An 8-week-old child with normal tympanograms and present acoustic reflexes at 1000 Hz at 90 dB HL requires which next step to estimate hearing sensitivity?

An 8-week-old child with normal tympanograms and present acoustic reflexes at 1000 Hz at 90 dB HL requires which next step to estimate hearing sensitivity?

• A. Behavioral observation audiometry
• B. Auditory evoked brainstem evaluation
• C. Visual reinforcement audiometry
• D. Reassuring the parents that hearing is normal

Answer: (B)

In infants who can’t reliably give behavioral responses, an objective test that captures neural activity in response to sound is the most informative way to estimate hearing sensitivity. With normal middle-ear status (tympanograms) and functional acoustic reflexes, the auditory pathway up to the brainstem appears intact, so the next step is to measure the brainstem’s response to sound. Auditory brainstem response testing records electrical activity from the auditory nerve through the brainstem and can provide frequency-specific thresholds even when the infant is asleep. This makes ABR the best choice for estimating how well the infant can hear at this age. Behavioral methods like visual reinforcement audiometry aren’t feasible yet at eight weeks, and relying on reassurance alone wouldn’t yield a hearing estimate.

In infants who can’t reliably give behavioral responses, an objective test that captures neural activity in response to sound is the most informative way to estimate hearing sensitivity. With normal middle-ear status (tympanograms) and functional acoustic reflexes, the auditory pathway up to the brainstem appears intact, so the next step is to measure the brainstem’s response to sound. Auditory brainstem response testing records electrical activity from the auditory nerve through the brainstem and can provide frequency-specific thresholds even when the infant is asleep. This makes ABR the best choice for estimating how well the infant can hear at this age. Behavioral methods like visual reinforcement audiometry aren’t feasible yet at eight weeks, and relying on reassurance alone wouldn’t yield a hearing estimate.