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Department of Otolaryngology and Communication Enhancement
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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
TestWhat it measuresHow 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.

TestWhat it measuresHow it's done
Tympanometry and acoustic reflexesThese 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

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

  • 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 

An auditory processing evaluation uses a variety of tests designed to stress the auditory system. The audiologist diagnoses an auditory processing disorder based on the results of this evaluation.

An auditory processing evaluation can be completed with a child as young as 7, without significant cognitive or developmental delays. The testing requires that the child respond by repeating information, therefore the child’s speech must be intelligible to an unfamiliar listener. The child must also be able to remember and repeat strings of numbers and simple sentences. Testing requires that the child be able to tolerate wearing earphones.

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 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