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 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.