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Updated: May 28, 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
Exploring and Overcoming Challenges for Efficient Audiological Testing in Children Under 5 Years of Age-Screening
Nienke Streefkerk1, Franciscus A Diepstraten1, Evangeline A Huis In 't Veld1
1Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands.
Insights
Otoacoustic emissions (OAEs) can screen for cisplatin-induced ototoxicity in young children. Standardized testing and interpretation are crucial, but OAEs alone are insufficient for definitive diagnosis, requiring further audiological assessment.
Area of Science:
- Pediatric Audiology
- Ototoxicity Monitoring
- Cancer Therapeutics
Background:
- Cisplatin chemotherapy poses a significant ototoxicity risk in pediatric cancer patients, especially those under five.
- Assessing hearing loss in young children is challenging due to limitations in standard audiological tests and variability in otoacoustic emissions (OAEs) and tympanometry interpretation.
- Early detection of cochlear damage is critical for timely intervention and management of hearing impairment.
Purpose of the Study:
- To identify challenges in audiological monitoring of young children exposed to cisplatin.
- To establish an international consensus on optimal testing procedures and interpretation criteria for otoacoustic emissions (OAEs) and tympanometry.
- To develop a framework for assessing early cochlear damage in this vulnerable population.
Main Methods:
- Evaluation of audiological data (tympanometry, TEOAEs, DPOAEs) from 11 children under five exposed to cisplatin in utero.
- Review and analysis of data by an international panel of 10 pediatric oncology audiology experts.
- Identification of areas of disagreement and consensus-building on testing and interpretation protocols.
Main Results:
- Substantial inter-expert variability was observed in interpreting cochlear status from OAEs and tympanometry.
- Consensus was reached on essential technical and interpretative requirements for OAE testing in young children.
- A classification framework integrating OAEs and tympanometry was proposed, emphasizing that normal OAEs do not exclude ototoxic damage.
Conclusions:
- Otoacoustic emissions (OAEs), especially distortion product OAEs (DPOAEs), are valuable screening tools for ototoxicity in young children when standardized.
- OAEs alone are insufficient for a definitive diagnosis of hearing loss; longitudinal monitoring and confirmatory tests are essential.
- Further validation of the proposed classification system is necessary to improve the audiological management of pediatric cancer patients undergoing cisplatin treatment.
Background/Objectives:
Cisplatin-exposed pediatric cancer patients are at increased risk of ototoxicity, particularly those under 5 years of age. In this group, audiological monitoring is challenging, as interpretation of otoacoustic emissions (OAEs) and tympanometry, used to supplement behavioral audiometry, is subject to interindividual variability. This study aimed to identify key challenges and establish an international consensus on optimal testing procedures and interpretation criteria for assessing early cochlear damage.
Methods:
Audiological data from 11 children (<5 years) exposed to cisplatin in utero were evaluated. An international panel of 10 pediatric oncology audiology experts reviewed tympanometry, transient evoked OAEs (TEOAEs), and distortion product OAEs (DPOAEs). Areas of disagreement were analyzed, and consensus was sought regarding testing conditions, interpretation, and clinical application.
Results:
Agreement on cochlear status was good in 10/22 ears, moderate in 3/22 ears, and poor in 9/22 ears, highlighting substantial variability in interpretation. Consensus was achieved on minimal technical and interpretative requirements for OAE testing in this population. The panel proposes a classification framework integrating OAEs and tympanometry to guide clinical follow-up. Importantly, normal OAE results were not considered sufficient to exclude ototoxic damage or mild hearing loss.
Conclusions:
OAEs, particularly DPOAEs, are valuable as a screening tool in ototoxicity monitoring programs for young children, provided that testing conditions and interpretation are standardized. However, OAEs alone are insufficient for definitive assessment. Longitudinal monitoring and confirmatory testing with behavioral audiometry or ABR/ASSR remain essential. Further validation of the proposed classification system is warranted.
