| Test Environment |
- Test in a quiet place.
- Choose room that is not close to busy hallway or bathroom, if possible.
- Carpet, cork boards, fabric covered boards/room dividers help to create a quieter test environment.
- Small table or counter with small chair for child and chair for tester.
- Ideally, controls for screening audiometer should be out of view of child.
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| Equipment |
- Prior to first hearing screening of the day, complete a listening check of screening audiometer by presenting one tone at 20dB HL in each headphone. Note, individual performing listening check should have normal hearing.
- If there are concerns following a listening check (e.g., one headphone sounds louder than another or there is no sound), check headphone jack in back of audiometer to ensure that the headphone jack has not become dislodged. If concerns still persist, contact CHOP Biomed for service call and when possible, for provision of loaner audiometer.
- Ensure that headphones pads are clean. Headphones should be also cleaned between patients when indicated (e.g. secretions from ear.)**
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| Screening Procedure |
- Show child headphones, explain that child is going to listen carefully and respond (see tips section) when he/she hears “quiet beep-beep sounds.”
- Place headphones on child.
- Screen each ear at 20 dB HL @ 1000 Hz, 2000 Hz, 4000 Hz (6000 Hz and 8000 Hz for patients ages 11-21 years)
- Do not use picture pointing hearing screening (e.g., point to toothbrush). This type of screening can yield a false negative, missing the identification of a permanent hearing loss.
- Do not screen at levels above or below 20dB HL (with the exception of familiarizing child to sound at a louder level if they do not initially respond at 20dB HL).
- Do not screen at 500 Hz. This frequency is impacted by ambient noise levels and transient middle ear conditions and subsequently yields a higher referral rate.
- Begin by presenting one of the frequencies (Hz) at 20 dB HL and if child does not respond, make stimulus louder (40 dB HL) to familiarize child with target sound and after child responds, return to 20dB HL.
- Child must respond to at least two presentations of each test stimulus to assure reliability. No more than three presentations of any test stimulus per ear should be presented.
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| Screening Technique Tips |
- Check and modify headphones for size.
- For children > 4 years old, ask child to respond to sound by raising his/her hand or saying “I hear it.”
- Do not ask child to raise right or left hand. The individual performing the screening can choose which ear to present to (right/left) on the audiometer. At soft levels, the child may hear the sound but not know which ear it is coming from.
- For children < 4 years old, introduce screening as a game. Have some simple toys available (e.g., small plastic animals or blocks and a bucket**). Ask the child to throw the toy in the bucket when he/she hears the “beep-beep sound.” Take a moment to model and show the child what you would like them to do.
- If child is cooperative for testing and understands task but is not responding at one or more test frequencies (Hz), remove and re-position headphones. Rescreen the frequencies he/she did not pass. Research has shown that almost 50% of children who have failed a screening, pass with repositioning of headphones.
- If audiometer is in view of child, shield visual cues (e.g. light blinking or hand pressing control button) with other hand.
- Consider having a reward bucket with stickers for cooperative behavior.
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