Behavioral audiometry is just one part of the hearing test process. It differs from objective tests as it requires a behavioral response from the patient in response to a sound stimulus. It is used with both children and adults to identify the level at which a patient can hear, and understand, sound and speech. Early detection is important for all patients, but is especially important for children, as untreated hearing loss can negatively affect their overall development. In adults, untreated hearing loss can lead to social and emotional difficulties.
What Is Behavioral Audiometry Evaluation?
Behavioral audiometry refers to an audiologist observing a patient’s behavioral response to a controlled sound stimulus. This differs from objective tests as it requires the patient to consciously respond to the sound and for the audiologist to interpret that response.
This type of testing is recommended for both children and adults once a concern for hearing loss is identified, as it gives the audiologist a deeper understanding of how a patient is perceiving sound, and frequency-specific information, which is important for assessing and fitting for hearing aids.
How Behavioral Audiometry Works
While behavioral audiometry tasks differ for children and adults, the foundation of the procedure is the same. The patient is instructed to do a behavioral response when they hear a sound. For children, they often engage in play or are given a visual reinforcement for responding to a tone. In adults, they are asked to press a button or raise their hand when they hear the tone.
For speech stimuli with adults, the patient is asked to repeat the word or phrase they hear. In pediatrics, or if the patient is unable to give a verbal response, they may use a picture board to point to the picture that matches the word they heard. In infant speech testing, they look for any type of behavioral response to speech, such as smiling or turning their head.
Types of Behavioral Audiometry Tests
- Visual reinforcement audiometry (VRA) is the most common type used with infants. In this procedure, at least two screens, or visual reinforcement items, are placed 90 degrees from the infant’s head to the left and right. This method uses the infant’s reflex to look towards a sound.When a sound stimulus is played in the right ear, the infant likely will look towards the right if they hear the sound. When they look right, the audiologist (or assistant) plays a video or other visual stimuli to pair the sound with an enticing visual to encourage the infant to turn their head when they hear a sound.
- Conditioned play audiometry (CPA) is used with toddlers and young children. Like VRA, the child is taught to play a game when they hear a sound stimulus. For example, the audiologist may ask the child to “listen closely” to a block. When the sound is played, the child then stacks the block to indicate they heard the sound and is given verbal praise by the audiologist.
- Conventional audiometry can be used with older children and adults. This is the simplest method, as the patient is instructed to do a simple task, such as raising their hand or pressing a button to indicate they heard the sound.
Who Needs Behavioral Audiometry?
Many populations can benefit from behavioral audiometry assessments. Children and infants who are suspected to have hearing loss due to speech, language, or behavioral concerns, adults with communication concerns such as having difficulty during conversations, or individuals requiring follow-up testing after a routine or community hearing screening are examples of those who should seek out behavioral audiometry testing.
Benefits of Behavioral Audiometry
Behavioral audiometry is a non-invasive and safe test. It doesn’t require any physiologic measurements and participation in the test is completely voluntary and can be stopped or modified as needed.
Similarly, the test itself can be tailored to developmental age or ability. If an adult patient is developmentally delayed, they can still participate in behavioral testing by simply modifying the task and instructions given.
Additionally, this test allows us to identify the type and degree of hearing loss by comparing results from all testing completed during the evaluation.
Limitations of Behavioral Audiometry
Due to the nature of the testing, it requires patient cooperation and attention span to obtain comprehensive results.
Given this, the test may be less accurate for very young or non-cooperative patients. It’s not uncommon, especially in pediatrics, to need multiple sessions of behavioral audiometry to determine degree and type of hearing loss.
Lastly, behavioral audiometry does not give us complete information about a patient’s auditory function, and it must be supplemented by objective testing.
What to Expect During Your Appointment
Before the first appointment, compile your medical history, including your child’s pre- and post-natal information. Your audiologist will determine what information is relevant, so providing as much information as possible is best. If your child is going to be participating in behavioral audiometry, specifically CPA, at their appointment, it may be helpful to practice doing different tasks to sounds at home.
The evaluation in total can take anywhere from 15 to 45 minutes, depending on the tests selected by the audiologist, and if any objective measures are obtained during the appointment. Your audiologist will explain your results to you immediately after testing. If hearing loss is identified, you will be given information and a specific recommendation for amplification, such as hearing aids.
When to See an Audiologist
People often wait many years to visit the audiologist after they notice a decline in their hearing. If you notice signs and symptoms such as avoiding social situations, asking for repetition, feeling as though others are mumbling, feelings of pressure or fullness in the ears, or ringing, request a referral for an audiologist.
Regular check-ups are important for hearing health, especially for children. Children who do not receive early identification and treatment for hearing loss are at greater risk for social isolation, speech and language delays, academic difficulties, and negative self-image.
Get Your Hearing Evaluated By An Expert
Behavioral audiometry is an important element of audiometric testing as it allows the audiologist to obtain specific information about your hearing and gain further understanding of your own perception of sound. Seeking out a professional hearing evaluation can give you a better understanding of your own hearing and grant you access to resources to manage, and monitor, your hearing.