Pediatric Hearing Loss — Key Vocabulary

Essential vocabulary terms drawn from Chapter 7 covering early detection, pediatric test methods, screening metrics, and related concepts.

Early Hearing Detection and Intervention (EHDI)

A three-part system (birth-admission screening, prompt diagnostics, and intervention by 6 months) designed to find and treat infant hearing loss early.

Universal Newborn Hearing Screening (UNHS)

Program that screens every newborn for hearing loss, usually before hospital discharge, rather than only those with risk factors.

Joint Committee on Infant Hearing (JCIH)

Interdisciplinary U.S. body that issues guidelines and position statements on infant hearing screening, diagnosis, and intervention.

Apgar Test

Quick newborn assessment of Appearance, Pulse, Grimace, Activity, and Respiration; low scores are linked to higher hearing-loss risk.

Auditory Brainstem Response (ABR)

Electrophysiologic test that records neural activity from the auditory nerve to brainstem, widely used for infant hearing screening and threshold estimation.

Automated ABR

Portable, easy-to-interpret ABR system used by trained technicians for large-scale newborn screening.

Otoacoustic Emissions (OAE)

Sounds generated by outer hair cells and recorded in the ear canal; presence indicates normal cochlear (≤ 30 dB) function.

Distortion-Product OAE (DPOAE)

Type of OAE elicited with two tones that provides frequency-specific cochlear information between 500–4000 Hz.

Transient-Evoked OAE (TEOAE)

Broadband OAE response evoked by clicks or tone bursts, commonly used in newborn screening.

Auditory Neuropathy/Dys-synchrony (AN/AD)

Disorder with present OAEs but absent/abnormal ABR and reflexes, indicating neural timing problems rather than cochlear loss.

Behavioral Observation Audiometry (BOA)

Infant test (≈0–6 mo) where clinicians watch for reflexive responses (e.g., eye blink) to sound presented in the sound field.

Auropalpebral Reflex (APR)

Involuntary eye-blink or eyelid contraction to intense sound; used in early infant screening studies.

Moro Reflex

Infant startle reaction to sudden stimuli; can be elicited by loud sounds in very young babies.

Minimum Response Level (MRL)

Lowest intensity that evokes an observable reaction from an infant/young child; usually above true threshold.

Conditioned Orientation Reflex (COR)

6-24 mo procedure: child learns to turn toward a loudspeaker paired with an illuminated toy when a sound occurs.

Visual Reinforcement Audiometry (VRA)

Test (≥ 6 mo) in which correct head turns to sound are rewarded with a lighted toy or video image.

Puppet-in-the-Window (PIWI)

Variant of COR/VRA using animated puppets as visual reinforcers for sound localization responses.

Operant Conditioning Audiometry (OCA)

Technique (≈2–5 yrs) that trains a child to press a switch when hearing a tone; correct responses are reinforced (e.g., food pellet).

Tangible Reinforcement OCA (TROCA)

OCA version in which correct responses trigger delivery of a tangible reward (candy/token).

Play Audiometry (Conditioned Play)

From ~2 yrs: child performs a fun action (drop block, ring stack) each time a tone is heard, allowing ear-specific thresholding.

Cross-Check Principle

Guideline that no single pediatric test result should stand alone; findings must be confirmed by at least one independent measure.

Speech Detection Threshold (SDT)

Lowest level at which a listener can detect speech presence 50 % of the time; often used with very young children.

Speech Recognition Threshold (SRT)

Lowest level at which spondee words are correctly identified 50 % of the time; expected ~10 dB above SDT in normal ears.

Ling Six Sound Test

Quick listening check using /a, u, i, ʃ, s, m/ to verify detection across speech frequencies (250–4000 Hz).

Warble Tone

Frequency-modulated pure tone used in sound-field testing to reduce standing waves and hold children’s attention.

Narrowband Noise

Noise restricted around a center frequency; used when pure tones fail to elicit responses but frequency-specific info is needed.

Sound-Field Audiometry

Assessment with loudspeakers rather than earphones; responses represent the better ear and lack ear specificity.

Insert Earphones

Foam-tipped transducers placed in the ear canal; reduce ear-canal collapse and increase interaural attenuation in children.

Tympanometry

Immittance test measuring middle-ear pressure/compliance; screens for otitis media and other conductive problems.

Acoustic Reflex

Stapedius muscle contraction elicited by loud sound; presence helps cross-check hearing level and rule out conductive loss.

Immittance Testing

Combined evaluation of tympanometry and acoustic reflexes to assess middle-ear and lower brainstem function.

Auditory Steady-State Response (ASSR)

Objective measure that estimates frequency-specific thresholds, especially useful for severe/profound losses.

Loudness Recruitment

Abnormally rapid growth of loudness common in cochlear loss; may cause startle at only moderate levels.

Sensitivity (Screening)

Proportion of true hearing-impaired individuals correctly identified by a screening test.

Specificity (Screening)

Proportion of normal-hearing individuals correctly passed by a screening test.

Predictive Value

Likelihood that a screening result (pass or fail) accurately reflects true hearing status, considering prevalence.

Tetrachoric Table

2×2 matrix (true/false positives/negatives) used to evaluate sensitivity and specificity of screening tools.

High-Risk Registry

Older JCIH checklist of medical conditions indicating higher likelihood of infant hearing loss; supplements but does not replace UNHS.

School Hearing Screening

Periodic pure-tone and immittance checks (AAA 2011: 1k, 2k, 4k Hz @ 20 dB HL plus tymps) for preschoolers and select grades.

American Academy of Audiology (AAA) Childhood Screening Guidelines

2011 protocol outlining grade levels, test frequencies/intensities, tympanometry criteria, and rescreen timelines.

Support Personnel

Technicians supervised by audiologists who operate screening equipment, maintain devices, and manage data in newborn programs.

Diagnostic Imperative

Concept that early hearing diagnosis may also reveal or prevent related conditions (e.g., SIDS, enzyme deficiencies).

Maladaptive Parenting

Environmental risk factor noted by Walker (2003) that can compound outcomes for infants with undiagnosed hearing loss.

Corrected Age

Chronological age minus weeks of prematurity; used when comparing infant ABR responses to normative data.

Pre-Stimulus Activity Level

State of alertness (alert, drowsy, light/deep sleep) that affects infant responsiveness during behavioral tests.

Conductive Hearing Loss

Impairment due to outer or middle-ear pathology; typically shows abnormal tymps and absent OAEs but normal cochlea.

Sensory/Neural Hearing Loss

Hearing impairment originating in the cochlea or auditory nerve; OAEs and reflexes help differentiate from conductive loss.

Calibration (Audiometer)

Scheduled verification of output levels and earphone integrity; essential for accurate school and clinical screenings.

Non-organic Hearing Loss

Apparent hearing impairment without organic basis, often due to malingering or psychological factors; detected via inconsistencies.