Nemours/Alfred I. duPont Hospital for Children, Wilmington


1600 Rockland Road
Wilmington, DE 19803
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Hours: Monday – Friday, 7 a.m. to 5 p.m.
To Schedule or Cancel Appointments: (302) 651-6043
Fax: (302) 651-6219

Meet the Team:
  • Susanne Abate, AuD, CCC-A
  • Annemarie Cox, AuD, CCC-A
  • Rebecca Huzzy, AuD, CCC-A
  • Yell Inverso, AuD, PhD, CCC-A – manager of audiology
  • Liesl Looney, AuD, CCC-A
  • Jessica Loson, AuD, CCC-A
  • Paula Moore, AuD, CCC-A
  • Shanda Morlet, AuD, CCC-A
  • Tammy Riegner, MS, CCC-A
  • Stacy Szymkowski, AuD, CCC-A
  • Sarah Zavala, AuD, CCC-A
  • Emily Zwicky, AuD, CCC-A
 
What to Bring

Please bring any past test results related to hearing to your appointment.

Other items to bring with you:
  • photo ID
  • medical and pharmacy insurance cards
  • preferred pharmacy name and phone number
  • names and dosage of all medications, including over-the-counter medication, your child is currently taking
  • guardianship and custody papers, if a legal guardian rather than a parent accompanies your child
New Patients

Bring these forms for your first appointment:

Returning Patients
 
Forms & Resources
New Patient Forms
Returning Patient Forms
Resources for Patients & Families

Hearing loss and auditory disorders can cause delays in a child’s speech, language, and cognitive development, so early identification and management of auditory problems and hearing loss in children is important.

The Audiology Department at Nemours/Alfred I. duPont Hospital for Children offers comprehensive audiological services for children from birth to age 21. Our board-certified audiologists are specially trained to perform evaluations on children with hearing, balance, and other ear-related problems. We use the most up-to-date equipment and innovative pediatric assessment techniques to determine your child’s hearing sensitivity and management needs.

Working as a Team to Help Your Child

Our audiologists also serve as integral members of several multi-disciplinary and research teams throughout Nemours for:

This team approach allows us to gather as much information as possible to make sure your child receives the most appropriate care.


Hearing Conditions We Treat

Our services include assessment, management, and monitoring of children with conditions such as:

 
Central Auditory Processing Disorder

We are the Delaware Valley’s only hospital-based referral for children with central auditory processing disorder (CAPD). Children with CAPD have no problem hearing, but they do have difficulty interpreting and storing words that are heard because the ears and brain do not fully coordinate.

 
Vestibular (Balance) Disorders

Our Pediatric Vestibular team offers offers advanced testing and treatment for balance problems (dizziness, falling or the sensation of falling, headaches, disorientation, or nausea) caused by problems of the inner ear. Our state-of-the-art and kid-friendly equipment helps pinpoint the cause of the problem, to provide appropriate treatments and recommendations.

 
Auditory Neuropathy Spectrum Disorder

We have a specialized program for children with auditory neuropathy spectrum disorder (ANSD), an auditory nerve disorder that can make it difficult for children to hear or distinguish one sound from another. Our program targets diagnosis, treatment, and research.

 
Hearing Loss

About 3 in 1,000 babies are born with hearing loss (also called hearing impairment), making it the most common birth defect. A hearing problem can also develop later in life. Our program is designed to closely monitor children with hearing loss. We collaborate with our Nemours Otolaryngology (Ear, Nose & Throat) department to ensure that your child receives an appropriate work-up and investigate the possible cause of your child’s hearing loss. We may also recommend a genetics consultation, imaging, and vestibular (balance) evaluation, depending on your child’s needs.


Hearing Evaluations for Children

Our Audiologists conduct full hearing diagnostic evaluations in sound-treated rooms with specialized, state-of-the-art equipment. The methods used to test a child’s hearing will depend on the age of the child, the child’s ability to cooperate, developmental, and health status.


General Diagnostics

Typically, hearing evaluations begin with general diagnostics, or behavioral testing, in one of our sound-proof booths. These tests include:

 
Behavioral Audiometry
Hearing tests based on child’s age and functional level:
  • Children 6 months to 3 years: Visual Reinforcement Audiometry (VRA). The child is seated on the parent’s lap and sound is transmitted through the soundfield speakers, looking for localizations or changes in behavior. This is not an ear-specific test, but reflects the sensitivity of the better ear.
  • Children 3-5 years: Conditioned Play Audiometry (CPA). The child wears either insert earphones or supraaural (headphones) and responds to ear-specific stimuli through the use of a game (i.e. putting a coin in the bank etc.).
  • Children 5-18 years: Standard Behavioral Testing. The child wears insert or supraaural earphones and responds to stimuli by repeating a word or pressing a button.
 
Tympanometry & Middle Ear Muscle Reflex (MEMR) Testing

Tests eardrum flexibility and reflexes of the middle ear muscle. While not a hearing test, it is helpful in identifying middle ear problems, such as fluid collecting behind the eardrum.

The child’s ears are evaluated with an immittance bridge by placing a soft tip in the ear which then assesses eardrum movement, middle ear pressure, and the reflex of the middle ear muscle. This does not require a response from the child, although sitting quietly is required for this brief evaluation.

