L&L Therapy Services, LLC

Behavioral observation audiometry (BOA) is the only test protocol that provides a direct measure of hearing. This valuable technique can be used to monitor hearing and hearing aid benefit in infants who are not yet able to participate in visual reinforcement audiometry (VRA). In this article, I present a carefully developed protocol that uses changes in sucking, resulting in a reliable threshold measures. Key points include

Auditory brainstem response (ABR) testing, auditory steady state response (ASSR) testing, and otoacoustic emissions (OAEs) testing provide critical information about the status of the auditory pathways but are not direct measures of hearing.

Only behavioral testing provides a direct measure of hearing.

Behavioral testing can be used to monitor hearing and performance with hearing technology.

When carefully performed, using appropriate criteria including using changes in sucking as an indication of a response, behavioral observation audiometry can be used by clinicians to accurately measure thresholds in infants cognitively less than 6 months of age.

Children with hearing loss have a world of opportunities available to them because of marvelous advances in hearing technology, including super-powered digital hearing aids, cochlear implants, wireless FM systems, infrared classroom technology for sound field, and the bone-anchored hearing aid (BAHA). These advances, along with the ability to identify children with hearing loss soon after birth and fit them quickly with hearing technology, have changed the face of intervention and education. It is important for clinicians to start listening and spoken language (LSL) intervention very early, because babies' brains' neural pathways have increased sensitivity to sound before age 3 years. When children with hearing loss learn to speak through listening, they may stay on a normal path to speech and language development (Cole & Flexer, 2007). Now, children with hearing loss who learn to listen and speak typically develop regional accents, clear speech production, the ability to grasp idioms and jokes, and competent conversational skills. The purpose of this article is to describe the processes that are typical as a child with hearing loss transitions from services provided by professionals at an outpatient cochlear implant center to services provided in school settings.

Early identification and diagnosis of hearing loss in infants and young children is the first step toward appropriate and effective intervention and is critical for optimal communicative and psychosocial development. Limitations of behavioral assessment techniques in pediatric populations necessitate the use of an objective test battery to enable complete and accurate assessment of auditory function. Since the introduction of the cross-check principle 35 years ago, the pediatric diagnostic test battery has expanded to include, in addition to behavioral audiometry, acoustic immittance measures, otoacoustic emissions, and multiple auditory evoked responses (auditory brainstem response, auditory steady state response, and electrocochleography). We offer a concise description of a modern evidence-based audiological test battery that permits early and accurate diagnosis of auditory dysfunction.

As telecommunication technology continues to evolve, opportunities are emerging for telepractice to meet the communication needs of children with hearing loss. As well, documented shortages of well-trained speech-language pathologists and pediatric audiologists are leading some centers to augment their service delivery through telepractice as a means to meet a need for qualified providers. For families of young children with hearing loss, obtaining services that support auditory learning and spoken language can be a challenge in some communities. One form of telepractice, teleintervention, provides early intervention services to families of children with hearing loss using internet-based videoconferencing to model and coach parents in language facilitation techniques. Though it is a relatively new service delivery model, preliminary results are promising.