What is conditioned play audiometry?
Conditioned play audiometry (CPA), sometimes called play audiometry, is a method of testing the hearing ability of a child of toddler or preschool age.
CPA is a fun and interactive game. It involves conditioning the child to listen to sounds and indicate a response when the sound is heard through a playful activity. The response is elicited by making it interesting to the child, such as throwing a ball in a bucket, adding a block to the castle, putting a piece into a puzzle, or pretty much any playful activity that the child may enjoy.
It begins by conditioning the child to the task by playing a sound through speakers at a comfortable volume, at a level that is likely to be heard.
The tester will show the child what activity they get to do when they hear the sound (i.e. when you hear the beep you throw the ball in the bucket) and guide them to this response until they understand the task.
Once the child is conditioned to the activity and will respond with consistency to the sound, the volume is lowered by the audiologist to attempt to find the softest sound the child can hear (their hearing thresholds).
Depending on the attention of the child to the activity, the tester may need to switch activities during testing to hold the child’s interest. It is important that the tester or testing assistant give positive reinforcement to the child when they complete the task successfully.
Conditioned play audiometry can be performed in a soundfield condition or under headphones. The headphone condition is ideal because you’re able to receive information about the hearing level of each ear, whereas the soundfield condition is played through external speakers and only gives information about the better hearing ear. With soundfield testing, you can not determine the hearing level of each ear independently. Typically the conditioning phase of the testing is done in soundfield and then headphones or earphones are placed on the child for the testing phase, if the child will tolerate them.
Sounds are presented by the tester using an audiometer and testing is completed in a soundbooth or sound-treated room.
When is conditioned play audiometry used?
Conditioned play audiometry is used by an audiologist to test a child’s hearing ability.
Typically, children between the ages of 2 and 5 will be tested using conditioned play audiometry. Depending on the mental age of the child, some children may not respond well and will need to be tested via visual reinforcement audiometry (VRA).
In some cases an assistant is used to help the audiologist and the child through the testing. If an assistant is unavailable, the parent may be recruited to help the child with the task, although it is important that the parent not cue the child when the sound is heard during testing.
Conditioned play audiometry is necessary if a hearing loss is suspected in a child at this age.
A hearing test may be recommended if the child has failed a school or pediatrician’s hearing screening, the child has been previously diagnosed with a hearing loss, or if the child is diagnosed with a condition that can cause hearing loss, such as an ear infection.
The goal of CPA is to determine the hearing level of the child in each ear and across different frequencies. How much information is obtained about the child’s hearing will depend on the testing skill of the audiologist, as well as the attention and behavior of the child during testing.
In some cases, multiple sessions of conditioned play audiometry may be necessary.
Activities used in play audiometry
There is no limit to the activities that can be used in play audiometry, as long as they can be performed while the child sits quietly. The goal is to keep the child interested in the task so that the tester can get as much reliable hearing information as possible.
Some of the following games may be played during conditioned play audiometry:
- Toss a ball in a basket when the sound is heard
- Place the puzzle piece in the puzzle when the sound is heard
- Put the ring on the cone when the sound is heard
- Place the peg in the pegboard when the sound is heard
- Give mom/dad a high-five when the sound is heard (useful when no toys are available)
- Place the block on the castle when the sound is heard
How to prepare your child for conditioned play audiometry
If your child will be having their hearing evaluated, it is a good idea to practice the “listening game” with your child beforehand. This way they are more likely to understand the task and the Audiologist will be able to obtain very thorough information about your child’s hearing level.
Find out more information about how you can prepare your child for their hearing test here.