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Is it Always Necessary to Test Both Ears When Conducting an ABR to Estimate Hearing Sensitivity?

James W. Hall III, PhD

December 19, 2016

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Question

Do you always test both ears when conducting ABR testing in infants to estimate hearing sensitivity, or is there a protocol for estimating the opposite ear in certain cases?

Answer

Well that's a good question. I always evaluate both ears. Let’s say a child failed a hearing screening in one ear, and comes back to the clinic for a diagnostic assessment. A unilateral failure in the nursery means the other ear that passed the screening is at risk for hearing loss, and there is a lot of research to support that fact.  We do not want to assume that just because the screening result was normal in one ear, that a diagnostic assessment of that ear is not in order.

In addition, sometimes you have a unilateral anomaly – such as unilateral atresia or unilateral microtia. Some audiologists would recommend performing ABR only on the ear with the anomaly. That makes no sense to me. If you perform ABR only on the ear with the anomaly, you are assuming that because one of the child’s ears is typical in appearance that there is normal hearing in that ear. If that were the case, we wouldn’t ever have to do hearing tests because we could assume everyone with a typical-looking pinna had normal hearing.  Of course we know as audiologists, that you can have a profound hearing loss (or any degree of hearing loss) with a typical-looking outer ear.

In addition, when you have a concern about a conductive loss, whether it is based on an ear anomaly like microtia, based on a delayed wave I in the ABR, or based on an abnormal tympanometry result, always do air and bone conduction ABR on both sides. You may think that if there is aural atresia, you only need to do bone conduction to prove that the cochlea is normal. That's not a good idea. You can’t estimate the degree of conductive loss based on looking at somebody’s ear. I've evaluated hundreds of patients with aural atresia and you never know what to expect in terms of hearing.  I've had cases with aural atresia in one ear, a perfectly normal looking other ear, but they had otitis media in that ear, which resulted in a bilateral conductive loss.

I would always test both ears, but not always do a bone conduction ABR unless there are some risk factors for conductive loss. Always test both ears and try to always use clicks and tone bursts unless you have some other compelling evidence that hearing sensitivity is normal, such as normal OAEs plus the ABR.

This Ask the Expert was taken from the Q & A session of the course, Update on Auditory Evoked Responses: Value of Chirp Stimuli in ABR/ASSR Measurment, which is available in both a recorded course and a text course format.


james w hall iii

James W. Hall III, PhD

James W. Hall III, PhD is an internationally recognized audiologist with 40-years of clinical, teaching, research, and administrative experience. He received his Ph.D. in audiology from Baylor College of Medicine under the direction of James Jerger.  During his career, Dr. Hall has held clinical and academic audiology positions at major medical centers. Dr. Hall now holds appointments as Professor at Salus University and the University of Hawaii, and as Extraordinary Professor at the University of Pretoria South Africa. Dr. Hall is the author of over 160 peer-reviewed journal articles, monographs, or book chapters, and nine textbooks including the 2014 Introduction to Audiology Today and the 2015 eHandbook of Auditory Evoked Responses.

 


Related Courses

Update on Auditory Evoked Responses: Evidence-Based ABR Protocol for Infant Hearing Assessment
Presented by James W. Hall III, PhD
Recorded Webinar
AudiologyOnline

Presenter

James W. Hall III, PhD
Course: #27299Level: Intermediate1 Hour
  'Very informative and concise, the presenter stayed on topic and had helpful visuals'   Read Reviews
A clinically feasible and effective protocol for infant hearing assessment with ABR is described. Research findings support all recommended stimulus and acquisition parameters. This course is open captioned.

Please note: You may earn ABA Tier 1 credits for this course if you complete it as part of the course 27890.

View this Course for FREE.
Need CEUs? Become a AudiologyOnline member to get unlimited CEUs.

Only $129/yr

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Update on Auditory Evoked Responses: Value of Chirp Stimuli in ABR/ASSR Measurement
Presented by James W. Hall III, PhD
Recorded Webinar
AudiologyOnline

Presenter

James W. Hall III, PhD
Course: #27300Level: Intermediate1 Hour
  'This was a wonderful course'   Read Reviews
In this course chirp stimuli are described and their rationale for clinical application is discussed. Data are presented in support of the use of chirp versions of click and tone burst stimuli in ABR and ASSR assessment of infants and young children. This course is open captioned.

Please note: You may earn ABA Tier 1 credits for this course if you complete it as part of the course 27885, "Auditory Evoked Responses for Infant Hearing Assessment Series". Course 27885 contains recordings of all three events from our 2016 series on Auditory Evoked Responses for Infant Hearing Assessment. ABA Tier 1 CEUs can be earned only when all modules are completed as part of course 27885.

View this Course for FREE.
Need CEUs? Become a AudiologyOnline member to get unlimited CEUs.

Only $129/yr

Learn More

Auditory Evoked Responses for Infant Hearing Assessment
Presented by James W. Hall III, PhD, Susan Small, PhD
Recorded Webinar
AudiologyOnline

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Course: #27890Level: Intermediate3 Hours
  'Knowledge of speaker and clarity of information delivered'   Read Reviews
This modular course reviews hearing assessment for infants and young children using ABR. An evidence-based protocol as well as chirp and brief-tone bone-conducted stimuli are discussed.

View this Course for FREE.
Need CEUs? Become a AudiologyOnline member to get unlimited CEUs.

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Rethinking Your Audiology Test Battery
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  'Dr Hall is a very good presenter and provided the information in a way that was easy to understand'   Read Reviews
This course reviews the evidence and rationale for creating individualized audiologic diagnostic and screening test batteries with an emphasis on maximizing diagnostic value and enhancing clinical efficiency. It provides practical information for audiologists to review their protocols and implement value-added changes.

View this Course for FREE.
Need CEUs? Become a AudiologyOnline member to get unlimited CEUs.

Only $129/yr

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20Q: Preschool Hearing Screening is Essential for Early Identification of Childhood Hearing Loss
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This course discusses preschool hearing screening in an engaging Q & A format. Topics covered include: universal newborn screening, and why some children are not screened or lost to follow up; types of assessments for preschool hearing screenings; evidence-based protocols for preschool hearing screening and follow up.

Please note: You may earn ABA Tier 1 credits for this course if you complete it as part of the course 29608, "Audiological Test Battery Series." Course 29608 contains recordings of all three events from our 2017 series on Audiological Test Batteries. ABA Tier 1 CEUs can be earned only when all modules are completed as part of course 29608.

View this Course for FREE.
Need CEUs? Become a AudiologyOnline member to get unlimited CEUs.

Only $129/yr

Learn More

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