Auditory brainstem response (ABR)
Evoked otoacoustic emissions (OAE)
Limitations of ABR and OAE tests
Conditioned oriented responses (CORs) or visual reinforced audiometry (VRA)
Conventional screening audiometry
For children 4 years and older, conventional screening audiometry can be used. The child is asked to raise the right or left hand when a sound is heard in the respective ear. The test should be performed in a quiet environment using earphones, because ambient noise can affect test performance significantly, especially at lower frequencies (i.e., 500 and 1000 Hz). Each ear should be tested at 500, 1000, 2000, and 4000 Hz. Air conduction hearing threshold levels of >20 dB at any of these frequencies indicate possible impairment.
Audiometric evidence of hearing loss should be substantiated by repeat screening. Earphones should be removed and repositioned, and instructions should be carefully repeated to the child to ensure proper understanding and attention to the test. A child whose repeat test shows hearing thresholds >20 dB at any of these frequencies, especially if there is no pathologic abnormality of the middle ear on physical examination, should be referred for formal hearing testing. Children with unilateral or mild hearing loss also should be further evaluated; studies show such children to be similarly at risk for adverse communication skills as well as difficulties with social, emotional, and educational development.