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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
Is behavioral audiometry achievable in infants younger than 6 months of age?
Monique Delaroche1, Isabelle Gavilan-Cellié, Sylvie Maurice-Tison
1Pediatric Audiology Unit, Department of ORL-HNS, University Hospital of Bordeaux, France. rene.dauman@chu-bordeaux.fr
Insights
Behavioral audiometry, using the Delaroche protocol, reliably assesses hearing in infants before six months. This method, including bone and air conduction, is crucial for early hearing impairment detection in young children.
Area of Science:
- Pediatric Audiology
- Developmental Pediatrics
Background:
- Early detection of hearing loss in infants is critical for speech and cognitive development.
- Objective tests alone may be insufficient for comprehensive hearing assessment in very young children.
Purpose of the Study:
- To evaluate the reliability of early behavioral audiometry (Delaroche protocol) in hearing-impaired infants before six months of age.
- To analyze the accuracy of behavioral hearing thresholds using cross-sectional and longitudinal study designs.
Main Methods:
- Seventy-three hearing-impaired infants were behaviorally tested before six months using the Delaroche protocol.
- Cross-sectional analysis compared auditory brainstem response (ABR) with behavioral thresholds; longitudinal analysis reassessed thresholds at 18 months.
Main Results:
- Behavioral testing was completed in 87% of infants by six months.
- Both cross-sectional and longitudinal analyses showed high reliability (intraclass correlation coefficients > 0.80).
Conclusions:
- Behavioral audiometry, including bone and air conduction, is a reliable method for assessing infant hearing.
- Hearing assessments post-newborn screening should incorporate behavioral tests adjusted for developmental stage, alongside objective measures, before 5.5 months.
Background And Goal:
When carried out in addition to objective tests, behavioral audiometry performed in children with the so-called "Delaroche protocol" [IJORL 68 (2004) 1233-1243] enables to determine hearing thresholds by air and bone conduction over the whole auditory frequency range. In the present report, seventy-three hearing-impaired infants with different levels of motor and cognitive development were tested behaviorally before 6 months of age. Reliability of these early determined behavioral thresholds was then after analyzed using: (a) cross-sectional study, and (b) longitudinal study.
Methods:
Cross-sectional study compared click-evoked ABR thresholds in the better ear with binaural high-frequency hearing thresholds. In longitudinal study, early measured binaural hearing thresholds from 500 through 4000 Hz were reassessed at 18 months.
Results:
In 13% of babies behavioral testing was not fully completed by 6 months of age. Nevertheless, both cross-sectional and longitudinal studies yielded intraclass correlation coefficients above 0.80, suggesting that behavioral testing is applicable to this very young population.
Conclusions:
Assessment of hearing after newborn screening should not be restricted to objective tests before 5 ½ months. It should also include bone- and air-conduction behavioral tests adjusted to developmental stage and performed in presence of parents.
