Pediatric Services

Fauquier Hearing Services is proud to provide state-of-the-art services for hearing testing and hearing loss management for infants and young children.  We are a registered diagnostic facility for the Virginia Hearing Impairment Identification and Monitoring System.  We are the only facility in the region to utilize brainstem response equipment that allows us to effectively evaluate babies and the difficult-to-test population without the use of sedation.  When you bring your baby or child for evaluation at Fauquier Hearing Services, there are several test methods that we may use.  Depending on the needs of your child, we may use one or more of the following methods to determine his/her hearing status:

Tympanometry
This test allows us to determine the function of the eardrum, airspace behind the eardrum and the bones in the middle ear.  This test can also identify wax that occludes the ear canal or a hole in the eardrum.  Our equipment allows us to perform high frequency tympanometry, a specific method that is preferred to obtain accurate results for the six-month and younger age population.

Otoacoustic Emissions
An otoacoustic emission (OAE) is a sound that is generated from the inner ear.  It disappears in response to middle ear problems or inner ear dysfunction/hearing loss.  OAEs are an important element in the diagnostic battery for infants and children.  An abnormal OAE is a red flag for abnormal auditory function that likely represents hearing loss. 

Auditory Brainstem Response Testing (ABR/BAER)
This test evaluates both the ear and the brain.  The timing of electrical waves that occur in response to clicks or tones is measured to determine approximate hearing thresholds.  Threshold estimation in children unable to overtly and accurately respond to sound is the most common use of this test.  The waveforms also allow us to identify or rule out auditory neuropathy.  This test is also used with children and adults to identify possible lesions on the auditory nerve or at the level of the brainstem. 

Fauquier Hearing Services is proud to offer the Vivosonic Integrity system.  This technology allows us to collect the necessary information without sedation.  Additionally, the recording box is wireless, so the baby can be held and rocked by the parent during testing.  With the filter system unique to Vivosonic Integrity, a sleeping baby is no longer necessary.  The baby can be awake and moving and data can still be collected.  Because of this innovation, we can now also evaluate toddlers – hereto before essentially impossible without sedation and it’s associated risks.

Behavioral Testing in the Soundroom
Once children are six months of age or older, the gold standard for hearing evaluation is behavioral testing.  Children are escorted into the soundroom and typically sit on their parent’s lap.  Young children are taught or “conditioned” to search for a visual reinforcer (a flashing bear or monkey) in response to the sound stimulus.  An older child, perhaps in the three- to four-year-old range might be taught “play audiometry”.  The audiologist will teach your child to respond to the sounds presented by throwing a block in a bucket or performing some similar task.  Preferably we will use earphones, either over the ear or earphone inserts.  However, many children are resistant to earphones in which case we present the sounds via a speaker system.  This method is extremely useful to allow us to determine best hearing thresholds in anxious children but we cannot rule out unilateral hearing loss (hearing loss in just one ear) without use of earphones.

Auditory Processing Evaluation
Auditory processing disorder (APD) is a disorder in the way that the brain uses or processes auditory information.  Individuals usually have normal hearing sensitivity. While this condition may be congenital or acquired, the actual cause is typically not known.  Some of the characteristics of APD include the following:

• May have trouble paying attention to and remembering information presented orally
• May cope better with visually acquired information
• May have trouble paying attention and remembering information when information is simultaneously presented in multiple modalities
• May have problems carrying out multi-step directions given orally; need to hear only one direction at a time
• May appear to have poor listening skills, and need people to speak slowly
• May need more time to process information.
• Do better with written communication
• May be accused of “not listening”.
• May have behavioral problems

APD testing can be completed on children as young as five years of age but is typically performed with persons who are seven years of age or older. Evaluation of APD includes a test battery.  Basic audiometry is completed, as is OAE testing and ABR testing to rule out auditory neuropathy.  Further testing will include speech in noise tests, degraded speech tests and dichotic tests (the listener hears one word in one ear while simultaneously hearing another word in the other ear).   Results of the test battery yield recommendations for management and/or remediation therapy.  Speech/language evaluation is often recommended if not already completed.

Preparing Your Child for Hearing Testing
If your child is less than six months of age, it is very helpful if he is sleepy when you arrive.  So please wake your baby earlier than usual on this day and/or skip a nap so that he might be able to sleep for testing.  Try to keep him up on the trip to the office!  We have found that by feeding your baby upon arrival, he/she is more likely to feel comfortable and ready for a nap.  While a sleeping child is not necessary, the quieter and more relaxed he/she is the faster we can determine the baby’s hearing ability.   OAEs are often completed with the baby nursing or taking a bottle and as you know, naptime often comes next. 

If your child is older than six months, we will likely plan to test him/her in the soundroom.  This requires that your child is alert.  So please plan to bring your child at his/her best time of day, if that can be determined.  This might be after naptime or early in the morning.  With a young child, you may want to “practice” before you come to your appointment.  If you have a set of earphones, you could place them on your child and teach him/her to throw a block or toy in a bucket when you make a sound.  This could go a long way in helping him/her to be prepared and less frightened in the test environment.

On rare occasion, we will see a child who will simply not cooperate.  A child who is extremely anxious or frightened may resist even entering a test room and may scream and cry at the idea of being touched at all.  In this case, we still have a few options including the following:

1. We may make an educated judgment regarding his/her hearing based on your observations and on those of the audiologist.  This will include your observations of your child’s speech/language development and responses to speech and sounds in his environment. 
2. We may have you return for a second visit.  Often children who are frightened at their first visit are more comfortable upon subsequent visits. 
3. Depending on how close your child is to age appropriate speech/language development, in rare instances we may need to refer to a facility that will perform sedation in order to determine hearing status.