Audiology Program

Programs & Services

Audiology diagnostics

Your child's appointment will take about one hour. Please arrive on time to ensure that we can perform a full evaluation and provide appropriate recommendations and referrals for follow-up. The test room should be quiet, so we ask that siblings only attend the session if another adult is able to come with you.

We will tailor your child's hearing assessment to his or her individual needs, with developmentally appropriate behavioral and objective measures.

Behavioral measures

Behavioral measures record your child's actions in response to sound. We use behavioral measures to:

Determine the presence, type, and degree of hearing loss
Assess your child's ability to hear and understand speech information

Test	What it measures	How it's done
Visual Reinforcement Audiometry (VRA): Typically performed between the developmental ages of 6 months to 2 years*	This test measures the quietest level your child responds to sounds.	Various sounds will be played through speakers or earphones. We will look for your child's response, such as turning their head to the sound.
Conditioned Play Audiometry (CPA): Typically performed between the developmental ages of 2 to 4 years*	This test measures the quietest level your child responds to sounds. We may also measure your child's ability to repeat words.	Your child will play various listening games, such as dropping a block into a bucket, whenever they hear a quiet beep.
Conventional Audiometry: Typically performed with children developmentally age 5 and older*	This test measures the quietest level your child responds to sounds. We may also measure your child's ability to repeat words and sentences.	Your child will raise his or her hand each time he or she hears a beep.

* — Developmental age is a way to express your child's ability to perform certain tasks and functions.

Objective measures

Objective measures record how your child's auditory system responds to sound.

Test	What it measures	How it's done
Tympanometry and acoustic reflexes	These tests help identify problems with the ear drum and middle ear space.	We will place a small earphone in your child's ear canal. The earphone will measure how well sound enters the middle ear at various air pressures.
Otoacoustic emissions (OAEs)	This test assesses the function of the hair cells in the inner ear. It is used to screen for significant hearing loss in infants, and to monitor the effects of drugs that can damage hearing.	We will ask your child to remain still and quiet for a few minutes. Sounds will be presented through a small earphone, and a response from the inner ear is recorded.
Auditory brainstem response (ABR)	This test assesses electrical activity from the auditory nerve and the auditory pathway in the lower part of the brain. It determines the presence, type, and degree of hearing loss.	This test is performed while your child is asleep or under sedation. Sound is presented to each ear, and we measure the brainwaves that correspond to hearing.

After completing your child's hearing evaluation, the audiologist will give you the results of the hearing test. If there is a hearing loss, the audiologist will:

Monitor the hearing loss
Provide informational counseling to you and your family regarding the hearing loss
Recommend hearing aids, communication strategies, and ways to maximize the use of residual hearing, as appropriate
Refer your child for additional language or developmental assessments as needed
Direct you to community resources for educational or financial assistance
Answer any questions you may have at any time

Auditory Processing Program

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.

About the program

The Auditory Processing Program is designed to assess both the peripheral hearing status and the integrity of the central auditory pathways. The child’s performance is compared to norms for children the same age, as the auditory system continues to mature through adolescence. 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 CAPD testing, children must meet the following criteria for evaluation:

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

You may request an intake packet for the Boston, Lexington, or Waltham locations 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.

Bone-Anchored Hearing Implant Program

Children with hearing loss due to disorders of the outer or middle ear may benefit from devices that send sound vibrations through the skull. This type of amplification is called a bone conduction hearing system. The system can be worn on the head as a headband or surgically implanted into the skull. When surgically attached, it is called a bone-anchored hearing implant.

The Bone Anchored Hearing Implant Program provides a coordinated team approach for evaluation of candidacy for a bone-anchored hearing implant.

The Bone-Anchored Hearing Implant Program team members include:

Program coordinator
Otolaryngologist
Audiologist
Psychologist
Reimbursement specialist

To make an appointment, please contact the program coordinator, Eleanor ("Ethel") Penn-Whitehead, at 617-355-BAHS (2247) or boneconduction@childrens.harvard.edu.

