Development of a hearing test protocol for profoundly involved multi-handicapped children

The purpose of the present study was to develop a protocol for use in testing the hearing of profoundly involved multi-handicapped children. Behavioral observation audiometry, visual reinforcement audiometry, auditory brain stem response (ABR), and noise-tone-difference tests were administered to 156 children with multiple handicaps. Eighty-three percent of the children with normal middle ear function were estimated to have normal hearing or, at worst, a mild hearing loss, by one or more of the tests. ABR was the single best test, followed by behavioral observation audiometry and noise-tone-difference. However, only 65% of the children would have passed had they only been tested with ABR. If agreement among two of the tests had been required, hearing loss would have been ruled out in only 34% of the children. A factor analysis revealed that the various hearing tests were associated with different medical and physical conditions which might influence threshold estimation for multi-handicapped children. These results support use of a series-positive test battery protocol in which individual tests are used sequentially with the purpose of ruling out moderate-profound sensorineural hearing loss.