History

Age: 3 years 6 months

Gender: Female

KM did not pass a neonatal hearing screening.  She was identified as hearing impaired using auditory brainstem response testing at two months of age. She was fit for hearing aids at age 4 months, first with “loaner hearing aids” and then with her own hearing aids after hearing loss severity was confirmed with VRA testing at age 6 months.  She has been tested at frequent intervals since.

She was then seen during “cold and flu” season; her father brought her in and said the he believes KM is not hearing well as a result of the colds.

Otoscopy:

The ear canals were free of debris. The audiologist’s notes say the “tympanic membranes appear injected”.

Questions

• What form of pediatric hearing testing is “VRA testing”?

• What does it mean to say “tympanic membranes are injected”?

The last hearing test showed the following audiogram.  It was obtained at age 3 years 0 months with “play audiometry”.

“VT?” indicates the audiologist is questioning whether the response is vibrotactile.

• What is the loss type in the right ear?  What does “vibrotactile” mean, and how does that alter your decision on the type of loss in the right ear?
• What is the loss type and severity in the left ear?
• What is “play audiometry” – list at least five different “games” that could be used in play audiometry.

Some children on discovering that they are making you happy by giving a play response, such as dropping the block in the bucket, proceed to drop the block even when there is no stimulus present.  You need to stop that behavior, but of course you don’t want to be cross with a little child.

• What strategies would you suggest to deal with the incorrect false positive responses that would occur in a 3 year old?

• Why do you think the audiogram does not include 8000 Hz?