Pediatric Audiology

Within the last decade, the role of the pediatric audiologist has expanded to include the evaluation, diagnosis and management of infants and young children. The age for successful audiologic intervention has dramatically decreased due to the implementation of universal newborn hearing screenings, as well as significant advancements in infant testing procedures. With this new responsibility comes the need to produce clinicians that are competent in assessing and managing the infant patient. However, mistakes must be anticipated as pediatric audiologists attempt the initial learning curve. Gravel (2001) presents several case studies that demonstrate the most common mistakes made during infant audiologic assessments. Additionally, the author discusses potential solutions and outlines a comprehensive infant test battery. This chapter serves as an educational tool aimed at reducing the amount of audiological pitfalls encountered by current and future pediatric audiologists.

Gravel (2001) cites misidentification of the type or degree of hearing impairment as the most common type of audiological misdiagnosis among infants. An error in identifying either factor may cause delays in confirming the child's true hearing capabilities. As a result, it may take longer for the child to be referred for necessary medical treatment or early intervention services. One case presents a three month old infant with a temporary conductive hearing loss due to middle ear effusion who was mistakenly diagnosed with sensorineural hearing loss (SNHL). Gravel suggests this mistake could have been avoided had the audiologist recognized the need to use more age-appropriate test procedures. For instance, Type A tympanograms were obtained using a 220Hz probe tone, suggesting normal middle ear function. However, Gravel cites several research studies that indicate a 678Hz probe tone is more sensitive in identifying middle ear pathologies for infants under four months of age. High-frequency tympanometry may have provided the clinician with the evidence needed to correctly diagnose a conductive hearing loss. Additionally, air conducted auditory brainstem response (ABR) thresholds were elevated bilaterally. The clinician did not pursue bone conducted ABR thresholds that would have shown significant air-bone gaps, further evidence of a conductive component. Gravel suggests bone conduction ABR be a routine component of the infant audiological assessment. This case supports the need

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