Testing Babies: You Can Do It! Behavioral Observation Audiometry (BOA)

Behavioral observation audiometry (BOA) is the only test protocol that provides a direct measure of hearing. This valuable technique can be used to monitor hearing and hearing aid benefit in infants who are not yet able to participate in visual reinforcement audiometry (VRA). In this article, I present a carefully developed protocol that uses changes in sucking, resulting in a reliable threshold measures. Key points include Auditory brainstem response (ABR) testing, auditory steady state response (ASSR) testing, and otoacoustic emissions (OAEs) testing provide critical information about the status of the auditory pathways but are not direct measures of hearing. Only behavioral testing provides a direct measure of hearing. Behavioral testing can be used to monitor hearing and performance with hearing technology. When carefully performed, using appropriate criteria including using changes in sucking as an indication of a response, behavioral observation audiometry can be used by clinicians to accurately measure thresholds in infants cognitively less than 6 months of age.