Hearing Thresholds, Minimum Response Levels, and Cross-Check Measures in Pediatric Audiology
Publication: American Journal of Audiology
Volume 24, Number 2
Pages 137-144
Abstract
Purpose
Pediatric audiologists must identify hearing loss in a timely manner so that early intervention can be provided. In this article, the methods important for differentiating between a hearing threshold and minimum response level (MRL), important for an accurate diagnosis, are described.
Method
Operant conditioning procedures, used during visual reinforcement audiometry and conditioned play audiometry, are reviewed. Case examples are provided that demonstrate the importance of using evidence-based procedures, evaluating the success of such procedures, and using cross-check measures for interpreting responses as thresholds or MRLs.
Results
Behavioral-hearing thresholds can be obtained when operant conditioning procedures are successful and cross-check measures corroborate the audiometric results. When MRLs are obtained, cross-check measures are critical in determining the likelihood of hearing loss and making follow-up recommendations.
Conclusions
Early diagnosis of hearing loss is important so that intervention can be initiated within critical periods during infant and childhood learning. Accurate diagnosis depends on the audiologist, who must adhere to evidence-based procedures, use cross-check measures, and evaluate the validity of each procedure. Future research and guidelines are needed to examine decision-making processes in pediatric audiology that ensure diagnostic accuracy and timely intervention for infants and children identified with hearing loss.
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References
American Academy of Audiology. (2012). Audiologic guidelines for the assessment of hearing in infants and young children. Retrieved from http://www.audiology.org/publications-resources/document-library/pediatric-diagnostics
American Speech-Language-Hearing Association. (1988). Determining threshold level for speech [Guidelines]. Retrieved from http://www.asha.org/policy/gl1988-00008.htm
American Speech-Language-Hearing Association. (2005). Guidelines for manual pure-tone threshold audiometry [Guidelines]. Retrieved from http://www.asha.org/policy/gl2005-00014.htm
American Speech-Language-Hearing Association. (2014). Permanent childhood hearing loss [ASHA Practice Portal Clinical Topics]. Retrieved from http://www.asha.org/Practice-Portal/Clinical-Topics/Permanent-Childhood-Hearing-Loss/
Bagatto, M. P., Moodie, S. T., Scollie, S. D., Seewald, R., Moodie, S., Pumford, J., & Liu, K. P. (2005). Clinical protocols for hearing instrument fitting in the desired sensation level method. Trends in Amplification, 9, 199–226.
British Society of Audiology. (2014). Recommended procedure: Visual reinforcement audiometry. Available from http://www.thebsa.org.uk/wp-content/uploads/2014/04/BSA_VRA_24June2014_Final.pdf
Fulcher, A., Purcell, A. A., Baker, E., & Munro, N. (2012). Listen up: Children with early identified hearing loss achieve age-appropriate speech/language outcomes by 3 years-of-age. International Journal of Pediatric Otorhinolaryngology, 76, 1785–1794.
Gelfand, S. A., & Silman, S. (1985). Functional hearing loss and its relationship to resolved hearing levels. Ear and Hearing, 6, 151–158.
Gelfand, S. A., & Silman, S. (1993). Functional components and resolved thresholds in patients with unilateral nonorganic hearing loss. British Journal of Audiology, 27, 29–34.
Gorga, M. P., Neely, S. T., Ohlrick, B., Hoover, B., Redner, J., & Peters, J. (1997). From laboratory to clinic: A large scale study of distortion product otoacoustic emissions in ears with normal hearing and ears with hearing loss. Ear and Hearing, 18, 440–455.
Gravel, J. S. (2000). Behavioral audiologic assessment for hearing aid fitting: Big challenges from tiny ears. In Seewald, R. (Ed.), A Sound Foundation Through Early Amplification: Proceedings of an International Conference (pp. 33–46). Murten, Switzerland: Phonak, AG.
Jerger, J., & Hayes, D. (1976). The crosscheck principle in pediatric audiometry. Archives of Otolaryngology, 102, 614–620.
Joint Committee on Infant Hearing. (2007). Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Pediatrics, 120, 898–921.
