Audiology & Hearing

child hears with headphones

Even mild hearing loss can affect a child’s ability to speak and understand language, as well as impact behavioral development. Nemours' audiologists use state-of-the-art technology and innovative testing techniques to assess your child’s hearing sensitivity. We can evaluate and treat hearing at any age, beginning at birth.

Read More About Audiology

Hearing loss in children occurs in an estimated three out of every 1,000 babies born in the United States each year. At Nemours, we are dedicated to finding the best solutions to address each child’s hearing impairment, and we’re committed to counseling and educating families to be advocates for their children in the community.

We have board certified audiologists who are licensed with specialized experience in pediatric audiology.

Our audiologists help diagnose and develop treatment plans for children with hearing disorders such as:
  • hearing loss  
  • (central) auditory processing disorder (APD)
  • auditory neuropathy spectrum disorder (ANSD)
  • balance (vestibular) and dizziness disorders

At Nemours/Alfred I. duPont Hospital for Children and a number of Nemours Children’s Clinic locations in the Delaware Valley and North and Central Florida, we are also able to provide children with hearing impairment special services.

These services include:
  • prescriptions for hearing aids and other assistive and/or amplification devices as well as instruction on the use, care and maintenance of these devices
  • cochlear implant, programming and therapy
  • counseling for families regarding adjustment to hearing aids and cochlear implants
  • specialized programs for children diagnosed with central auditory processing disorder or auditory neuropathy spectrum disorder
  • working with a child’s school and teacher to ensure proper classroom equipment and modifications are in place

We look forward to forming close relationships with our patients and monitoring their progress over time.

Nemours Children's Specialty Care, Orlando

1717 S. Orange Ave.
Orlando, FL 32806
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For Appointments: (407) 650-7715

Hours: Monday–Friday, 8 a.m. to 5 p.m.
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For Appointments: (407) 650-7715

What to Bring
  • 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
Helpful Resources
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.

Audiologists at Nemours Children’s Specialty Care, Orlando are specially trained to evaluate children with hearing, balance and other ear-related problems. Our Audiology Department offers comprehensive audiological services for children from birth to age 18 — and our audiologists respect the uniqueness of your child, your family, and your culture. 

Taking a Team Approach to Your Child’s Care

Along with our family-centered focus, we use state-or-the-art equipment and innovative pediatric assessment techniques to obtain an in-depth view of your child’s individual hearing capabilities and management needs. We can also consult nationally recognized Nemours professionals onsite in our clinic in the fields of:

  • genetics
  • imaging
  • psychology

This multi-disciplinary input from experts on a case-specific basis helps us best serve your child and your family’s needs.

Our services include assessment and management of children with conditions such as:
(Central) Auditory Processing Disorder

Children with APD have no problem hearing, but they do have difficulty analyzing or making sense out of what they hear. They may demonstrate difficulties in speech, language, and/or learning. They may also appear hearing impaired and/or be inattentive, easily distractible, hypersensitive to loud sound, or have difficulty following oral directions. These difficulties are compounded under adverse listening situations such as, in the typical,
noisy classroom.

Auditory Neuropathy Spectrum Disorder

We have a specialized program for children with Auditory Neuropathy Spectrum Disorder (ANSD).  ANSD is a disruption in auditory nerve function that can make it difficult for children to understand speech, especially in the presence of “noise”. Our program targets diagnosis, treatment, and long-term support.

Hearing Loss

About 3 in 1,000 babies are born with hearing loss making it the most common birth defect. A hearing problem can also develop later in life.
Our close partnership with the physicians in the ENT department is unique
in this area. It ensures that every child will receive a comprehensive hearing test, a complete diagnosis, and timely medical input to facilitate effective intervention.

Hearing Evaluations

Our audiologists conduct full hearing diagnostic evaluations in sound-treated rooms with specialized, state-of-the-art equipment. The methods used to test hearing will be individually tailored to your child’s age, ability to cooperate, developmental level, and health status.

What to expect:
  • Children 6 months to 3 years: Visual Reinforcement Audiometry (VRA). The child is seated on the parent’s lap and sounds are transmitted through speakers or specialized pediatric “earbuds”.  The audiologist conditions your child to turn toward an interesting animated toy or video clip after presentation of calibrated sounds or speech.  The child’s turning response is then used to confirm that your child hears progressively softer sounds and speech.
  • Children 3-5 years: Conditioned Play Audiometry (CPA). The child wears either specialized “earbuds” or traditional headphones and responds to calibrated, ear-specific sounds during a “listening  game” (i.e. putting a ring on a stick, putting a block in a bucket, etc.,)  immediately after hearing a sound.  Responses to speech are also assessed by having the child point to pictures or repeat age-appropriate speech stimuli.
  • Children 5-18 years: Standard Behavioral Testing. The child wears specialized “earbuds” or traditional headphones and responds to calibrated stimuli by repeating words and acknowledging the presence of sounds.

