Types of Hearing Tests for Children

In order to successfully measure hearing, PENTA’s audiology team offers a wide variety of audiological testing that can help determine the type and degree of hearing loss in children of all ages. The following is a simple listing of the most common types of hearing testing provided by our audiologists.


The Early Hearing Detection and Intervention (EDHI) program suggests babies are screened for hearing loss by 1 month of age, diagnosed by 2 months of age and provided intervention by 3 months of age. Hearing screens are typically completed before the baby leaves the birthing center. A hearing screen result is typically PASS or REFER. A “REFER” result does NOT confirm hearing loss, it means further diagnostic information is needed to determine the baby’s hearing status. A baby is referred for diagnostic evaluation after 2 failed hearing screens.

Automated Otoacoustic Emissions (AOAE) is a screener completed by placing a small probe in the baby’s ear and playing different sounds to elicit a response back from the inner ear. This screening method is quick and painless and preferably completed while the baby is sleeping; however, the test can still be completed if patient is awake and calm.

Automated Auditory Brainstem Response (AABR) is a screener completed by placing stickers (electrodes) on the baby’s forehead and behind each ear and placing a small ear bud in each ear. A sound is played, and the machine will determine if a response from the brain was measured.

Although it is common for babies to have fluid in and behind the ears at birth that could affect the results of the screening, fluid is NOT always the reason a baby refers on the newborn hearing screen. It is imperative to follow-up after a refer result to confirm the baby has adequate access to sounds to prevent delays in their communication, language and social skill development.


Behavioral hearing test require your child to complete an observable behavior when speech or sound is presented to them. There are different types of behavioral test for different age groups and developmental ability. In addition, some children may require a combination of these techniques. We will ensure to alter testing based your child’s needs.

Visual Reinforcement Audiometry (VRA) – 6 months – 2.5 years old

This hearing test is completed by presenting speech and/or tones through speakers or headphones. We determine hearing by observing patient making head turns toward the sound source. When the patient finds the source a toy, video or light is presented to reinforce the correct response.

Conditioned Play Audiometry (CPA) – 2.5 years to 4 years old

Conditioned Play Audiometry is completed by presenting speech and/or tones through speakers or through headphones. We determine hearing by patient making completing a task when they hear the sound. When the patient hears the sound, they are conditioned to place a toy in the bucket or complete another task.

Standard Audiometry – 5 years and older

This hearing test is completed by the patient raising their hand or indicating verbally they heard the sound.



The ABR and ASSR evaluation are completed in office while the child is sleeping. However, the ASSR can be completed on children who are awake, but quiet and still. These appointments are scheduled for 2-hours to allow for test preparation, testing and result counseling.

Auditory Brainstem Response (ABR) Evaluation – birth to 5 months

The ABR evaluation is a diagnostic test of the neural integrity of the auditory system. An ABR is completed when on any baby who REFERS on the newborn hearing screen or who is suspected to have hearing loss. This test allows the audiologist to screen for Auditory Neuropathy Spectrum Disorder (ANSD) <link See Appendix B>. The ANSD screen can determine the integrity of the auditory nerve function. If the integrity of the auditory nerve is determined to be normal, the ABR is also used to estimate hearing thresholds to estimate degree and type of hearing loss.

Look or sound familiar? The ABR is the diagnostic version of the automated test used for newborn hearing screens in the hospital known as Automated Auditory Brainstem Response (AABR).

Auditory Steady State Response (ASSR) Evaluation – all ages

PENTA is one of the only pediatric facilities in the metro Atlanta area that routinely provides ASSR evaluations. Similarly, to the ABR, this test can estimate hearing thresholds of children with normal neural function. The most unique aspect of the ASSR test is that it can test both ears simultaneously and estimate hearing sensitivity at four important frequencies at the same time. This provides the opportunity for a shorter test time as the ABR can only test one pitch in one ear at a time. The ASSR test can be scheduled for infants who did not pass the newborn hearing screen or for older children who are not developmentally able to participate in behavioral hearing test strategies, but can sit quiet and still for testing.


Tympanometry is the assessment of middle ear function. This test can be used to determine if the ear drum (tympanic membrane) is moving normally or abnormally. Abnormal readings on this test can indicate the presence of fluid or negative pressure behind the ear drum, a hole (perforation) in the ear drum, or functionality of a pressure equalization tube. Tympanometry is completed by placing a small probe tip at the entrance of the patient’s ear and sending a gentle puff of air into the ear to elicit movement of the ear drum. The test is quick and painless.


Otoacoustic emissions is a sensitive test of inner ear cochlear function. This test is completed by placing a small probe in the patient’s ear. Different tones are presented to the ear and as a result, a healthy ear will create an “echo” back that can be measured. When we can measure that “echo,” it indicates normal function of the important cells in the inner ear. This test is used to obtain ear-specific information for patients unable to complete behavioral hearing test or cannot tolerate headphones.

This test is very sensitive to middle ear dysfunction. If a patient has ear infections, fluid or negative pressure, responses may not be able to be obtained and can be unreliable.

Look or sound familiar? This test is also used for newborn hearing screens in the hospital and in our clinic.


An acoustic reflex is a small reflex measurement elicited by a sound and can be measured in the ear. We have a natural reflex that occurs when we perceive a sound as being loud. That reflex occurs when the stapedial muscle in our middle ear tenses causing the ear drum to stiffen. The stiffening of that eardrum can be measured using a small probe in the ear. The reflex requires the involvement of the VIIth (facial) cranial nerve and the VIIIth (auditory) cranial nerve to occur. This reflex provides information on the integrity of those nerves.