Using Conditioned Play Audiometry to Test Hearing in Children Older Than 2 1/2 Years

Key Points

  • Play audiometry can be successfully accomplished with children once they reach a cognitive age of ~30 months
  • By being creative, the pediatric audiologist can find tasks that keep the young child interested and sufficiently cooperative to obtain necessary testing information
  • The audiologist needs to own the responsibility for obtaining test results. If testing is not completed, the audiologist must take responsibility and say "On this day, I cannot test the child."
  • Play audiometry or conditioned play audiometry (CPA) was first described by Hoverston, Lowell, Rushford and Stone
  • As has been known for decades, once children reach a cognitive age of ~30 months, they can bein to cooperate voluntarily in hearing testing. By this age, children can be taught to drop a toy in a bucket or put a ring on a ring stand
  • determine the child's cognitive age

Test Protocol for Conditioned Play Audiometry

  1. Set the child in a highchair or at a children's table so the child is comfortably seated
  2. Select a toy that will be enjoyable for the child and within the child's skill range
  3. Begin using a test stimulus that you expect the child to be able to hear
  4. Begin by demonstrating the task. The audiology assistant holds the toy to her ear. When she hears the sound she says " I hear that" and drops the toy into the bucket
  5. After a few presentations, the child is given the toy and the audiology assistant holds the toy to the child's ear. When the sound is heard, the audiology assistant helps the child drop the toy into the bucket
  6. Care must be taken to encourage the child to drop the toy in the bucket only when you are certain the child heard the sound
  7. This is repeated until the child is able to perform the task without assistance
  8. Once the child is conditioned and performing reliably, testing can begin
  9. If the child appears to be bored, change toys to increase interest.
  10. Testing can be accomplished by air and bone conduction with hearing aids, cochlear implants, BAHA and FM systems

When a child is not cooperating, it is tempting to try a different test protocol, such as moving from play audiometry to VRA. This is almost always a bad choice. If the child is cognitively old enough to do play, testing with VRA will give inaccurate test results, and may suggest hearing loss that is not present!