Potential Pitfalls in the Audiological Assessment of Infants and Young Children

Progress made over the last several years in early identification of hearing loss through implementation of newborn hearing screening (NHS) programs has created a unique opportunity for audiologists to provide amplification to children with permanent hearing loss (PHL) very early in life. Along with this long-awaited opportunity comes the daunting responsibility for accurately determining the type, degree and configuration of an infant’s hearing loss so that appropriate counseling of parents, fitting of hearing aids, management planning and follow-up can proceed in a timely manner. Also critically important is to confirm the presence of normal hearing in a baby who failed NHS (a false-positive outcome), so that parental anxieties can be alleviated and unnecessary interventions avoided. Key to this process is the comprehensive audiological assessment. Current otoacoustic, physiological, electrophysiological and behavioral technologies and procedures have provided the pediatric audiologist with an assessment armamentarium that can yield information about the integrity of the auditory pathway from the periphery through the central auditory system. Unfortunately, as clinicians are learning rapidly, there are numerous ‘pitfalls’ that must be anticipated when evaluating the hearing status of infants and very young children and when monitoring children with confirmed PHL over time. Unknowingly encountering an audiological pitfall can deleteriously impact the validity of the audiological assessment, the primary building block of a