A battery of different tests is usually employed to test a child’s hearing. The diagnosis of hearing loss is based upon the results obtained from multiple tests, which are complementary to each other, and not from a single test. Multiple visits to the audiologist may be necessary to complete the entire audiological evaluation. The child’s and family’s history is recorded, evaluation of risk factors for congenital hearing loss is done, and an assessment of parental report of the infant’s responses to sound is performed before proceeding with the test battery. Some of the tests that may be used in different age groups are as follows:

Birth to 6 Months of Age

• ABR (BERA): Frequency – specific assessment using air-conducted tone bursts and bone conducted tone bursts, when indicated. A frequency-specific ABR testing is needed to determine the degree and configuration of hearing loss in each ear for fitting hearing aids when a permanent hearing loss is detected.Click-evoked ABR testing is used, if there are risk indicators for neural hearing loss (auditory neuropathy/auditory dyssynchrony) such as hyperbilirubinemia or hypoxia. Any infant who demonstrates “no response” on ABR elicited by tone-burst stimuli must be evaluated by a click-evoked ABR.
• Distortion product or transient evoked Otoacoustic Emissions (OAEs).
• Tympanometry
• Behavioral Observation audiometry (BOA)
• Behavioral observation alone is not adequate for determining whether hearing loss is present in this age group, and it is not adequate for hearing aid fitting.

6 to 36 Months of Age

• Behavioral audiometry (Visual reinforcement or conditioned-play audiometry, depending on the child’s developmental level), including pure-tone audiometry across the frequency range for each ear and speech-detection and -recognition measures.
• OAE testing.
• Acoustic immittance measures (tympanometry and acoustic reflex thresholds).
• ABR (BERA): If responses to behavioral audiometry are not reliable or if ABR testing has not been performed in the past.