Recommended Hearing Test for a 9-Month-Old Infant
Visual Reinforcement Audiometry (VRA) is the recommended hearing test for a 9-month-old infant, as it is specifically designed for children aged 9 months to 2.5 years and assesses the child's auditory perception. 1, 2
Age-Appropriate Hearing Assessment Options
Visual Reinforcement Audiometry (VRA)
- Primary recommended test for 9-month-olds 1, 2
- Takes approximately 15-30 minutes to complete
- Technique conditions the child to associate speech or frequency-specific stimuli with a reinforcer (such as a lighted toy or video clips)
- Requires a calibrated, sound-treated room
- Provides diagnostic assessment of the child's auditory perception
- Limitations:
- When performed with speakers, only assesses hearing of the better ear (not ear-specific)
- Can be made ear-specific if performed with insert earphones, which can rule out unilateral hearing loss
Alternative Testing Options for 9-Month-Olds
Evoked Otoacoustic Emissions (OAEs)
- Can be used for any age, including 9-month-olds 1
- Quick 10-minute test
- Involves placing a small probe with a sensitive microphone in the ear canal
- Advantages:
- Ear-specific results
- Not dependent on whether patient is asleep or awake
- Quick test time
- Limitations:
- Child must be relatively inactive during testing
- Not a comprehensive test of hearing (doesn't assess cortical processing)
- Very sensitive to middle-ear effusions, cerumen, or vernix in ear canal
- May miss mild hearing loss 3
Automated Auditory Brainstem Response (ABR)
- Can be performed on children of any age 1
- 15-minute test
- Involves placing electrodes on the child's head to detect neurologic responses
- Advantages:
- Ear-specific results
- Responses not dependent on patient cooperation
- Limitations:
- Child must remain quiet (sedation often required)
- Not a comprehensive test of hearing
- Designed primarily to identify moderate or greater hearing loss 3
Testing Protocol Considerations
Follow-up Recommendations
- If screening tests are failed, referral to a pediatric audiologist for comprehensive diagnostic testing is essential 1, 2
- For children who fail initial screening, comprehensive audiological evaluation should be completed by 3 months of age 2
- Children with risk factors for hearing loss should have at least one diagnostic audiological assessment by 24-30 months, even if they passed newborn screening 2
Important Clinical Considerations
- Developmental abnormalities or behavioral problems may preclude accurate results on routine audiometric screening
- In such cases, referral to an otorhinolaryngologist and pediatric audiologist with specialized equipment and expertise is necessary 1
- Two-stage screening protocols (OAE followed by ABR) provide better specificity than single-stage testing 2, 4
- Each screening test evaluates different aspects of hearing function; they are complementary rather than interchangeable 4
Pitfalls to Avoid
- Relying solely on OAE or ABR can miss mild hearing loss, as these tests are primarily designed to detect moderate to severe hearing loss 3
- Failing to follow up on failed screenings (studies show 13-31% of infants who fail initial screening don't return for definitive testing) 2
- Assuming a passed newborn hearing screen eliminates the need for ongoing monitoring, as progressive or late-onset hearing loss can develop 2, 4
- Using inappropriate testing methods for the child's developmental age can lead to inaccurate results 1