Cleft Lip and Palate Program

The Cleft Lip and Palate Program provides a multidisciplinary approach for the care of children and adolescents with cleft lip and/or cleft palate in the diagnosis, treatment, and follow-up in our Boston and Waltham locations.

To make an appointment, please contact the program coordinator at 617-355-6309.

An appropriate referral will be needed prior to the appointment date from the patient's pediatrician for every specialist to be seen during a particular clinic visit.

Cochlear Implant Program

Children with severe to profound sensorineural hearing loss and children with unusually poor speech perception may benefit from a device called a cochlear implant. A cochlear implant consists of a small wire that is inserted into the inner ear in order to stimulate the auditory nerve.

Our interdisciplinary Cochlear Implant Program is located within the Department of Otolaryngology and Communication Enhancement, and it's recognized as the largest and most comprehensive pediatric cochlear implant program in New England.

Click the link to view the Cochlear Implant Program webpage.

Craniofacial Anomalies Program

Boston Children's Hospital craniofacial specialists treat craniofacial anomalies in children covering a wide variety of congenital and acquired deformities. This is a specialty program within the Department of Plastic and Oral Surgery. The clinic is held in Boston on Fegan 3 generally on the second, third, and fourth Fridays of the month in the afternoon.

The Craniofacial Anomalies Program team members include (but are not limited to):

Neurosurgeon
Plastic surgeon
Dentist
Geneticist
Audiologist
Speech pathologists
Psychologist and social worker

To make an appointment, please contact the program coordinator at 617-355-6309.

Hearing Aid Program

Most children with hearing loss will benefit from the use of hearing aids. Well-programmed and comfortably fitted hearing aids are essential to ensure a child with hearing loss has the best access to the auditory environment. Without hearing aids, children with hearing loss are at risk of language delays and academic problems. The audiologists at Boston Children’s will make sure your child’s hearing aid is fit specifically to the acoustic characteristics of their ear and will monitor your child’s auditory progress and functional outcomes. To schedule an appointment, call 617-919-6080

Down Syndrome Program

The Down Syndrome Program in the Developmental Medicine Center offers multidisciplinary clinical evaluations for people with Down syndrome from birth until the age of 22. With each appointment, we are also able to make referrals and connections with any of the other specialty clinics at Boston Children's. The Down Syndrome Program is more than a clinic, however. We strive to provide resources, advocacy, and support to all families depending on their individual needs.

The Down Syndrome Program team members include (but are not limited to):

Developmental-behavioral pediatrician
Nutritionist
Dentist
Speech pathologist
Physical therapist
Audiologist
Program coordinator

To make an appointment, please contact the Down Syndrome Program's coordinator at 617-218-4329.

Sound Outreach to Schools

The Sound Outreach to Schools (SOS) Educational Audiology Program at Boston Children's at Waltham has been developed to deliver a full spectrum of educational audiology services to children with all types of auditory disorders in our local school systems.

Services can be provided to an individual student or to multiple students within a district. Contracts are typically established for ongoing consultation throughout the school year but can also be provided on a one-time basis.

Services may include:

Recommendations for accommodations, including assistive listening systems
Verification of these systems to determine proper fit and function
Training of teachers and students to use and maintain educational amplification systems and to optimize the student's auditory access
Maintenance and record-keeping of existing equipment
Loaner equipment that can be borrowed by the school while a system is being repaired
Assessment of the classroom listening environment and recommendations for improvements as needed
Presentations to groups of students about hearing loss and hearing protection

For more information, please contact:

General email box:
soundoutreach@childrens.harvard.edu

Caitlin Agreda, AuD, CCC-A
caitlin.agreda@childrens.harvard.edu
781-216-2207

Christine Macdonald, AuD, CCC-A
christine.macdonald@childrens.harvard.edu
781-216-2207