Karzon, R. (2007). Consensus for normal thresholds for BOA and VRA. Retrieved from http://www.audiologyonline.com/ask-the-experts/consensus-for-normal-thresholds-boa-311
Kemp, D. T. (2002). Otoacoustic emissions, their origin in cochlear function, and use. British Medical Bulletin, 63, 223–241.
Lantz, J. (n.d.). FRESH noise [White paper]. Retrieved from http://www.otometrics.com/Knowledge-Center
Matkin, N. (1977). Assessment of hearing sensitivity during the preschool years. In Bess, F. (Ed.), Childhood deafness (pp. 127–134). New York, NY: Grune and Stratton.
McConnell, F., & Ward, P. H. (1967). Deafness in childhood. Nashville, TN: Vanderbilt University Press.
Norrix, L. W., & Velenovsky, D. S. (2014). Auditory neuropathy spectrum disorder: A review. Journal of Speech, Language, and Hearing Research, 57, 1564–1576.
Northern, J. L., & Downs, M. P. (1974). Hearing in children. Baltimore, MD: Williams & Wilkins.
Olsen, W. O., & Matkin, N. D. (1979). Speech audiometry. In Rintelman, W. (Ed.), Hearing and assessment (pp. 133–206). Baltimore, MD: University Park Press.
Olsho, L. W., Koch, E. G., Carter, E. A., Halpin, C. F., & Spetner, N. B. (1988). Pure-tone sensitivity of human infants. The Journal of the Acoustical Society of America, 84, 1316–1324.
Parry, G., Hacking, C., Bamford, J., & Day, L. (2003). Minimal response levels for visual reinforcement audiometry in infants. International Journal of Audiology, 42, 413–417.
Reliability [Def. 2]. (n.d.). In Merriam-Webster Online. Retrieved from http://www.merriam-webster.com/dictionary/reliability
Sabo, D. L., Paradise, J. L., Kurs-Lasky, M., & Smith, C. G. (2003). Hearing levels in infants and young children in relation to testing technique, age group, and the presence of absence of middle-ear effusion. Ear and Hearing, 24, 38–47.
Sininger, Y. S., Grimes, A., & Christensen, E. (2010). Auditory development in early amplified children: Factors influencing auditory-based communication outcomes in children with hearing loss. Ear and Hearing, 31, 166–185.
Thompson, G., & Weber, B. (1974). Responses of infants and young children to behavioral observation audiometry. Journal of Speech and Hearing Disorders, 39, 140–147.
Widen, J. E., Folsom, R. C., Cone-Wesson, B., Carty, L., Dunnell, J. J., Koebsell, K., … Norton, S. J. (2000). Identification of neonatal hearing impairment: Hearing status at 8 to 12 months corrected age using a visual reinforcement audiometry protocol. Ear and Hearing, 21, 471–487.
Widen, J. E., & Keener, S.K. (2003). Diagnostic testing for hearing loss in infants and young children. Mental Retardation and Developmental Disabilities Research Reviews, 9, 220–224.
Widen, J. E., & O'Grady, G. M. (2002). Using visual reinforcement audiometry in the assessment of hearing in infants. The Hearing Journal, 55, 28–36.
Wilson, R. H., Morgan, D. E., & Dirks, D. D. (1973). A proposed SRT procedure and its statistical precedent. Journal of Speech and Hearing Disorders, 38, 184–191.
Wilson, W. R., & Thompson, G. (1984). Behavioral audiometry. In Jerger, J. (Ed.), Pediatric audiology (pp. 2–44). San Diego, CA: College-Hill Press.
Yoshinaga-Itano, C., Sedey, A. L., Coulter, D. K., & Mehl, A. L. (1998). Language of early- and later-identified children with hearing loss. Pediatrics, 102, 1161–1171.
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Copyright © 2015 American Speech-Language-Hearing Association.
History
- Received: Dec 28, 2014
- Revised: Feb 6, 2015
- Accepted: Feb 15, 2015
- Published in issue: Jun 1, 2015
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