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Updated: Jun 25, 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
[Evaluation of the infants' hearing loss in hearing screening]
Sheping Xiao1, Minqing Liao, Wanwen Wu
1Department of Otolaryngology, Lecong Hospital, Foshan 528315, China. xiaosheping@yahoo.com.cn
Insights
Infant hearing screening can be confusing due to middle ear issues. The 226 Hz tympanometry is unreliable for assessing infant middle ear status, leading to potential misinterpretations of hearing screening results.
Area of Science:
- Pediatric Audiology
- Neonatal Hearing Screening
- Auditory System Development
Context:
- Infants failing initial hearing screenings require further audiological evaluation.
- Understanding factors influencing auditory brainstem response (ABR) and tympanometry results in infants is crucial.
- High-risk factors for hearing impairment in newborns necessitate accurate diagnostic methods.
Purpose:
- To analyze confounding factors and clinical/audiological characteristics of ABR and tympanometry in infants who failed initial hearing screenings.
- To evaluate the reliability of 226 Hz tympanometry in assessing middle ear function in infants.
- To determine the prevalence of different hearing loss degrees in infants referred for audiological testing.
Summary:
- A study of 94 infants (144 ears) who failed otoacoustic emissions (OAE) screening revealed varied tympanogram types and ABR results.
- Normal hearing was observed in 44.4% of ears via ABR, with 40.3% showing mild hearing loss.
- The 226 Hz tympanometry showed a high false-negative rate, indicating unreliability for infant middle ear assessment.
Impact:
- Findings suggest that middle ear function and auditory system development can complicate infant hearing screening.
- The study highlights the limitations of 226 Hz tympanometry in infants, recommending appropriate interpretation of screening results.
- This research emphasizes the need for refined diagnostic approaches for accurate infant hearing assessment.
Objective:
To analyze the confusing factors and clinical and audiological characteristics of ABR and tympanometry in infants who failed the first and second hearing screening.
Method:
Between August 2005 and November 2007, 94 infants (144 ears) with detailed birth record and hearing screening record were reviewed in the study. The age of this series ranged from 48 days to 6 months. They received hearing screening with otoacoustic emissions (OAE), and all failed in the first and second hearing screening. The birth history, high-risk factors of hearing-impaired during newborn period and pregnancy history of subjects were fully detailed. Subjects were classified according to the age: 1 to 3 months old infants were considered as group 1, while 4 to 6 months old infants were considered as group 2. Auditory brainstem response (ABR), distortion product otoacoustic emissions (DPOAE) and acoustic immittance measurement were examined.
Result:
(1) The 226 Hz tympanograms of 144 ears showed type A of a single-peaked tympanogram in 77 ears (53.4%), a double-peaked tympanogram in 23 ears (16.0%), type Ad of a single-peaked tympanogram in 20 ears (13.9%), type As of a single-peaked tympanogram in 16 ears (11.1%), a flat-shaping tympanogram (type B) in 6 ears (4.2%), and others shapes (including C and D type) in 2 ears (1.4%). (2) The results of ABR showed that there were 64 ears (44.4%) with normal hearing (according to the threshold of ABR), 58 ears (40.3%) with mild hearing loss, 12 ears (8.3%) with moderate hearing loss, 3 ears (2.1%) with severe hearing loss, 7 ears (4.9%) with profound hearing loss. And the proportion of mild hearing loss was increased in the group, while the proportion of moderate and severe hearing loss was decreased. (3) The proportion of type A tympanogram was 50% (32 ears) in normal hearing subjects, which implied that the 226 Hz probe tones to record tympanogram would lead to a high false negative rate. And type proportion of type B tympanogram was higher in normal (4.7%) and mild hearing loss (3.4%) groups than in moderate and severe group.
Conclusion:
Middle ear function and development of auditory system in infants may be confusing factors in hearing screening. The 226 Hz probe tones to record tympanogram are unreliable for accurate assessment of middle ear status of infants. Therefore the results of hearing screening should be interpreted appropriately.
