Audiology & Hearing

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

Other items to bring with you:

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.

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.

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.

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 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.

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.

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.

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.

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 multistep directions, poor reading/spelling/language skills, oral comprehension problems, etc.). This evaluation takes approximately 3 hours.

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

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