Instead of, launching quickly into hearing tests with small children. Observation of each child for some time lets us know about the relationship between them and adults, their gaits, standing positions, and other indications of general motor performance and their methods of communication. Hence, complete, and detailed case histories are important.
Generally, the broader frequency spectrum of sound attracts the attention of a small child. Hence, the clinician uses speech or broadband signal testing. The limitation of this lies in the fact that many children have good sensitivity in some frequency ranges and poor sensitivity in others. Many children have sharp fallen high-frequency hearing loss and respond overtly to sounds such as clapping or calling their names. Few of the children have congenital low-frequency sensorineural hearing losses as given by Ross & Matkin, 1967.
Behavioral Observation Audiometry (BOA):
The variety of noisemakers includes bells, rattles, rustling papers, and Xylophones. Spoon stirring in a cup is used for soft sounds that may evoke responses from children's daily life. Between the age of 4 to 8 months, one individual sits before the child and another individual behind, and utters phonemes such as “s, s, s, s”.
Response: The child searches for a sound by turning their head. If the child does not turn and locate the sound by 8 months old, indicates hearing loss, mental retardation, and some childhood symbolic disorders.
Sound field audiometry:
Presenting different sounds like tape recordings of animal sounds and baby cries via multiple loudspeakers kept in a room at certain distances can elicit effective responses. High-pitched sounds may have equal intensity in the low and high-frequency ranges, based on spectral analysis.
Responses: The child may search for the sound source, cease ongoing activity, awaken from light sleep, change facial expression, or offer a vocalized response.
Visual Reinforcement Audiometry (VRA):
Generally, at 2 months, a soft voice begins to stimulate better than a loud voice. At 1 to 3 months, instruments elicit the best response such as startle responses such as Moro reflex, overall activity increase, or crying. At 4 months, the human voice gains more effectiveness than the instruments. At 6 months of age reflex activity begins disappearing. Based on the localization ability of 4 months old normal hearing babies the sound field procedure is called conditioned orientation reflex.
The children are seated between a pair of loudspeakers, each will hold an illuminated doll within the children’s visual area. The pure tone and light presentation are paired with each other and after several presentations, children will begin to glance at the source of light anticipating the light. The introduction of light will be delayed and later this will serve as reinforcement.