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Updated: Aug 16, 2026
Behavioral Assessment of Hearing in 2 to 4 Year-old Children: A Two-interval, Observer-based Procedure Using Conditioned Play-based Responses
Published on: January 23, 2017
[Problems in the evaluation of hearing of infants]
Fumiko Hata1, Takema Sakoda, Aya Nosaka
1Department of Sensory and Motor Organs, Division of Otolaryngology Head and Neck Surgery, Tottori University School of Medicine, Yonago.
Insights
Early identification of infant hearing loss is crucial for speech development. A simple parent questionnaire effectively screens for hearing impairments, distinguishing normal hearing from moderate to severe loss in infants.
Area of Science:
- Pediatric Audiology
- Developmental Pediatrics
- Otolaryngology
Context:
- Infant hearing loss requires early detection to prevent speech and language delays.
- Traditional audiological assessments like conditioned orientation response audiometry (COR) and auditory brainstem response (ABR) can be challenging for infants.
- Parental reporting of auditory responses to environmental sounds offers a potential alternative for hearing assessment.
Purpose:
- To evaluate the clinical utility of a parent-administered questionnaire in estimating infant hearing.
- To determine if the questionnaire can differentiate between normal hearing and moderate to severe hearing loss in children.
- To propose a screening tool for ENT physicians to identify potential hearing loss in infants.
Summary:
- A questionnaire assessing infant responses to environmental sounds was administered to parents.
- The study included 79 children under 4 years old.
- Results showed high accuracy in identifying normal hearing (95.6%) and moderate to severe hearing loss (no 'yes' responses) in children with typical development and intellectual disabilities.
Impact:
- The questionnaire serves as a valuable screening tool for identifying hearing loss in infants.
- It can assist ENT physicians in initial hearing assessments, particularly when behavioral testing is difficult.
- Early identification facilitates timely intervention, supporting optimal speech and language development.
Abstract:
Infant hearing loss should be identified early to prevent delays in the development of speech and language. However, evaluation of hearing of infants is not so easy, because training is required to estimate auidiometric thresholds from behavioral testing such as conditioned orientation response audiometry (COR). Most ENT physicians who are not capable of behavioral testing tend to evaluate hearing of infants only from testing auditory brainstem response (ABR). Information about the infant's auditory response to the environmental sounds could be obtained easily and might be a substitute for a behavioral testing. We administered a questionnaire to the parents to obtain accurate information about the infant's auditory response. Tanaka-Shindo's developmental battery test of auditory function is an established questionnaire with various questions about auditory response and development of speech according to the age of infants from 0-15 month. We administered Tanaka-Shindo's questionnaire to the parents of infants before 8 months, and administered the following questionnaire to the parents of infants over 8 months. (1) If you call out the child's name from behind, does the child turn his/her head? (2) Does the child turn his/her head to any sounds on television, to any small sounds (for example: listened when someone opens the door or opens wrapping paper), or to beeping sounds from electric devices? To investigate the clinical usefulness of the questionnaire to estimate hearing in infants, 79 children (under 4 y.o.) evaluated their hearing at the Tottori University Hospital were studied. Forty-three out of 45 (95.6%) who had normal hearing had yes in the questionnaire, but the 18 who had moderate to severe (60 dB) hearing loss did not have yes in the questionnaire. For the mentally retarded 33 children, 27 out of 29 (93%) who had normal hearing had yes in the questionnaire, but the 4 who had moderate to severe hearing loss did not have yes in the questionnaire. Questionnaire about the infant's auditory response is useful to differentiate between normal hearing and moderate to severe hearing loss. We recommend our questionnaire as screening procedure to most ENT physicians to identify hearing loss in infants. It is important refer patients not evaluated as normal to an ENT physician who is capable of diagnosing the hearing of infants by behavioral testing.
