Hearing Test

What does a hearing exam involve for children? As with adults, a hearing exam is a non-invasive procedure that consists of several behavioral and physiological tests. These tests are the same as for adults with some modifications depending on the developmental age of the child.

Otoscopic Exam: the audiologist will look in your ears to ensure that the ear canals are clear of earwax, debris, or foreign objects. We observe anatomical markers, check that the eardrum is intact, and look for any visible abnormalities such as infection.

Tympanometry: the audiologist uses a device (a tympanometer) that changes the air pressure in your ear canal while measuring the sound that bounces back from the eardrum. This helps us detect infections, perforations, ossicular disarticulations, and other conditions of the outer and middle ear that may not be visible during the otoscopic exam. For the patient, this test feels as though you are traveling in an elevator for a few seconds.

Middle Ear Reflexes: the audiologist uses the tympanometer to play some loud sounds for a few seconds and stimulate the middle ear reflex. Observing this reflex helps to identify neurological problems that could cause or contribute to hearing problems.

Otoacoustic Emissions (OAEs): the audiologist uses a device to play some sounds in your ear. If the inner ear is functioning correctly, it generates an echo, which is then measured by the device. Observing these echoes helps to identify problems in the inner ear that can cause or contribute to hearing problems.

Speech audiometry: the audiologist plays some recorded words through a pair of calibrated headphones and asks you to repeat them. This allows us to observe how well you are able to detect and recognize speech. Puretone Audiometry: the audiologist presents sounds to find the softest sounds that you can hear at different pitches. These scores, called puretone thresholds, are compiled into a graph to illustrate which environmental and speech sounds you are able or unable to hear.


Some modifications for pediatric hearing tests may include:

Behavioral Observation Audiometry: some children may not be able to respond directly to the sounds that are presented. In this case, we vary the timing of our presentations and observe changes in the child’s behavior that occur with the sounds (ex: eye shift, head turn, facial expressions).

Visual Reinforcement Audiometry: some children may respond to sounds by looking toward the source of the sound (usually starting at around 6 months of age). We use remote-controlled toys that move and light up when the child looks toward the source of the sound to reinforce this behavior.

Conditioned Play Audiometry: some children are able to respond to sounds in the form of a game (usually starting at around 1-2 years of age). We teach the child to take turns in a game whenever a sound is heard.

Picture-Pointing Audiometry: some children may not be able to repeat the words we give them, but can point the words out on a picture board. We ask the child to point to the pictures (ex: “where is the snowman?”) or to point to other objects (ex: “where is your nose?”).

If you have any other questions or concerns about scheduling a hearing examination, please feel free to call us at 360-551-4800. If an audiologist is not available to answer your questions, we will call you back as soon as possible.

Newborn Hearing

Every newborn is required to be screened for hearing loss before they leave the hospital, as part of the Early Hearing Detection and Intervention Act of 2000. This is because the development of verbal communication relies heavily on one’s ability to hear, so untreated hearing loss is likely to cause delays in speech and language. When a baby is born, a hearing screening is performed using either or both of the following methods: (1) otoacoustic emissions (OAEs); or (2) auditory brainstem response (ABR). Each method tests the auditory system in different ways to ensure that the child can hear. For most newborns, OAEs are an efficient and accurate screening test. However, for those newborns who are at risk for hearing loss an ABR is usually the preferred screening test. If your baby does not pass the first hearing screen, a repeat screen should be performed within 2 weeks. An ABR is required for repeat screens according to Washington State EHDDI standards, regardless of whether the initial hearing screen was an OAE or ABR. Washington State EHDDI standards also require that both ears are tested during the repeat screen, regardless of previous screening results. If your baby does not pass the repeat screen, a threshold ABR is recommended. The threshold ABR is just a modified version of the ABR that looks at individual pitches within the frequency spectrum of speech. This helps us estimate the volume at which the child perceives those pitches. Link Audiology is the only facility in the area that performs both screening and threshold ABR testing.

How do I prepare for a threshold ABR? The threshold ABR yields the best results when the baby is sleeping, so it is helpful if you keep your baby awake the night before the test. At your appointment, we have a private room with a recliner where you can feed your baby and get your baby to sleep. You can bring a carrier, or hold your baby through the procedure, whichever you prefer. Anticipate a 2 hour appointment for the threshold ABR test. Please understand that we cannot always get all of the information we need in one appointment. Sometimes infants will not sleep through the exam, or cannot be consoled to lie still for the amount of time it takes to complete the exam. We will do everything we can to try to complete the full threshold ABR during one appointment, but there is no guarantee.

