Due to the increasing number of neonatal screening programs, infants are referred for audiological assessment and hearing loss at very young ages. Early diagnosis of hearing loss requires early initiation of rehabilitation including amplification synthesis. Providing adequate amplification depends on having a reliable definition of a child’s hearing loss. Consequently, the evaluation process amounts to a process of rehabilitation and hearing assistance. (sabo, 1999)
Unlike most adults who can determine hearing loss in one visit to the clinic, children often need frequent visits before determining the composition and degree of hearing loss. Auditory assessment in children is often a difficult, time-intensive, and ongoing process, especially when evaluating a very young child. Infants and young children do not have the breadth of responses that adults do, requiring adjustments to behavioral auditory methods. Additionally, electrophysiological tests are sometimes required to provide a basic estimate of the auditory function in order to obtain complete behavioral auditory results. However, complete behavioral auditory information is not necessary before the hearing aids installation and early intervention processes begin. The valuable time should not be wasted while waiting for full information. Instead, the amplification process should start with improvements and modifications to the hearing equipment that occur while obtaining more accurate information. (sabo, 1999)
Both electrophysiological and behavioral tests are used in the auditory evaluation of a very young patient. Behavioral tests are usually seen as subjective, and electrophysiological tests are seen as objective because of whether or not they depend on patient participation, respectively. At very young ages, electrophysiological testing results often predominate in the decision-making process for the management of a hearing impaired child, but for older children, the auditory-behavioral outcomes for which management decisions are made. However, these two types of tests provide information about the various aspects of a child’s hearing function, and they cannot act as an ideal substitute for each other. (sabo, 1999)
Below is a brief description of electrophysiological and behavioral tests appropriate for a young child patient. It should be emphasized that the behavioral auditory test for a young child can produce reliable results if you follow the appropriate procedures during the testing session. (sabo, 1999)
Speech audiometry is routinely performed at the clinic. It complements the pure tonal auditory measurement, which only gives an indication of the thresholds of absolute perception of tone sounds (terminal function), while speech auditing determines the clarity of speech and the distinction (between audios). It is important during hearing synthesis and the diagnosis of some diseases behind the cortex (auditory nerve tumor, auditory neuropathy, etc.) and tests of both peripheral and central systems. (lewis, 2016)
The speech recognition threshold (SRT) is the lowest level at which a person can recognize voice from a closed list of logical words. The WRS requires a list of words with individual syllables unknown to the patient at the speech recognition limit + 30 dB. The correct word count is recorded from the number of words provided to give WRS. The score of 85-100% is considered normal when the threshold of the natural tone (A) is normal, but it is common for WRS to decrease with increased sensory hearing loss. (lewis, 2016)
On the other hand, the ‘B’ curve indicates hearing impairment (slight auditory impairment), and ‘C’ indicates a deep loss of speech clarity with distortion occurring at a density greater than 80 dB HL It is important to distinguish between WRS, which gives an understanding of speech, and SRT, which is the ability to distinguish phonemes.
Test stimuli can be provided through headphones to test each ear separately, or in a free field in a sound booth to allow binaural hearing test with or without hearing aids or cochlear implants. The test material adapts to the individual’s age and language ability. (lewis, 2016)
Speech Threshold Examination includes several considerations. It includes the purposes of the test or the reasons for taking the test, the materials to be used in the test, and the method or procedure for testing. (schoepflin, 2012) A number of purposes were given to test the threshold of speech. In the past, speech thresholds were used as a means of validating pure tone thresholds. This purpose lacks some validity because we have other physiological and physiological procedures such as OAEs and simulation test results to assist us in this examination. However, the measurement of speech threshold is a hearing test. It is not entirely incorrect to conduct it as a shared review to hear a pure tone. Sometimes I think we’re keen to get rid of things because we feel we have a better way than other tests, but in this case, it might not be the wisest thing to throw them away.
Also in past years, speech thresholds have been used to define a speech recognition test level above the limit. This also lacks validity, because the level at which the test is performed above the limit depends on why you performed the test itself.
It is necessary to test speech thresholds if you are going to bill 92557. In addition, the current purpose of the speech threshold test is to assess children and the difficulty of testing patients. Clinical practice surveys tell us that most doctors take speech test thresholds for all of their patients, whether for billing purposes or not. (schoepflin, 2012).
Auditory perception begins before birth. During development, the human brain becomes a highly specialized system of cognitive functions, memory and semantics required to understand and produce language and enjoy music. The features of this development step by step have its foundations in nervous development and are closely related to auditory exposure and communicative procedures in childhood. (huotilainen, 2010)
There are many skills for speech and music awareness in the infant’s brain early in childbirth. The newborn’s brain can already recognize familiar sounds and rhythms from the fetus’ period. Also, newborns learn new sounds quickly and pay close attention to combining visual and auditory information. They are interested in matching what they hear with what they see. They quickly learn the correspondence between some of the vocal sounds and sounds, and the way lips, tongue, and throat move to produce them. Some speech and music awareness skills developed during the fetus period, while others were ‘more solid’. During the first few years, auditory perception becomes so accurate and effective that it allows to understand fast speech even in noisy conditions, enjoy music and retrieve accurate information from environmental sounds. (huotilainen, 2010)
