Hearing Testing

Hearing testing is recommended when OME persists for 3 months or longer or at any time that language delay, learning problems, or a significant hearing loss is suspected. Conductive hearing loss often accompanies OME and may adversely affect binaural processing, sound localization, and speech perception in noise. Hearing loss caused by OME may impair early language acquisition, but the child's home environment has a greater impact on outcomes; recent randomized trials suggest no impact on children with OME who are not at risk as identified by screening or surveillance.

Studies examining hearing sensitivity in children with OME report that average pure-tone hearing loss at 4 frequencies (500, 1000, 2000, and 4000 Hz) ranges from normal hearing to moderate hearing loss (0–55 dB). The 50th percentile is an ~25-dB HL, and ~20% of ears exceed 35-dB HL. Unilateral OME with hearing loss results in overall poorer binaural hearing than in infants with normal middle-ear function bilaterally. However, based on limited research, there is evidence that children experiencing the greatest conductive hearing loss for the longest periods may be more likely to exhibit developmental and academic sequelae.

Initial hearing testing for children 4 years old or older can be done in the primary care setting. Testing should be performed in a quiet environment, preferably in a separate closed or sound-proofed area set aside specifically for that purpose. Conventional audiometry with earphones is performed with a fail criterion of more than 20-dB HL at 1 or more frequencies (500, 1000, 2000, and 4000 Hz) in either ear. Methods not recommended as substitutes for primary care hearing testing include tympanometry and pneumatic otoscopy, caregiver judgment regarding hearing loss, speech audiometry, and tuning forks, acoustic reflectometry, and behavioral observation.

Comprehensive audiologic evaluation is recommended for children who fail primary care testing, are less than 4 years old, or cannot be tested in the primary care setting. Audiologic assessment includes evaluating air-conduction and bone-conduction thresholds for pure tones, speech-detection or speech-recognition thresholds, and measuring speech understanding if possible. The method of assessment depends on the developmental age of the child and might include visual reinforcement or conditioned orienting-response audiometry for infants 6 to 24 months old, play audiometry for children 24 to 48 months old, or conventional screening audiometry for children 4 years old and older. The auditory brainstem response and otoacoustic emission are tests of auditory pathway structural integrity, not hearing, and should not substitute for behavioral pure-tone audiometry.