Screening methods

Screening methods depend on age.  During the first 6 months there should be a “startle” reflex in response to short bursts of high intensity sound. This test produces false positive responses.  The second 6 months of life are very important since hearing can easily be determined and any hearing loss discovered is early enough for help. At this age the child can be tested by distraction techniques.  Appropriate sounds presented at ear level about 3 feet away cause a normal child to turn towards them.  The sounds must be meaningful to the child.  Low frequencies can be produced by the spoken voice, high frequencies by a special rattle.  Crinkled tissue paper provides a broad-spectrum stimulus.  From 12 months to two years children become uncooperative and difficult to test.  Quiet speech with an expectation of comprehension is an appropriate stimulus.  By the age of 3 years children are once again cooperative.  In addition to assessing speech comprehension, pure tone audiometry is possible using free field sounds or in some cooperative children with earphones.   The child is conditioned to react to the stimulus of sound by putting marbles into a box when the sound is heard.  Objective testing with Brainstem Evoked Audiometry (BERA) or Electrocochleography may be required in cases of uncooperative children or when more accurate information is required.  These tests can be performed by sedating the child and the results of the test are not dependent on the responses of the child.