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Behavioral audiometry: protocols for measuring hearing thresholds in babies aged 4-18 months
Monique Delaroche1, Rodolphe Thiebaut, René Dauman
1Pediatric Audiology Unit, CHU Pellegrin, Bordeaux, France. rene.dauman@audio.u-bordeaux2.fr
Insights
This study introduces new behavioral audiometry protocols for early hearing threshold measurement in infants, including those with multiple handicaps. These methods enable timely diagnosis and intervention for hearing loss in young children.
Area of Science:
- Pediatric Audiology
- Developmental Pediatrics
- Hearing Science
Background:
- Accurate hearing assessment in infants, especially those with developmental challenges, is crucial for early intervention.
- Existing audiometry protocols may be difficult to implement in very young children and those with multiple handicaps.
Purpose of the Study:
- To present original behavioral audiometry protocols for measuring hearing thresholds in very young children (4-18 months).
- To include protocols specifically adapted for multiply handicapped infants.
- To enable early and comprehensive hearing assessment across the full frequency range.
Main Methods:
- Utilized bone conduction vibrator testing, unaffected by middle ear infections, as a key diagnostic step.
- Employed air conduction testing with headphones, using a unique setup to elicit reliable 'surprise reactions'.
- Replaced classical visual reinforcement with interactive, dynamic play-based exchanges between examiner and child.
Main Results:
- Tested 105 infants (4-18 months) with bilateral sensorineural hearing loss.
- Achieved full bilateral air conduction results in 82.4% of non-handicapped infants before 12 months.
- Obtained results in multiply handicapped infants, with 37.5% achieving full bilateral air conduction before 12 months.
Conclusions:
- The developed protocols facilitate early measurement of hearing thresholds across all frequencies.
- These methods are effective even in multiply handicapped infants and those with developmental delays.
- The protocols enable timely diagnosis and intervention, minimizing sessions required.
Objective:
This paper provides the first report in English of original behavioral audiometry protocols for measuring hearing thresholds in very young children, including the multiply handicapped.
Methods:
Based on reactions to one or two well-calibrated acoustic stimulations delivered in the sound field, the protocol first involves the use of a vibrator to measure hearing levels by bone conduction. This measurement technique, which is not affected by middle ear infections, is the key diagnostic step. Moreover, in profoundly hearing loss children, it triggers reactions through vibratory stimulation and sets the scene for the conditioning of responses. Next, hearing levels are assessed by air conduction with the aid of headphones, in order to measure hearing levels in each ear as early as possible. A unique set-up is used to facilitate the emergence of reliable "surprise reactions", which may be interpreted by a sole examiner. Classical visual reinforcement is replaced by a highly interactive, dynamic and playful exchange between child and examiner, which gives meaning to the perception of stimuli and heralds the learning of hearing.
Results:
The results concern 105 babies suffering from bilateral sensorineural hearing loss and aged 4-18 months at the first behavioral test. Group 1 comprised 91 babies with no other handicap, in whom full bilateral air conduction was obtained in 82.4% before 12 months and in 98.9% before 18 months. In this group, air conduction in each ear was obtained in 47.0% before 12 months and in 70.3% before 18 months. In Group 2, which included 14 multiply handicapped babies, full bilateral air conduction was obtained in 37.5% before 12 months and in 78.6% before 18 months. Air conduction in both ears was obtained in 28.6% before 18 months.
Conclusion:
The protocols described make it possible, in a minimum number of sessions, to measure hearing thresholds early over the whole range of hearing frequencies, even in multiply handicapped babies and those suffering from developmental retardation.
