Diagnostic Audiology Program Frequently asked Questions (FAQ)

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Why should my child have a hearing test?

An infant should have a hearing test if he or she did not pass the newborn hearing screening test in one or both ears. Even if your child's passed the newborn hearing screening test, your baby's hearing should be tested again if there is a reason why your child might develop a hearing loss.

Reasons your child might develop a hearing loss:

  • having a close relative who had hearing loss in childhood
  • having a syndrome in which hearing loss often occurs
  • infections at birth such as cytomegalovirus (CMV)
  • being on a ventilator for a long time
  • having congenital diaphragmatic hernia or needing ECMO therapy
  • having repeated courses of IV antibiotics and diuretics

Your child's hearing also should be checked if:

  • you think your child is not responding normally to sounds
  • your child is not starting to understand words and talk at the usual age
  • your child has frequent ear infections or persistent middle ear fluid

How is my child's hearing tested?

There are many ways to test a child's hearing, depending on the age and health of the child. The Audiology program performs the following tests:

  • Auditory Brain Stem Response (ABR) test
  • Regular (Behavioral) Audiological Evaluation
  • Auditory Processing
  • Tympanometry
  • Otoacoustic emissions (OAEs)
  • Hearing Aid verification    

Auditory Processing


What is Auditory Processing?

Auditory processing is the brain’s ability to accurately perceive speech in both quiet and noisy settings.  The brain can detect, analyze and discriminate small differences in pitch, loudness and duration.  However, some children with normal hearing have difficulty with this ability, leading to difficulty with discrimination of speech.  This is a (central) auditory processing disorder or (C)APD.  (C)APD can impact the listener’s ability to develop language, succeed academically and/or communicate effectively.

What are common symptoms of a (Central) Auditory Processing Disorder or (C)APD?

  • Trouble hearing in background noise
  • Difficulty figuring out where sound is coming from
  • Seems distracted or inattentive in noisy environments
  • Mishears words or similar sounds
  • Asks for repetition often
  • Academic issues, including single word reading, reading by phonics, spelling
  • Difficulty following multi-step instructions provided orally
  • Difficulty with auditory nonverbal information, such as detecting sarcasm, understanding jokes
  • A lack of music appreciation, child speaks without inflection

What is not auditory processing?

Auditory processing does not include:

  • Comprehension of spoken language
  • Higher level language skills, such as inferencing or abstract thinking
  • Organization, retrieval or formulation of language
  • An attention disorder

What is an auditory processing evaluation?

An auditory processing evaluation uses a variety of tests designed to stress the auditory system.  The child’s performance is compared to norms for children the same age, as the auditory system continues to mature through about age 12 years.  The audiologist is the professional who diagnoses an auditory processing disorder based on this evaluation.

Who is an appropriate candidate for referral for auditory processing testing?

Due to the complex nature of the evaluation, children who can be successfully evaluated for auditory processing issues include children:

  • At least 7 years of age
  • Without significant cognitive or developmental delays
  • With sufficient receptive and expressive language skills to follow the directions and respond to the tasks
  • With speech that is intelligible to an unfamiliar listener
  • For whom English is the primary language
  • With normal to near-normal hearing

Does an AP evaluation test my child's comprehension/understanding of language?

A (central) auditory processing disorder is different from a language comprehension disorder.  An auditory processing evaluation will tell us how the brain is able to access information presented through the auditory system, but does not test understanding of the language.  A speech language pathologist would be an appropriate professional to address this area.

How do I make an appointment?

You may request an intake packet for the Lexington or Waltham location by calling 617-355-6042.  Once the parent questionnaire is returned with copies of the child’s cognitive, educational, speech-language evaluation and current IEP (if applicable), it is reviewed by an audiologist.  If the audiologist requires further information, you will be contacted by telephone.  Once we have determined that your child is a candidate for an evaluation, you will be contacted to schedule an appointment.

Why do I need to submit my child's previous testing?

Many factors may have an impact on a child’s candidacy and ability to participate in an auditory processing evaluation, including attention, executive function, cognition, memory and language skills.  This information is required to ensure your child receives appropriate testing and an accurate diagnosis.

What should I bring to the appointment?

Please bring your insurance card and referral number if your insurance requires it. You may wish to bring a snack and/or a drink for your child. 


Auditory Brainstem Response Test


What is an Auditory Brainstem Response test?

An Auditory Brainstem Response (ABR) test is a sleep hearing test which shows the softest sounds your child's ears can detect at various pitches.

How is the test performed?

There will be 3 or 4 small stickers on your child's head, connected to leads going into a computer. Sounds will be presented through an earphone to each ear separately while a computer analyzes how the hearing nerve responds to sounds.

The test is not painful or uncomfortable in any way, but it is necessary for your child to be asleep in order to obtain clear recordings during the test.

You will be in the room with your child during the test, and the results will be explained immediately afterward.

This test may be performed sedated or unsedated, depending on the age and health of your child.

What should I bring to the appointment?

  • Insurance cards
  • Referral number (if your insurance plan requires a referral for audiological evaluations)
  • For an ABR evaluation, with sedation, bring:
  • Anything your child usually likes to fall asleep with, such as a toy or blanket
  • A stroller if your child would be heavy to carry to the car afterward
  • A clear liquid for your child to drink when s/he wakes up

How long does an ABR test take?

ABR evaluations, both sedated and unsedated, take approximately 2-3 hours to complete. As your child will need to sleep for the evaluation, please bring him/her hungry and tired but not yet sleeping. For an unsedated test, you will be able to feed your child shortly after arrival.

Please follow these feeding instructions for sedated testing

Under 6 months of age:
No solid food, milk, or formula for 4 hours before the test.

6 months or older:
No solid food, milk, or formula for 6 hours before the test.

For all children:
Clear liquids such as water, breast milk, or apple juice should be given until 2 hours before the test. Please bring your child awake but very sleepy.


Behavioral Audiological Evaluation


What is a Behavioral Audiological Evaluation?

A Regular (Behavioral) Audiological Evaluation measures degrees of hearing for different tones (pitches). This is important for hearing speech and language.

We understand that children respond reliably when interested in the task, so testing is conducted as a listening game that is played in a sound-treated room.

How is the test performed?

The type of listening game will be chosen according to your child's age and abilities:

  • Visual Reinforcement Audiometry observes head-turning responses to sounds, rewarding the responses with a lighted toy or video
  • Play Audiometry shows your child how to respond to sounds with a play task such as placing a block in a bucket after hearing the sound.

Older children can respond to sounds during the test by raising a hand or pushing a button, and by repeating words.

What should I bring to the appointment?

  • Insurance cards
  • Referral number (if your insurance plan requires a referral for audiological evaluations)

How long does a behavioral evaluation take?

Behavioral audiological evaluations take approximately 45 minutes to 1 hour. The test room should be quiet, so we ask that siblings only attend the session if another adult is able to come with you.




What is a Tympanometry test?

This is a very brief test which involves putting a soft tip in the ear canal opening and taking a measurement of the air pressure required for the child's eardrum to move.

Tympanograms help to determine whether your child might have any middle ear problems which need medical attention.


Otoacoustic Emissions (OAES) 


What is an Otoacoustic emissions test?

Otoacoustic emissions (OAEs) are measured with a soft tip in your child's ear canal. OAEs indicate whether the hair cells of the cochlea (inner ear) are functioning, and can be measured to be present or absent as long as your child has no wax or fluid in the ear.


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