Found. of Aud. Exam 3: Peds Testing (from class + book)

Pediatric testing: what is the ultimate goal with every child you test?

• Get earphones on them

• Get ear-specific information

When does earphone testing usually become possible with a baby, and what kind?

• Around 6 months, once they can sit up

• Insert earphones, because headphones are too heavy

• Takes a very skilled clinician

Why can't an ABR alone give the full picture of a child's hearing?

• It is not a behavioral test

• Behavioral results have to be coupled with it

What is the paradox of pediatric testing?

• The population we need the most information on is the one we can get the least information from

• Results have to be pieced together

Fitting a baby with technology: what does a conservative approach mean, and why?

• Set it at the lowest volume possible

• Too-loud hearing aids worn every day could cause noise-induced hearing loss

• Do no harm

What is a warble tone?

An FM tone that warbles back and forth around a center frequency (e.g., all around 1000 Hz)

Pediatric testing: what is narrowband noise?

The same narrow band of noise used for masking, centered on a frequency (e.g., a 2000 Hz NB)

Soundfield: a baby keeps looking at the right speaker. What can you report?

• That the baby seemed to favor the right side

• Not that the left ear has a problem, because soundfield is not ear specific

Conditioned play audiometry in one line

Regular testing set in a game environment

A child points to the bathtub picture. Does that still count as an SRT?

• Yes; pointing shows they heard it

• SRT = the level where the person detects speech at least 50% of the time

Body parts were used instead of spondee cards. How do you record it?

• Note in the report or on the audiogram (check 'other') that body parts were used

• It is not a true SRT, since an SRT uses spondees (equal stress on both syllables)

Why is it so hard to test a young child alone?

• In a two-room booth, one person must be with the child and one at the audiometer

• Solo clinicians book a two-audiologist appointment

Using a parent as the assistant: what is the risk, and the fix?

• Parents cue the child ('Did you hear that, honey?') or jerk when the sound comes on

• Tell them to act like they hear nothing, or put earplugs/headphones on them

• Remove the parent if they can't stay neutral

Hearts for Hearing: who is in the room during an established child's hearing test?

The child's own speech-language pathologist

Why can you start pure tones at 2000 (or even 4000) Hz when the SRT is normal?

• The SRT agrees with the PTA (500, 1000, 2000 Hz)

• A normal SRT suggests those frequencies are near normal

• So higher frequencies give new information first

The child says 'I don't want to do this anymore.' What do you do?

• End on your terms: 'one more time,' then stop

• Otherwise they learn they can end testing whenever they want

Why do SRTs in both ears before any pure tones?

A little information in both ears beats a full audiogram in one ear and nothing in the other

Air SRT is 40 dB and bone-conducted SRT is 0 dB. What does that suggest?

• A conductive component in at least one ear (not ear specific)

• Check with tympanograms

Pediatric word recognition: what can it reveal?

• Picture pointing: receptive language

• Repeating words: articulation

• May lead to a referral to an SLP (screening is within audiology scope)

Ages 5 to 10: lesson from the scared 8-year-old in the booth

• Kids who can do adult tests are still not adults

• They may be frightened alone in the booth

• Use lots of verbal praise and keep things moving

Why is malingering more likely in teens than in 6-year-olds?

• Failing can seem cool or be an excuse (bad grades, making mom feel bad)

• 6-year-olds aren't sophisticated enough to fake

Besides off-guard questions, how else can you check a teen malingerer?

• Ask things like their address or teacher's name at a soft level (e.g., 15 dB)

• Run OAEs

A malingering child may be a cry for help. What do you do?

• Gently find out why (e.g., attention-seeking after a family loss)

• Refer to the school counselor

A 16-year-old has NIHL. Who do you counsel?

• The teen directly, as an adult

• They are accountable and will live with it

• The parent can ask questions after

A report says 'age-appropriate auditory behaviors.' What does it mean?

• Responses matched the Index of Auditory Behaviors for that age

• It does not mean hearing is normal

Index of Auditory Behaviors: about when do we expect pure-tone responses near 15 to 25 dB?

About 2 years (21 to 24 months, around 25 dB for tones)

Why don't newborns respond to soft sounds?

• Neural connections in the central auditory nervous system aren't made yet

• Sound doesn't mean anything to them yet

Quieting (6 weeks to 4 months): give the example

• A wailing baby quiets on hearing mom coming down the hall

• Speech around 50 dB

A 4-month-old does not respond to a 20 dB warble tone. Hearing loss?

• No; responses aren't expected that soft

• Don't even present below about 70 dB at that age

• 70 dB warble tone and about 50 dB speech = age appropriate

A 6-month-old responds at 50 dB. Is that a moderate hearing loss?

No; it is an age-appropriate response

BOA: the phrase she told you to write down

BOA is a passive response to a sound

BOA: what can the baby be doing during testing?

• Sitting in a car seat or swing, or eating

• Nursing is fine: watch for the sucking pattern starting or stopping

BOA: the baby startles to a loud tone. Good or bad?

• Good: it means they heard it

• No response is more concerning

BOA: why is a second person needed in the room?

• The clinician at the audiometer can't see subtle eye widening

• Someone has to watch the baby and report responses

A baby with hearing loss wears hearing aids. How often are they tested?

• Very often, about monthly

• They outgrow earmolds

A child is the age for VRA but can't do it. What do you do?

• Drop to the next lower test (BOA)

• Ages are guidelines: prepare for the expected test, divert down if needed

Rank BOA, VRA and CPA from most basic to most advanced

• BOA: most basic

• VRA: requires conditioning

• CPA: most advanced

VRA: map it onto Pavlov's dog

• Tone = the bell

• Visual reinforcer = the treat

• Head turn = the conditioned response

• VRA is the first conditioned-response test

VRA: what ruins the conditioning?

Giving the reinforcer without the tone (pressing the wrong button)

VRA: what reinforcers does her clinic use?

• Dark plexiglass boxes with drumming toy animals that light up

• A video system that plays a short cartoon

VRA: the child is frightened and cries at the reinforcer. Now what?

• Crying (negative reinforcement) can still keep them conditioned

• Used only occasionally

CPA: example games

• Throw a ball into a laundry basket

• Tic-tac-toe, barrel of monkeys, macaroni necklace

• Blocks in a bucket

CPA: the child throws a ball when there was no tone. What do you do?

• 'You tricked me': take the ball back and redo it

• The response must come from hearing the tone

CPA: what should you avoid?

• Long board games (too slow)

• Small objects that are a choking hazard

How can you keep a child still during tympanograms or OAEs?

Bubbles or a bubble-pop app on your phone

What is the minimum response level (MRL)?

(Book supplement)

• The softest level a child responds to on a given day

• May not be the true threshold; the younger the child, the more likely a response is an MRL

What are COR and TROCA?

(Book supplement)

• COR: conditioned orientation reflex, the umbrella term VRA falls under

• TROCA: tangible reinforcement (e.g., food) instead of a visual reward

BOA: when does a behavior count as a response?

(Book supplement)

Both examiners must agree it was a response

What is modified play audiometry?

(Book supplement)

A simpler version of CPA for younger children

JCIH 2019: by what age should newborns be screened, and how?

(Book supplement)

• By 1 month

• With physiologic measures (OAE/ABR); behavioral cross-checks after a failed screen

Book: which pediatric tests are true, direct measures of hearing?

(Book supplement)

Only behavioral tests