Hearing Excellence offers Child Hearing Tests for neurodivergent (Special needs) individuals. It is like a physical examination for your ears; its purpose is to understand the overall auditory health and well-being of your ears without being invasive. Hearing tests are conducted in a soundproof room known as a Sound Booth.   

For children with special needs, a hearing test is necessary to detect any underlying hearing difficulties. The American Speech-Language-Hearing Association (ASHA) recommends that all children with special needs should receive a comprehensive hearing screening by the age of six months. This screening helps to identify hearing problems early on and ensure that the child is able to access appropriate treatments or interventions as soon as possible. 

The child hearing test will assess the listening ability (hearing thresholds) for all patients. Speech testing, the patient’s comprehensive ability and speech intelligibility, will also be tested for all patients, but to what degree depends on the age and capabilities of the individual. These tests let us know the softest sounds the patient is able to hear, as well as let us test for speech awareness and understanding. 

Getting tested early is important! A hearing test is an important step in ensuring that any underlying hearing issues are detected early on in children with special needs. Early detection means more effective interventions can be put into place, allowing the child to access treatments which will help them make progress towards achieving better outcomes later down the line. If your child has special needs and is over 6 months old, then it may be worth considering booking a hearing test for them—it could make a world of difference! This is done performing the various tests listed below: 

Pure Tone Testing (which test depends on ability of individual) 

Visual Reinforcement Audiometry (VRA) 

This test uses different pitched sounds and visuals to assess if there is a hearing loss and the degree of the hearing loss. In this test, tones at varied specified pitches are presented, either through earphones/headphones or loudspeakers. Those tones are presented with visuals (animated toys or videos) allowing the child to associate the tone they hear with an exciting visual. This association means the child, once they hear the tone, will respond by looking at the visual. This conditioned response allows the clinician to test hearing thresholds across different frequencies. 

Conditioned Play Audiometry (CPA) 

This test uses different pitched sounds and toys to assess if there is hearing loss and the degree of the hearing loss. In this test, tones at varied specified pitches are presented, either through earphones/headphones or loudspeakers. The child performs a game-like activity every time a sound is heard. For example, a child will be prompted to drop a block in a bucket or clap whenever a sound is heard. This game-like activity allows the clinician to test hearing thresholds across different frequencies. 

Standard Pure Tone Test 

This test uses different pitched tones to assess if there is hearing loss. If hearing loss is present, it will also allow the clinician to determine the degree of hearing loss as well as the type. In this test, tones at varied specified pitches (frequencies) are presented from a range of 250 Hz – 8000 Hz. The patient will be asked to press a button, say “yes”, raise their hand, or clap every time they hear the tone, no matter how soft or far away it sounds. There are two ways they perform this test:  

Air-conduction 

• Using headphones or earphones the clinician will present specific tones to find the softest sounds a patient can detect across different frequencies. This testing procedure determines whether sound is able to be conducted normally as sound is presented to the outer ear, which travels to the middle ear, and then to the inner ear wear the organ of hearing is located. 

Bone-conduction  

• Uses a bone oscillator, which is a small box on the end of a headband that is placed on the bone right behind the ear, the mastoid. Pure tones at specific frequencies will be presented via the bone oscillator, bypassing the patient’s outer and middle ear and directly stimulating and testing the organ of hearing.  

Combining these two test methods, air and bone are what allows the clinician to check for any discrepancies to help determine the nature of the hearing loss (if one is present).   

  Otoscopy 

An otoscopy exam uses an otoscope, a medical device designed to look into the ears, to visually inspect the patient’s outer ear, inside the ear canal, the eardrum, and the middle ear. This visual inspection can provide the clinician with valuable clues that may help answer the patient’s audiological concerns. For example, an otoscopy exam would inform the clinician if a patient has too much earwax, potentially causing temporary hearing loss. Visual inspection of the eardrum can also tell the clinician if a patient has an ear infection, in which case the audiologist can direct you towards a doctor for medical treatment. 

 Tympanometry and Acoustic Immittance 

Tympanometry 

This evaluation may be performed to explore disorders that could result in hearing loss, especially in children. Since children are at higher risk of developing ear infections, tympanometry is done in children only at the discretion of the clinician. 

Tympanometry measures how the eardrum responds to changes in pressure. A special machine will add positive and negative pressure and measure the response of the eardrum as it moves. This test checks if there are any pathology concerns or irregularities in the ear canal, ear drum, or middle ear. This could be something like a hole in the eardrum, or fluid build-up in the middle ear due to an infection. 

Acoustic Reflex 

In this test, the clinician measures the response of the stapedius muscle (in the middle ear) by playing loud tones. This replicates impulse noise, which is the noise of a short duration that carries a sudden bang or sharp sound, like a gunshot. When we hear an impulse noise our middle ear muscles reflexively contract, stiffening the eardrum and dampening the sound energy; this helps protect the ear. This is similar to how a physician does a knee reflex test. 

 Speech Audiometry 

Speech Reception Threshold (SRT) Test / Speech Awareness Threshold (SAT) Test  

In an SRT test, the clinician will ask the patient to repeat known words played at different volumes, gradually getting softer. The purpose of an SRT test is for the clinician to understand the lowest volume a patient can hear and recognize speech. For young children, SAT tests are performed instead. The purpose of an SAT test is to determine the softest level a patient can detect in the presence of words. 

Word Recognition Score (WRS) 

In this test, the clinician will ask the patient to repeat a list of unknown single-syllable words back to them at the speech recognition threshold (a comfortable hearing level for the patient). The purpose of determining the WRS is to identify the communication abilities and speech comprehension of the patient (speech intelligibility).