CONTOH

Objective audiometry
To reach a valid diagnosis on the type and the degree of a
child's hearing loss different test methods are employed.
Usually behavioral / subjective methods are combined with
objective measurements. In the following find a description
of the most common objective methods used for children.

Otoacoustic Emissions (OAE)

This is the most common method used in newborn hearing screening. It does not require any
active participation from the child. The outer hair cells in the cochlea are moved by sounds.
These movements cause sound waves, the otoacoustical emissions. These are utilized in this test.
A so-called probe microphone is placed in the outer ear canal. A probe mic combines a tiny
loudspeaker and a microphone. If the test stimulus of the probe loudspeaker moves the outer hair
cells, the microphone can detect the resulting sound waves. This measurement has to be carried
out in a very quiet environment.

In the event that no otoacoustical emissions are discovered, the child doesn't necessarily suffer
from hearing loss. Several other reasons are likely: The test environment may not have been
quiet enough. In newborn children, especially during the first three days of life, tissue from the
mother's womb or amniotic fluid might also block the ear canal and thereby cause a negative
OAE result. A middle ear infection or a common cold can also cause a temporary disturbance of
sound conduction.

The existence of OAE states that the outer hair cells are working correctly within certain limits.
However, the detection of OAE does not allow any conclusion concerning the functional
capability of the auditory nerve or related regions of the brain. For this purpose, auditory evoked
potentials (AEP, e.g. ABR/BERA) are used to objectively determine the hearing threshold.
Auditory Brainstem Responses (ABR) or Brainstem Evoked
Response Audiometry (BERA)
ABR, BERA, BSER or BAER - different names are used for this type of audiometry. This
method allows the Hearing Care Professional to determine the hearing threshold without the
cooperation of the child. It is very similar to an EEG (Electro Encephallogram /
Encephalography). The test is conducted while the child is asleep. Electrodes are attached behind
the ear. Headphones are placed over or in the ears. The electrical activity evoked by the test
signal is measured and recorded. The test shows whether sound is processed correctly, as well as
the hearing threshold for specific frequencies. The duration of the measurement depends on how
many frequencies are measured and the time the child is asleep. (IMAGE: WAVE DIAGRAM
WITH CAPTION: The resulting wave-diagram is analyzed by comparing it to the wave-
diagrams of subjects with normal hearing.)

The resulting wave-diagram is analyzed by comparing it to the wave-diagrams of subjects with

normal hearing.

Tympanometry
Problems of the middle ear, like inflammations, might also influence your child’s hearing ability.
Methods to examine the middle ear function are called tympanometry, which means eardrum
measurement. Tympanometry is based on measuring the resistance of the eardrum towards
sound.

The method which is used most commonly in audiological assessment is the impedance test. It is
carried out using a probe tube, which is placed in the ear canal and is hermetically sealed by a
gum plug. During the measurement, an ongoing tone is applied through a loudspeaker in the
probe. According to a pressure variation, the changes in sonic reflection of the eardrum are
analyzed. The resulting compliance curve allows a conclusion concerning the condition of the
middle ear.
With normal ventilation, the middle ear and the ear canal should have the same pressure. In the
compliance curve, this shows in an amplitude maximum within certain limits and a pressure
proportion of roundabout 0 daPa.

If a child has middle ear problems, the compliance maximum is shifted to negative values ≤100
daPa. In this case, the Eustachian tube is not able to provide appropriate ventilation. As a
subsequence, bacteria concentrate in the middle ear. This consumes oxygen and thereby causes a
retraction of the eardrum towards the middle ear. This process might quickly lead to hearing
problems.

Such a retraction process should be treated urgently, as it could lead to a serious middle ear
infection and subsequently become an effusion. This is shown in the tympanometry curve as a
flat course without an identifiable maximum.

Such a curve indicates that the eardrum is not able to move freely and thus cannot transmit sound
waves properly any longer. An effusion might cause a conductive hearing loss of up to 40-50 dB

How do you verify whether and to what extent a child is

affected by hearing loss? Babies and small children are
not able to respond to conventional hearing tests as
adults do.
Pediatric audiologists employ different methods of evaluating the hearing threshold for children
appropriately. Some of these measurements can even be done while the child is asleep. Thus,
parents can be assured that none of these methods will have any negative effect on the child.

The testing of the hearing ability is referred to as audiometry. Subjective as well as objective
measuring methods are available and commonly employed.

Subjective measuring methods:

 Reflex audiometry
 Visual reinforcement audiometry (VRA)

 Play audiometry

 Conventional pure-tone audiometry

 Speech audiometry

Objective measuring methods:

 Tympanometry
 OAE (Otoacoustic Emissions)

 BERA (Brainstem Evoked Response Audiometry)

Newborn hearing screening (NHS)

Two babies in every one thousand are born with a hearing

loss. As functional hearing is decisive for the mental,
emotional and social development of children, it is
crucial to discover congenital hearing loss as early as
possible. Newborn Hearing Screening (abbreviated NHS)
is usually done some days after birth prior to hospital
discharge. The test routine takes only a few minutes and
can be done while the baby is asleep or quiet.
In NHS, the Otoacoustic Emissions test is typically employed. Some institutions are also using
systems for ABR screening. Most of the test equipment used in NHS provides an automated
workflow and can easily be handled by non-experts.

The results of the screening are available directly after the

test. What do the test results mean?
Regular result for Otoacoustic Emissions

The function of the outer hair cells, and thus of the inner ear, is fine.

Please note that the NHS does not give any indication of the functionality of the auditory nerve
or the auditory processing. However, these kinds of dysfunctions are very seldom and usually
occur in concurrence with other diseases.

Irregular result for Otoacoustic Emissions

If the NHS shows irregularities, it might be an indication of a hearing disorder. However, a

number of other reasons are also likely. If the test has been conducted within the first three days
after birth, tissue from the mother's womb or amniotic fluid might still occlude the ear canal. The
test environment may not have been optimal, e.g. not quiet enough. Whatever the reason, the
result needs to be taken seriously and will lead to a rescreening 2-3 weeks afterwards.

If the rescreening still shows irregularities, the baby needs to see a pedaudiologist for further
audiometry (hearing diagnostics).

In many industrialized countries, hearing will again be screened during later developmental
checkups. Nevertheless, if you as a parent or caregiver have the slightest impression that your
child suffers from a hearing loss, don't hesitate to contact a pedaudiologist or a clinic for a
reliable diagnosis. The earlier a hearing loss is treated, the lesser the consequences for the child.