Hearing Aids/ALDs/Access

ALDs are devices, other than hearing aids, that can help you hear better in specific situations by either amplifying sounds or transmitting sounds directly to your hearing aids. For example, some ALDs wirelessly transmit your TV’s audio signal to amplified headphones that can help you hear the TV better. Other ALDs can wirelessly transmit a person’s voice across a room to your hearing aids. By decreasing the distance between you and the speaker, the intelligibility of the speech signal is enhanced.

Personal TV Amplifiers These headphones can be worn to amplify the sound from the TV or radio. The sound is sent wirelessly to the headphones via a transmitter, so someone else can listen through the standard speakers as well.

Amplified Telephones The telephone is amplified either by a built-in amplifier or by one that attaches to your telephone. Many amplified telephones have lights that flash when the phone rings, larger buttons for the visually-impaired, and other customizable features.

Captioned Telephones Some telephones can connect to the internet and provide live captioning of your telephone conversation. These can come with lights, touch screens, and other customizable features like amplified phones.

Personal Amplifiers A microphone, wired to an amplified headset, can be carried in your pocket, placed on a table, or pointed toward a speaker to help you understand.

Remote Microphones These microphones can be held or worn by someone else. As they speak into the remote microphone, the sound is transmitted wireless to a headset or to your hearing aids.

FM Systems These systems are typically used in group or classroom settings. The presenter wears a microphone and transmitter. The transmitter sends the signal out to anyone nearby with a receiver. The receiver is typically a small device that attaches to the bottom of your hearing aid.

Loop Systems These systems transmit sound over an electromagnetic signal that can be picked up by any device with a T-coil. Many hearing aids have T-coils built into them, allowing you to listen to audio over a loop system.

Other We can find an ALD or other device to suit almost any need – there are doorbells that make your lights flash, alarm clocks that vibrate your pillow, and more. Please ask us if you would like any additional information.


For school age children, listening environments become more complex, the content is more demanding, and collaboration among other professionals like teachers and educational audiologists is required. At this point, an Interventional Education Plan (IEP) is developed and implemented. The IEP is a continually developing plan that, like Early Intervention, is a collaborative process. Everyone involved in the IEP will continually assess how the child is doing in school and adjust the plan accordingly. An IEP might include things like preferential seating, use of visual cues and preprinted materials, extended test time, and speech therapy. The intervention plan may also focus on teaching skills like self-awareness and advocacy, to understand when communication difficulties exist and how to overcome those obstacles. At a parent or guardian’s request, our Audiologists are happy to work with anyone on your child’s team.

Central Auditory Processing

What are Auditory Processing Disorders (APD) and whom do they affect? Some people have difficulty understanding speech, even though their ears are working normally. When this occurs, it may be because the brain is unable to process the sounds correctly. So a person with APD might respond to the statement “Tell me something about a cat” by saying something inappropriate, like “It’s what you do on a stage.” In that particular instance, the person confused the sequence of letters in the word cat and heard the word act instead. APD may affect anyone, but it is most prominent in children as they are learning to listen to speech. Adults may also be affected by APD that went undiagnosed in their childhood or developed with traumatic brain injury. Since there are different models for diagnosis, and APD symptoms tend to overlap with those of other conditions like ADD/ADHD, it is difficult to tell exactly who may be affected by APD. Dr. Grolley and Dr. Souza both learned to diagnose and treat APD by Dr. Jeananne Ferre, one of the co-developers of the Ferre-Bellis model.

What is the Ferre-Bellis model? The Ferre-Bellis model aims to not only diagnose APD, but to determine where the problem exists within the brain and what specific processes are deficient, and then prescribe a rehabilitation program based on that information. This is important because the brain doesn’t just hear a word and produce a response; it dissects sound, identifies the individual components, puts it back together, attaches meaning to the sound, cross-references it to other parts of the brain for linguistic and emotional content, generates an appropriate response, then sends that information to the motor cortex to verbalize the response. And all of this happens in just a few milliseconds! When you understand this process, it becomes evident that there are a lot of places where the process can break down. It is for this reason that the Ferre-Bellis model breaks APD into 5 different types (3 primary and 2 secondary) and prescribes a rehabilitation program based on the APD type.

Aural Rehabilitation

What is aural rehabilitation and who may benefit from it? Aural rehabilitation is a program that helps you better use the sound that you hear. This is an important component when treating hearing loss, especially for those that have gone untreated for a long time. After having hearing loss for a while, the brain forgets how to correctly use the sounds that were lost. When those sounds are restored through amplification, you may have difficulty adjusting because the brain doesn’t know what to do with those sounds anymore. There are a variety of aural rehabilitation techniques, including computer programs (LACE, Fast ForWord), games, group sessions, and more. We select from these various techniques and adjust them for each patient, to create an individualized aural rehabilitation program that suits each patient’s needs.