Hearing Thresholds, Minimum Response Levels, and Cross-Check Measures in Pediatric Audiology Purpose Pediatric audiologists must identify hearing loss in a timely manner so that early intervention can be provided. In this article, the methods important for differentiating between a hearing threshold and minimum response level (MRL), important for an accurate diagnosis, are described. Method Operant conditioning procedures, used during ... Clinical Focus
Clinical Focus  |   June 01, 2015
Hearing Thresholds, Minimum Response Levels, and Cross-Check Measures in Pediatric Audiology
 
Author Affiliations & Notes
  • Linda W. Norrix
    The University of Arizona, Tucson
  • Disclosure: The author has declared that no competing interests existed at the time of publication.
    Disclosure: The author has declared that no competing interests existed at the time of publication.×
  • Correspondence to Linda Norrix: norrix@email.arizona.edu
  • Editor and Associate Editor: Larry Humes
    Editor and Associate Editor: Larry Humes×
Article Information
Hearing & Speech Perception / Hearing Disorders / Clinical Focus
Clinical Focus   |   June 01, 2015
Hearing Thresholds, Minimum Response Levels, and Cross-Check Measures in Pediatric Audiology
American Journal of Audiology, June 2015, Vol. 24, 137-144. doi:10.1044/2015_AJA-14-0095
History: Received December 28, 2014 , Revised February 6, 2015 , Accepted February 15, 2015
 
American Journal of Audiology, June 2015, Vol. 24, 137-144. doi:10.1044/2015_AJA-14-0095
History: Received December 28, 2014; Revised February 6, 2015; Accepted February 15, 2015

Purpose Pediatric audiologists must identify hearing loss in a timely manner so that early intervention can be provided. In this article, the methods important for differentiating between a hearing threshold and minimum response level (MRL), important for an accurate diagnosis, are described.

Method Operant conditioning procedures, used during visual reinforcement audiometry and conditioned play audiometry, are reviewed. Case examples are provided that demonstrate the importance of using evidence-based procedures, evaluating the success of such procedures, and using cross-check measures for interpreting responses as thresholds or MRLs.

Results Behavioral-hearing thresholds can be obtained when operant conditioning procedures are successful and cross-check measures corroborate the audiometric results. When MRLs are obtained, cross-check measures are critical in determining the likelihood of hearing loss and making follow-up recommendations.

Conclusions Early diagnosis of hearing loss is important so that intervention can be initiated within critical periods during infant and childhood learning. Accurate diagnosis depends on the audiologist, who must adhere to evidence-based procedures, use cross-check measures, and evaluate the validity of each procedure. Future research and guidelines are needed to examine decision-making processes in pediatric audiology that ensure diagnostic accuracy and timely intervention for infants and children identified with hearing loss.

Acknowledgments
Special thanks to James Dean and David Velenovsky for their critical thoughts and comments on an earlier version of this article.
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