 
Otoacoustic Emissions (OAEs)

Measures the function of the outer hair cells, or the “natural amplifiers,” which lie inside the cochlea. During an OAE test, a soft tip is placed in the child’s ear canal, which transmits sound to measure the outer hair cell function in the cochlea. This can be obtained in seconds on a sleeping infant or an older child who is able to sit quietly.

A normal recording is associated with normal outer hair cell function and this typically reflects normal hearing although in some cases the hearing loss may be due to problems in other parts of the hearing pathway.


Specialized Hearing Tests

If your child needs further testing beyond the behavior hearing evaluation, our audiologist may recommend one of the following diagnostic tests.

 
Auditory Brainstem Response (ABR)

This diagnostic test evaluates functioning of the auditory (hearing) nerve, and can be used as a predictor of hearing level.  It is done while the baby/child is asleep (if 3 months or under) or sedated (over 3 months of age).

ABR testing is commonly performed on:
  • babies that have failed their newborn hearing screening two times and have been medically cleared of middle ear fluid
  • children who are uncooperative for behavioral testing
  • children who cannot be reliably tested using general diagnostic tests (e.g., due to developmental delay, syndrome-related, etc.)

Testing is performed by placing soft electrodes on the baby/child and an insert tip in the ear canal, which sends a click sound to the ear. Audiologists then measure the neural response and determine the child’s threshold of hearing. It lasts approximately 1-2 hours.

 
Central Auditory Processing (CAP) Evaluation

This type of testing help diagnose auditory processing disorder, where the child has difficulty processing what is heard because the ears and brain do not fully coordinate.

CAP testing is for children age 7 and older, to evaluate what happens to an auditory signal once it leaves the peripheral system (cochlea) and travels to the brain.

It is conducted in the test booth and requires the child to listen and respond to various exercises. It is for children with normal intelligence and normal hearing who exhibit difficulties processing information (e.g., trouble hearing in noise, difficulty following multi-step directions, poor reading/spelling/language skills, oral comprehension problems, etc.). This evaluation takes approximately 3 hours.

 
Auditory Neuropathy Spectrum Disorder (ANSD) Evaluation

Assesses the function of the auditory nerve. Abnormal nerve function can make it difficult for children to distinguish one sound from another and understand speech clearly.

This testing is conducted the same way an ABR is done but looks at a different part of the response. The disorder occurs when sound enters the inner ear normally, but the transmission of signals from the inner ear to the brain is impaired,which is typically exhibited by present OAEs and absent or impaired ABR. We routinely do this evaluation as part of a diagnostic ABR and CAP (if warranted) to rule it out, but the test can be done independently without proceeding to do a threshold search.

It lasts about 1 hour and would be recommended for children when:
  • parents report their child to have difficulty understanding speech clearly, especially in the presence of background noise
  • behavioral testing reveals absent middle ear muscle reflexes and decreased speech discrimination testing in quiet and noise
  • speech and language development is a concern; children with this disorder can have speech that ranges from mildly distorted to absent
 
Balance (Vestibular) Disorder Evaluation

Nemours audiologists are part of a comprehensive, multi-disciplinary team that can assess symptoms of balance problems (dizziness, falling or the sensation of falling, disorientation, or nausea), help identify their cause, and develop a successful course of treatment. Our balance system is made up from 3 areas in our bodies: the inner ear, the eyes, and our proprioception (use of muscles and joints to maintain body position). Children undergo a thorough evaluation with Audiology, Physical Therapy and the Gait Lab to check for problems in many different areas.

Vestibular testing includes:
  • Audiometry: Hearing tests based on child’s age and functional level
  • Tympanometry and MEMR: Tests eardrum flexibility and reflexes of the middle ear muscle
  • Otoacoustic Emissions (OAE): Measures the function of the outer hair cells, or the “natural amplifiers,” which lie inside the cochlea
  • Videonystagmography (VNG): Records and measures eye movement to check for the presence of vestibular system abnormalities
  • Rotational Chair Testing (RVT): Tests the function of the vestibuloocular reflex (VOR), which allows us to keep objects in focus as we walk, play, and run.
  • Vestibular Evoked MyogenicPotential (VEMP): Assesses a specific part of the inner ear and vestibular nerve for abnormalities

Rehabilitation and Treatment

If your child is diagnosed with hearing loss or other hearing impairment, our audiologists will make appropriate recommendations based on your child’s specific needs and impairment.

Hearing Aids: If hearing aids are necessary, Nemours audiologists are qualified and experienced in the fitting of hearing aids for children of all ages, including young babies. As part of our program, we closely monitor your child’s hearing loss and hearing aid care.

Frequency Modulated (FM) Systems: For some children with hearing loss or hearing impairment, background noises and distance can interfere with hearing and understanding. FM amplification systems can be used by children with hearing aids as well as those children who are not candidates for hearing aids.

Cochlear Implant: A cochlear implant is a surgically implanted device for individuals with severe to profound hearing impairment who receive little to no benefit from hearing aids. The procedure does not restore hearing. What it does is transmit sound information past the damaged cochlea directly to the nerve of hearing. We provide a comprehensive Cochlear Implant and Auditory Rehabilitation Program, giving long-time support to children and families with ongoing therapy and involvement before and after surgery.

Auditory Verbal Therapy (AVT): For many children diagnosed with hearing impairments, speech-language therapy or auditory verbal therapy is recommended to help them develop their hearing and speaking skills.