Challenges in obtaining audiological certainty

Posted on: September 1, 2011

Or just how long should a diagnosis of hearing loss take?

My question of the day came from a researcher who has been interviewing parents about their experiences of diagnosis of hearing loss. She said that ‘some parents reported that deafness was diagnosed very late due to difficulties assessing behavioural responses and the need for repeat appointments” and asked “shouldn’t all young children be offered more reliable testing methods?” I thought this was a really interesting question and these were my thoughts…

We have had newborn hearing screening routinely offered across the UK since 2006. It certainly sounds then as if we can reliably test the hearing of any child from the day they are born. This is true to a certain extent but perhaps isn’t the full story. Audiologically we use both objective test measures as well as behavioural ones. In general we want to do our best to try and obtain behavioural results as this potentially tells us more about the child’s hearing. Objective test measures can very reliably tell us how the ear and hearing nerve is functioning but it is only behaviourally that we can see that the sound has got all the way to the brain, been processed and the child has responded appropriately. Behavoural testing can give reliable results from the age of 6 months when used by experienced paediatric audiologists. There are clearly occassions when we have to rely on objective test measures, such as when working with very young babies or older children with complex needs, but for most children we are using a combination of test techniques and putting the puzzle pieces together to complete the jigsaw picture of a their hearing difficulties.

The biggest stumbling block for objective audiology test measures is that they rely on children being very still and quiet, with their eyes closed (eye movement interferes with the results recorded), for the duration of the test and this could be 30 minutes or more. We can do this on very young babies whilst they naturally sleep during the day, and on older children by asking them to ‘pretend to be asleep’. Inbetween times a child needs to be sedated or under general anaesthetic. Unfortunately this also coincides with the toddler stage that is most difficult to test behaviourally! We would prefer not to have to sedate large numbers of children and this isn’t always appropriate. Sometimes we can piggyback whilst they are having a surgical procedure under anaesthetic (such as grommets) or whilst sedated for another test (such as an MRI scan). But there are of course children who have medical needs that make sedation or anaesthetics risky. So the whole situation needs to be balanced quite carefully – with what we understand about the child, their hearing, their medical history and the urgency to get hearing test results. Some children are referred to us following illnesses that are known to cause hearing loss, such as following meningitis or chemotherapy. Children who have been through traumatic experiences and hospital admittances are often particularly difficult to test behaviourally and we may have to spend a lot of time building up trust with them first.

All of this does not in any way mean that children (and parents) should be left in uncertainty for many months and this isn’t acceptable. Audiologists and doctors should be discussing these options and helping parents make an informed choice about what tests can and should be carried out and when. For information on the various hearing and medical tests that can be carried out, and what they can and can’t tell us download the free NDCS booklet Understanding your child’s hearing tests and know what questions to ask!

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