the play action to condition the child. Repeat if necessary
    Observe the child while presenting a loud sound you think the child will hear
  • Responses should be observed two-three times to be considered consistent
  • Decrease the test level and repeat the procedure.  


Children older than 3 years

Often when a child is around three years of age, Conditioned Play Audiometry (CPA) allows you to perform tone audiometry with the active cooperation of the child. Active participation of the child is fundamental for successful testing.  

The audiometry test is converted into a game, where the child is rewarded with a special action when a sound is heard. CPA is also often referred to as “Listen and Drop” test, as the child is condition to respond to sound performing a certain activity, like placing a peg in a pegboard, dropping a block in a bucket, etc. It’s often helpful to work together with an assistant who rewards the child by clapping hands or appraisals to ensure the child learns about the test procedure. 


CPA test protocol suggestion

  • Ensure the child is seated comfortably
  • Position the child towards you. When working with an assistant, ensure the child is focused towards you
  • When the child is unfamiliar with CPA tests, play a loud sound and perform the play action to condition the child. Some children will learn faster than others. Repeat if necessary
  • Observe the child while presenting a loud sound you think the child will hear
  • Responses should be observed two-three times to be considered consistent
  • Decrease the test level and repeat the procedure.  


Children older than 5 to 6 years

In children of this age, conventional audiometry can be conducted with ease. It might be helpful to ask the child to raise their hand when a tone is heard rather than pressing the response button and to offer the child a break if the concentration drops. 


Business support

Amplivox has spent years developing innovative and user-friendly audiometric equipment which is easy to operate and allows for fast operation thanks to specially designed key arrangement. 

The Model 116 screening audiometer has been proven to be a reliable and efficient choice for performing air conduction used in pre-school screening programs. When speech audiometry in free field setups is required, our Model 270+ is a popular choice for audiologists which can be used with up to two loudspeakers.

Since January 2020, the latest edition to our screening audiometer portfolio is the modelONE which allows healthcare personal screening children to configure their own hearing test, test settings and the entire workflow thanks to the specially designed ampliSuite BEEP software. 

For more information on our audiometry products please contact our customer support team on +44 (0)1865 880 846 or email us at solutions@amplivox.com.