hearing tests for children: signs to look for and what to expect

Colds, ear infections and 'glue ear' are common childhood complaints often associated with hearing loss. It can be hard to know when to book a hearing test for a child, especially if their symptoms fluctuate or if they are too young to tell you about a problem.


  -  Lack of attention to sounds
  -  Failure to meet hearing developmental milestones
  -  Not responding to their name or when called from another room
  -  Pulling, rubbing or scratching the ears
  -  Regularly saying "what?" or "pardon?"
  -  Difficulty following simple directions
  -  Difficulty hearing when there is background noise or other people speaking
  -  Using headphones at a high volume or sitting closer to speakers
  -  Talking loudly
  -  Speech and language delays

Although some of the most common causes of childhood hearing loss are temporary, recurrent or untreated hearing problems may have a lasting impact on your child's speech, language and auditory skill development. Early detection and intervention is key to minimising the impact of hearing loss on a child's learning and development.


Please note: Your child does not need a GP referral for a hearing assessment. Medicare rebates are only available with an Ear Nose and Throat Specialist referral or Enhanced Primary Care Plan through a GP.

What to expect from a paediatric audiological assessment:

Before the appointment

Take a moment to note situations or environments in which your child is having difficulty hearing. It can be very helpful to discuss your concerns with your child's Teacher, Speech Pathologist, or other people that regularly spend time with your child.

During your appointment

Information Gathering
The Audiologist will ask about your concerns regarding your child's hearing and ear health, and ask further questions in order to understand any past or current factors that may be part of the problem; this includes information on the pregnancy/birth of your child, their speech and language development, academic progress, social interaction and behaviour, their medical history, family history of hearing loss or learning difficulties, and history of loud noise exposure.

Ear Inspection
The outer ear, ear canal and ear drum will be examined for any pathology or blockage. The function of the middle ear system (between the ear drum and the inner ear; see The Ear) will also be checked using tympanometry, a simple pressure test. Where appropriate, acoustic reflex testing may be performed. This is an objective test of the middle ear muscle reflex that is elicited by loud sounds. The test involves sitting still and listening to a series of moderately loud short beeps.
These tests are typically not invasive or uncomfortable, but some children have a strong aversion to people touching their ears or items being placed in the ears. If your child has a strong aversion to loud sound, we may choose not to perform acoustic reflex testing.

Hearing Test
All hearing tests are performed in a sound treated enclosure with background noise levels reduced to those required by the current stringent Australian standards. Our West Perth clinic is equipped with a large sound booth for testing children younger than 4 years. Older children may be tested in the smaller booths that we have available at our visiting sites (Edgewater and Manjimup).

Your child's hearing will be tested using 'beeps' of different frequency (pitch) and intensity (volume). This is a behavioural test that requires a response from your child to indicate whether they have heard the presented sounds and the testing is modified based on the age of your child in order to achieve reliable age-appropriate responses. The results of the hearing test are plotted on an audiogram (see hearing assessment).

Age 12 months to 2.5-3 years: Visual Reinforcement Orientation Audiometry (VROA)
Testing is conducted in the 'free-field' using speakers 90 degrees to the left and right of your child. Using puppets and colourful lights as reinforcement, your child is encouraged to turn to the speaker when a sound is presented, therefore giving us information about the overall 'better ear' hearing ability of your child and their ability to localise the sound source.
Note: We cannot obtain hearing thresholds for each ear individually using this testing method, so the result must be cross-checked with other tests, such as the DPOAE.

Age 3 years to 4-5 years: Play Audiometry
Testing is conducted using headphones to obtain ear specific hearing information. Your child is directed to perform a task (such as putting a block in a box) each time they hear the presented sound.

Age 5 years +: Pure-tone Audiometry
From the age of 5, children may be able to undertake ordinary audiometric testing to obtain hearing thresholds in both ears. They are asked to push a button each time they hear a 'beep'.

Distortion Product Otoacoustic Emissions (DPOAE)
DPOAE testing is an objective measure of outer-hair-cell function in the cochlea. The hair cells are responsible for converting sound wave vibrations into neural signals that travel to the brain. The OHCs 'bounce' when they sense a vibration and we can detect that bounce in response to a sound using a very sensitive microphone placed in the ear canal. This test provides an indication of cochlea health and middle ear function, and typically supports the audiogram and other test results.

Speech Discrimination Test
Your child's ability to discriminate words or speech sounds may be assessed using recorded or live voice speech materials. We use this information to determine whether your child is having difficulty understanding speech as a result of hearing loss.

Review Results
Your audiologist will review your child's test results with you. If a hearing loss or other ear health issue is identified, together you can discuss management options, which may range from re-testing after a given time-frame, seeing a GP or an Ear Specialist for medical treatment, further assessment for Auditory Processing difficulties, or advice for hearing protection or good communication strategies. Please take time to consider the results and any recommendations made. It is also important to discuss them with people close to you and your child so that they can understand the situation.