Children's Hearing Test: What to Expect and Signs of Hearing Loss

Understanding Hearing Tests for Toddlers

If you’re wondering whether your toddler needs a hearing test and what to expect, you’re not alone. At Hear and Say, we often receive questions from parents about hearing tests for young children. To help, we’ve created this guide to explain the process and what you can do to support your child’s hearing health.

Objective testing doesn’t require a response from the child, and is similar to the hearing screening most newborns have called an Auditory Brainstem Response (ABR) test.

What Happens During a Toddler Hearing Test?

Hearing assessments for toddlers are typically fun and painless. The approach used depends on your child’s age, with two primary types of hearing tests:

Behavioural Testing – Used for older babies and toddlers, this test observes your child’s response to sounds, such as turning towards a speaker or engaging in a listening game. For example they might look to their parents or for a puppet in the window.

Objective (Electrophysiological) Testing – This test, often used for newborns and younger infants, measures how the auditory nerve responds to sounds without needing a response from the child. The most common form is the Auditory Brainstem Response (ABR) test.

Signs Your Toddler May Have Hearing Loss

Trouble following directions or responding to questions
Their speech or language is delayed or noticeably different compared to their friends or siblings
They don't react to loud noises or sounds
They are tired when they come home from childcare, kindy or school
Having behavioural problems or struggling with attention at school or home

What Increases the Risk of Hearing Loss in Children

Temporary Causes of Hearing Loss:

Ear wax build up
A foreign object, for example marbles or Lego, stuck in the ear canal
Ear infections in the middle ear (otitis media or glue ear)
Eustachian tube blockage (feeling of blocked ears) as a result of a cold or flu

Permanent Causes of Hearing Loss:

Genetics
Exposure to loud noises, for example an explosion (known as noise-induced hearing loss)
Accidents or injuries like a skull fracture
Virus or illnesses like meningitis
Perinatal viruses like cytomegalovirus (CMV)
Incomplete or partial formation of the ear structures

How Hearing Loss Affects Speech and Language Development

Hearing loss can happen at any age in children and can change slowly over time without them, their parents or teacher noticing. The number of children with hearing loss doubles by the time they reach school-age. Even if a child has passed previous hearing tests, such as the universal newborn hearing screen, it’s important to keep an eye on their hearing as it can impact their speech and language development.

Some signs of the impacts of speech and language development may include:

Finding it difficult to understand what the child is saying
They pronounce the same word in different ways for example saying 'dar' for 'car'
Using incorrect vowels for words such as 'car' turns into 'core'
Dropping the initial sound of a word off so 'car' is 'ar'
Getting frustrated when communicating with people
Trouble following instructions
Limited vocabulary with limited understanding of what words mean
Poor concentration
Having trouble answering questions starting with 'Wh-'

A speech pathologist can help by undertaking a speech and language assessment if you have concerns that your child may have a speech and language delay.

Behavioural hearing tests (six months to five years)

Visually Reinforced Orientation Audiometry (VROA)

A “puppet test” or VROA is often used with children under three and a half years. This involves the child learning to turn towards a speaker whenever a loud sound is presented. When the child looks to the speaker, a puppet is shown as a reward. Children quickly understand that when they hear the sound, the puppet will appear if they turn to the source. Once a child has learnt to turn to the sound at louder levels, we can check for the softest sound they can hear.

Individual ear results can be determined if the child will wear headphones during the test. Most children enjoy this game, and it’s possible to get a full graph of hearing for at least the better hearing ear on most children at this age.

VROA is used until a child is around two-and-a-half to three-and-a-half years where they can concentrate enough to move on to play audiometry.

Play audiometry

Play audiometry can be used for children between three to five years. This requires the child to listen for whistles or beeps while wearing headphones, and perform a fun task such as putting a coin in a piggy bank or a piece in a puzzle.

Making a “game” of the hearing assessment keeps the child’s interest and enables a full picture of the hearing in each ear to be gained in around 30 minutes.

Tympanometry

Another part of the assessment is called the ear pressure test or tympanometry, which looks at how well your child’s ear drum is moving. This involves putting a small plug in the ear and varying the pressure in the ear canal to check for any congestion or fluid behind the eardrum.

The pressure test is painless but does feel a little strange for young children. A parent/carer is typically asked to hold and reassure the child for this test, which only takes a few seconds to complete.

What are the four degrees of hearing loss?

The treatment recommendations for a child with hearing loss will be dependent on various factors including the degree of their hearing loss.

Mild hearing loss

A child experiencing mild hearing loss may have trouble hearing soft voices or speech at a distance. It may also be difficult to hear a conversation when there is background noise.

Moderate hearing loss

For a child who has a moderate hearing loss, everyday communication is impacted, especially in group scenarios with background noise. They will need to wear hearing aids which will make sounds louder so they can understand conversations and speech.

Severe hearing loss

A child who has a severe hearing loss will significantly struggle to understand speech in everyday conversations. Children who have a severe hearing loss may be candidates for cochlear implants.

Profound hearing loss

When a child has a profound hearing loss it's so extreme that they may only hear excessively loud sounds or speech. Children with profound hearing loss tend to have limited benefit from hearing aids and are cochlear implant candidates.

FAQs

How do I prepare for children's hearing tests?

You can prepare your toddler for hearing tests by offering them headphones to listen to a favourite song or story before the appointment. Explain they are going to play some fun listening games and we will check in their ears with a light.

You can also use a small torch to look inside their ear and playfully say, “What’s in your ear?” If they’re old enough to mimic you, give them the torch and let them look in your ear, too.

How often should my child have their hearing tested?

Even if a child passes their newborn hearing screening, they can still develop hearing loss as they get older. Children should continue to have their hearing checked in preschool or prep/ kindy and at any time you have concerns.

What is a normal hearing range for a child?

The typical hearing range for children is between 0 and 20 decibels at all frequencies. The lowest threshold of sound is around 20 decibels which is about the level of sound from whispers or a tap running.

What hearing range indicates a hearing loss?

A moderate to severe hearing loss is when a child cannot hear sounds between 56 to 70 decibels (for example, standard conversation) and a profound hearing loss is when sounds greater than 91 decibels (for example, motor bikes) cannot be heard.