The best ways to perform hearing tests in children

Reading Time: 10 mins
by Constanze Schmuck
Published 06/04/2021

Performing hearing tests with children can be challenging, but also rewarding. The priority is to make sure the child that you’re examining feels comfortable, both with you as an examiner, and also with the test process.

It’s also important to choose the right behavioural test technique to suit the development level of the child, rather than their physical age. Over the years, different test tactics have been developed to produce reliable responses from children. Here we'll share the most common tests and suggest some helpful protocols so you can perform successful audiometry in children:

Children less than 6 months old

However, behavioural observation alone is not sufficient for the hearing aid fitting process in children of such a young age.

Objective measurements which don’t require co-operation from the infant include tympanometry, OAE, ABR, and ASSR measurements. Depending on the child, it might be helpful to sedate them if the test time is longer than a few minutes. 

Here are some BOA test protocol suggestions:

  • 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

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


VRA is mostly performed with animated toys that are hidden and only made visible during the sound presentation. It’s a deviation of a technique called Condition Orientation Reflex (COR), where the child must localise the sound source themselves with no animated toy reward.

Here are some VRA test protocol suggestions:

  • 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

Usually when a child is around three years of age, Conditioned Play Audiometry (CPA) means you can perform tone audiometry with the active cooperation of the child. This active participation is essential for the test to be successful.

This approach to audiometry testing is made into a game where the child is rewarded with a special action when a sound is heard. Conditioned Play Audiometry (CPA) is often referred to as the “Listen and Drop” test, as the child is conditioned to respond to sound by performing a certain activity, like placing a peg in a pegboard, dropping a block in a bucket, etc. It can be helpful to work with an assistant who can focus on rewarding the child by clapping hands or appraising the child so they can learn more quickly.

Here are some CPA test protocol suggestions:

  • 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

By this age, conventional audiometry should be conducted fairly easily. It can be helpful to ask the child to raise their hand when a tone is heard instead of pressing the response button, and to offer them a break if their concentration drops during testing.

Innovative and user-friendly audiometry

Amplivox has worked hard to develop innovative and user-friendly screening and diagnostic equipment that’s easy and fast to operate, thanks to a 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.

For more information on our audiometry products please visit our audiometry webpage, contact our customer support team on +44 (0)1865 880 846 or email.