Hearing in Infants and Children

  • Indicators for hearing loss
  • What is Normal?
  • How we test Infant and Child hearing
  • Behavioral testing:
  • Speech Testing:
  • Other tests:
  • Types of Hearing Loss
  • Helpful Links

Three million children under the age of 18 have some hearing loss including four out of every thousand newborns. Newborns who have spent time in the NICU have an even higher incidence of 30 out of every 1000 newborns. Hearing loss occurs more frequently than any other birth defect. So, every parent and caregiver should be watchful of the signs of hearing loss in his/her child and seek a professional diagnosis. Hearing loss can increase the risk of speech and language developmental delays.

Indicators for hearing loss

Caregiver concern regarding hearing, speech, language

Family History

  • One or more individuals with permanent or progressive hearing loss that was present or developed early in life.

During pregnancy

  • Mother had German measles, a viral infection or flu.
  • Mother drank alcoholic beverages.

Newborn (birth to 28 days of age)

  • Weighed less than 3.5 pounds at birth.
  • Has an unusual appearance of the face or ears.
  • Was jaundiced (yellow skin) at birth and had an exchange blood transfusion.
  • Was in neonatal intensive care unit (NICU) for more than five days.
  • Received an antibiotic medication given through a needle in a vein.
  • Had meningitis.
  • Failed newborn hearing screening test.

Infant (29 days to 2 years)

  • Received an antibiotic medication given through a needle in a vein.
  • Had meningitis.
  • Has a neurological disorder.
  • Had a severe injury with a fracture of the skull with or without bleeding from the ear.
  • Has recurring ear infections with fluid in ears for more than three months.

Preschoolers and older

  • Turns up the volume of the TV excessively high
  • Responds inappropriately to questions
  • Does not reply when you call him/her
  • Watches others to imitate what they are doing
  • Has articulation problems or speech/language delays
  • Has problems academically
  • Complains of earaches, ear pain or head noises
  • Has difficulty understanding what people are saying
  • Seems to speak differently than other children his or her age

What is Normal?

Birth to 4 months:

  • Awakens or stirs at loud sounds
  • Startles at loud noises
  • Calms at the sound of a familiar voice
  • Responds to your voice (smiles or coos)

4 to 9 months:

  • Turns eyes toward source of familiar sounds
  • Smiles when spoken to
  • Notices rattles and other sound-making toys
  • Crys differently for different needs
  • Makes babbling sounds
  • Seems to understand simple word/hand motions such as “bye-bye” with a wave

9 to 15 months:

  • Babbles a lot of different sounds
  • Responds to his/her name
  • Responds to changes in your tone of voice
  • Says “ma-ma” or “da-da”
  • Understands simple requests
  • Repeats some sounds you make
  • Uses his/her voice to attract attention

15-24 months:

  • Points to familiar objects when they are named
  • Listens to stories, songs and rhymes
  • Follows simple commands
  • Uses several different words
  • Points to body parts when asked
  • Names common objects
  • Puts two or more words together

How we test Infant and Child hearing

If you suspect that your child may have hearing loss, discuss it with your doctor. Children of any age can be professionally tested.

Behavioral testing:

Behavioral Observed Audiometry : (6-10 months)
The audiologist observes the child’s facial expression, body movements, and other behavioral responses. This can be done with both tones and speech

Visual Response Audiometry (VRA): (7mths-2.5yrs)
The child is conditioned to respond to the sound by looking at a toy when the sound it presented. Localization can also be observed in this task

Play Audiometry: (2.5 to 5 years)
Child learns a game which involves responding to the stimulus, such as placing a block in a bucket when the stimulus is presented

Traditional Audiometry: (5 years & older)
Child raises his hand or pushes a button when stimulus is presented, just like an adult

Speech Testing:

Speech Awareness Threshold (SAT):

Response to speech presented by the testing audiologist

Speech Recognition Threshold (SRT):
Child identifies 2 syllable words. Helps measure the child’s knowledge of words and identification skills

Word Recognition Score (WRS):
Child repeats 25-50 words that are age appropriate and either identifies correct picture or repeats word. Measures the child’s ability to understand and identify common words

Other tests:

Tympanometry: looks at the health of the eardrum, middle ear bones, and eustachian tube

  • Type A is normal
  • Type B is a flat response and can signify fluid in the middle ear
  • Type C is negative pressure

Acoustic reflexes: test of the auditory pathway from the middle ear across the acoustic nerve

Otoacoustic Emissions (OAE): A test to verify the health of the cochlea, specifically the outer hair cells.  A healthy cochlea typically corresponds to normal hearing sensitivity. During the OAE test, a microphone is placed in the ear. It sends soft clicking sounds, and a computer then records the inner ear’s response to the sounds. This test can be used with infants to adults.

  • Auditory Brainstem Response (ABR): An electrophysiological test of the auditory pathway and can be used to as a way to verify the integrity of the auditory system and can give us an estimate of hearing sensitivity. In the ABR test earphones are worn and sensors are placed on the head to measure brain wave activity in response to the sound. This test can be completed with infants to adults.

Types of Hearing Loss

Hearing loss can even result from earwax or fluid in the ears. Many children with this type of temporary hearing loss can have their hearing restored through medical treatment or minor surgery.

In contrast to temporary hearing loss, some children have nerve deafness, which is permanent. Most of these children have some usable hearing. Few are totally deaf. Early diagnosis, early fitting of hearing aids, and an early start on special educational programs can help maximize the child’s existing hearing.

Helpful Links




Reprinted from the American Academy of Otolaryngology-Head and Neck Surgery Web site with permission of the American Academy of Otolaryngology-Head and Neck Surgery Foundation, copyright © 2013.