Tympanometry & Middle Ear Muscle Reflex (MEMR) Testing

These are tests of eardrum and middle ear mobility. While not hearing tests, they are helpful in identifying middle ear problems, such as fluid collecting behind the eardrum.

This procedure involves gently placing a soft tip against the child’s ear which, together with a computer, assesses eardrum movement, middle ear pressure, and a middle ear muscle reflex. This test does not require a response from the child. 

Otoacoustic Emissions (OAEs)

Measures the function of the outer hair cells, or the “natural amplifiers,” which are located in the inner ear.

During the OAE test, a soft tip is placed against the child’s ear canal.  This tip is used to send an auditory stimulus into the ear canal and to record the “echo” that is reflected back out of the canal. The strength of this “echo” is related to the health of the outer hair cells in the inner ear. OAE results can be obtained in seconds on a sleeping infant or an older child who is able to sit quietly.

A normal recording usually reflects normal or near normal hearing although in some cases hearing loss may be present due to problems in other parts of the hearing pathway. OAE testing does not provide information regarding the degree of hearing loss, if present.

Specialized Testing

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

Auditory Brainstem Response (ABR)

An ABR test will determine if hearing loss is present and it will provide information regarding how loud a sound has to be in order for your child to hear it. It shows how well the signal from the inner ear travels to the brain. An ABR test can NOT tell how well your child understands what he or she hears.

For the ABR test, your child must be still. Excessive movement can interfere with the test results. It usually can be performed during natural sleep in babies 5 months of age and under. Sedation is usually required after 5 months of age.

We typically use the ABR test for:
  • babies that have failed their newborn hearing screening two times
  • children who are uncooperative for behavioral testing
  • children who cannot be reliably tested in the traditional manner (such as children who are developmentally delayed)

ABR testing is performed by placing soft “disk-like sensors” on the baby/child and an insert tip against the ear canal. The insert tip sends acoustic stimuli into the ear. Audiologists then measure the neural response and determine the child’s threshold of hearing. Testing lasts approximately 1-3 hours.

If ABR testing is performed during natural sleep (babies 5 months of age and under), the parent’s role in preparing the baby is of the upmost importance.  If the baby does not sleep, testing usually cannot be completed. 

So, how can you prepare your child for ABR testing during natural sleep?  Depending on the child’s age, the following suggestions may help testing:

  • First and foremost, bring your child to the appointment tired and hungry.
  • Keep your baby awake for a few hours before the test.
  • When driving to the appointment, have an extra adult in the car to keep the baby awake.
  • Do not feed your baby before the appointment. Only feed your baby after preparation for testing.
  • Bring any special blankets or items that may help your baby sleep.
  • Siblings must be accompanied by a second adult and cannot be in the test room.
Auditory Processing (AP) Evaluation

A battery of tests designed to help identify a child who has normal hearing but has difficulty processing what is heard. AP testing is usually reserved for children 7 years of age and up.  Some younger children can be evaluated on a case-by-case basis. Children with auditory processing problems may demonstrate difficulties in speech, language, and/or learning. They may also appear hearing impaired and/or be inattentive, easily distractible, hypersensitive to loud sound, or have difficulty following oral directions.These difficulties are compounded under adverse listening situations such as, in the typical, noisy classroom.

AP testing is administered in a sound booth and generally simulates difficult listening situations that the child typically encounters. It is for children with normal intelligence and normal hearing, who exhibit difficulties processing auditory information.  This evaluation takes approximately 2 hours.

Auditory Neuropathy Spectrum Disorder (ANSD) Evaluation

Assesses the function of the auditory (hearing) nerve. ANSD 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 it looks at different characteristics of the ABR response. We routinely do this evaluation as part of a diagnostic ABR, but the test can be done independently. 

It 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 understanding especially in the presence of noise.
  • There is otherwise unexplained speech delay.
  • Expected benefit is not received from hearing aids after an appropriate period of consistent hearing aid use.

Rehabilitation and Treatment

If your child is diagnosed with hearing loss or other hearing impairment, our audiologists partner with your family to make appropriate recommendations tailored to your child’s unique needs.

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 babies as young as three months. We offer hearing aid evaluations, hearing aid fittings, hearing aid repairs, earmolds, and assistive listening devices.  Our program is designed to closely monitor the progress of each and every child to assure maximum hearing aid benefit.

Frequency Modulated (FM) Systems

For some children with hearing loss or auditory processing difficulties, background noise and/or distance from the speaker can interfere with hearing and understanding. FM listening systems address both issues and can be used by children with hearing aids as well as those children who are not candidates for hearing aids. Although the configuration of a FM amplification listening system can vary, it generally consists of microphone/transmitter (worn by the speaker) and a receiver/transducer (worn by or placed near to the child). The microphone picks up the speaker's voice and clearly transmits it to the student's receiver via a specific FM radio frequency.

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.