Pediatric Audiology Essay

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One objective of pediatric audiology is to estimate hearing thresholds so that hearing loss can be identified, quantified, and remediated during critical language-learning years. Although the goal is to closely estimate hearing thresholds, not all infants and children are able to provide behavioral responses that are close to threshold. Because audiologic test methods may not result in threshold estimates, Matkin (1977) coined the term Minimum Response Level (MRL), which is now widely used in the field of pediatric audiology. Matkin recommended using the term MRL to refer to audiologic behavioral responses obtained from pediatric clients when using techniques such as visual reinforcement audiometry “…until the reliability and the validity of the initial test findings are evaluated over time” (pg. 130). The use of the term MRL, according to Matkin, implies that the response behaviors may not be audiometric thresholds but may improve with the child’s maturation. Matkin provided an example, from an unpublished pilot study, when responses may not be indicative of audiometric thresholds. He stated that if a child is “actively involved in a play activity, response levels tended to be 20 to 30 dB poorer than those obtained when there was no sensory input competition”. Karzon (2007) mirrors this definition by recommending that MRLs be used, to represent the “best” response obtained rather than a threshold, when stimulus-response control is not achieved during visual reinforcement audiology (VRA) and/or conditioned play audiometry (CPA). When test techniques are not used to obtain stimulus-response control, it is well known that infants and young children respond at supra-threshold levels. The unconditioned response levels, expect... ... middle of paper ... ...ds so that accurate interpretation of the results and further recommendations can be made and intervention implemented when indicated. To obtain behavioral thresholds in infants and young children, evidenced-based operant conditioning techniques are required. The clinician must assess the success of the conditioning and the validity of the test measures for determining thresholds. Thresholds can be obtained when stimulus-response control is achieved and maintained within the test session. Valid threshold assessments will have a low rate of false positives and probe trials showing that conditioning was achieved and maintained. The validity of the test measures should be assessed by examining the agreement between the speech and tonal thresholds and by cross-checking the behavioral responses with physiologic measures such as acoustic reflexes, OAEs, and the ABR.

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