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Children's Hospital at Dartmouth Hitchcock (CHad)
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Audiologic assessment

Diagnostic capabilities

For children, a combination of behavioral and physiologic measures may be used when assessing the hearing/auditory status of infants and children. Behavioral audiometry methods may include behavioral observation, visual reinforcement, conditioned orientation response, conditioned play, and conventional audiometry; as well as speech audiometry.

Physiologic measures may include acoustic immittance measures (for example, tympanometry, acoustic reflexes), Auditory Brainstem Response (ABR – including sedated and unsedated/infant ABR for hearing threshold assessment), and Otoacoustic emissions (OAE). For adults, these same behavioral and physiologic measures are available in addition to adult assessment of balance (vestibular) function.

Please note: At this time, Dartmouth-Hitchcock Audiology does not offer auditory processing evaluations. Please contact us to find a center that offers this specialized testing.

Behavioral hearing test methods

Test Method

Age (developmental)

Behavioral Observation Audiometry (BOA)

0 to 5 months

Visual Reinforcement Audiometry (VRA), Conditioned Orientation Reflex (COR) Audiometry

6 months to 2+ years

Conditioned Play Audiometry (CPA)

2+ years

Conventional Audiometry

4 to 5 years

Physiologic auditory tests



Acoustic Immittance (for example, tympanometry, acoustic reflexes, acoustic reflex decay)

Status of the middle ear system

Otoacoustic Emissions (OAE)

Outer hair cell function in the inner ear

Auditory Brainstem Response (ABR)

Auditory nerve function and for estimation of peripheral hearing levels

Sedated auditory brainstem response (ABR) testing

Hearing evaluations via sedated ABR are scheduled following case review by pediatric audiology. The type of sedation used is determined and monitored by the CHaD Pain Free Anesthesia Team.

Unsedated auditory brainstem response (ABR) testing

Hearing evaluations via unsedated ABR are scheduled for infants from birth through age 6 months.

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