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Assessment of Hearing Loss
1
SH2030: Secondary Level Training Module.4

Objectives
• To familiarise the trainees with the normal
hearing and language milestones.
• To sensitize them to how they can suspect
hearing loss in a child or an adult.
• To inform them regarding further testing
modalities.
2

Suspicion
• If there has been a problem during
pregnancy or birth, such as:
– Maternal Rubella
– Use of Ototoxic drugs
– Difficult labour-Birth
Asphyxia
– Low birth weight
– Jaundice
– Prolonged stay in NICU
• If there is a Family history of
Deafness
• If the child has/had history
of discharge from the ear
• In case of malformation of
the head & neck.
In case of any such risk factor…. SUSPECT
HEARING LOSS:
REFER for Hearing Test
3

Hearing & Language
Development
• All children start listening and responding
to sounds gradually after birth.
• Gradually, they start babbling and then
speaking.
• Lets see how this development goes on…
4

0-3 month child
• Responds to loud sounds, such as bangs etc.
• S/he may blink or close the eyes or open them. May
wake up from sleep if loud sound is produced
nearby.
5

3-6 months
• Is able to recognise the
mother’s voice and
turns his head towards
her voice.
• Starts showing interest
in new sounds.
• Turns towards the
source of a sound.
6

6-9 months
• Starts making
babbling sounds by
this age.
• Shows interest in
squeaky toys.
7

9-12 months
• The child will start
responding to his/her
name.
• S/he will understand
small words such as
‘come’, ‘bye’ etc.
8

12-18 months
• Starts imitating small
words like mama,
papa…
• Tries to imitate words
that he/she hears
9

18-24 months
• Responds to
instructions like:
‘Touch your nose’,
‘Show your tummy’
etc.
• Will start speaking
small 2-3 word
sentences
10

In case any of the milestones is not
achieved…. SUSPECT HEARING LOSS:
REFER for Hearing Test
11

Ways to diagnose Hearing Loss
12

SH2030: Secondary Level Training Module.4 13
What is the modality for testing?
Hearing in an infant or young child can be
tested by:
• Use of Noisemaker (only for clinical
screening)
• Otoacoustic Emissions (screening test)
• Auditory Brainstem response (diagnostic
test)

Noisemaker
• In a quiet room
• 2 persons are required
• Mother/Parent holds the baby
• Stand in front of the baby with a toy to distract
him/her
• 1 person standing behind the child with the
noisemaker, shakes the rattle to make a noise.
• Observe the baby: Does he try to look for the
source of sound

A: Observer
B: Parent with child
C: Assistant with Noisemaker
A
B
C
Use of Noise maker

Diagnosis
• Once there is suspicion, Diagnosis can be
made by:
– OAE testing
– BERA test
Refer the child to the District hospital for detailed
assessment.

In an older child:
ASK, if the child has….
• discharge from the ear
• recurrent pain in the ear
• Difficulty in hearing
• improper development of speech
• Difficulty in understanding & following
commands
• Poor performance in school

Suspect hearing loss if ..
• Child
– Cannot follow simple instructions
– Gives wrong answers to questions
– Does not respond to your call
– Cannot sing/dance in time to music
– Cannot identify different sounds

Testing older Children and
Adults
• Clinical testing: Voice tests: excellent
clinical indicator
• Tuning Fork Tests
• Pure Tone Audiometry

Voice Tests (Child)
• Ask the child to repeat the words that you say.
OR
• Ask him/her (child) to do simple actions eg:
Touch your nose, Pat your head etc
OR
• Point to the object as you say the name
eg Chair, pen etc
If response is unsatisfactory:
Refer for Hearing assessment

• Sit about 1 meter from the child with one ear
facing you. Other ear should be blocked.
• Cover your lips while speaking (to prevent lipreading)
First speak in whisper:
Correct response=normal hearing
Incorrect response: Repeat in conversational voice
Correct response=slight H. loss
Incorrect response: Repeat in loud voice
Correct response=moderate H. loss
Incorrect response: Repeat by shouting in the ear
Correct response= Severe H. loss
Incorrect response: Deafness
Voice Tests

Voice tests (Adults & Older children)
• Ask patient to block off
one ear.
• Sit facing test ear at a
distance of 1meter from
the ear
• Cover your lips while
speaking (to prevent
lipreading)
22

• give stimulus in the form of spoken words, such as
Bicycle, Post-office, Aeroplane etc
• Ask patient to repeat back the spoken words
• Start with whispered voice & progress to shouted
voice, if required.
• Repeat with the other ear.

First speak in whisper:
Correct response=normal hearing
Incorrect response: Repeat in conversational voice
Correct response=slight H. loss
Incorrect response: Repeat in loud voice
Correct response=moderate H. loss
Incorrect response: Repeat by shouting in the ear
Correct response= Severe H. loss
Incorrect response: Deafness

Pure Tone Audiometry
• Standard technique for
older children &
adults.
• Gives us detailed
frequency specific
information about the
hearing of the child.
• Requires cooperation
from the child.

In Adults
Suspect hearing loss (Presbyacusis), if they are :
• isolating themselves socially
• Speaking too loudly
• Speaking too much (so as to not have to listen to
others)
• Speaking too little
• Raising the volume of the TV
• Have difficulty in understanding
what is being said over the phone
Refer for Audiometry

Suspect Noise Induced hearing loss
If the person:
• Has been working/living in noisy environment
• Has noisy pastimes (eg walkman, I-Pods)
• Complains of tinnitus
• Complains of difficulty in hearing bells etc.
• Complains of difficulty in understanding
speech/difficulty in hearing.
Refer for Audiometry

Counselling
The patient as well as the
Parent needs advice &
support in order to
rehabilitate the deaf child.
• Encourage the child and the
family
• Ensure that they start
rehabilitative therapy
• Encourage them to try to put
the child in a regular school.
• Warn the parents against
overprotecting the child

Whenever there is a suspicion of Hearing
Loss:
REFER
Thank You

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4_Assessment_of_hearing_loss[1].ppt

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