a. General. We need either physiologic or behavioral testing (other than screening testing, see
102.00B2g) that is appropriate for your age at the time of testing. See 102.00B2c-102.00B2f.
We will make every reasonable effort to obtain the results of physiologic testing
that has been done; however, we will not purchase such testing.
b. Testing requirements. The testing must be conducted in accordance with the most recently published standards
of the American National Standards Institute (ANSI). You must not wear hearing aids
during the testing. Additionally, a person described in 102.00B1c must perform an
otoscopic examination immediately before the audiometric testing. (An otoscopic examination provides a description of the appearance of your external ear canals and an evaluation
of the tympanic membranes. In these rules, we use the term to include otoscopic examinations
performed by physicians and otoscopic inspections performed by audiologists and others.)
The otoscopic examination must show that there are no conditions that would prevent
valid audiometric testing, such as fluid in the ear, ear infection, or obstruction
in an ear canal. The person performing the test should also report on any other factors,
such as your ability to maintain attention, that can affect the interpretation of
the test results.
c. Children from birth to the attainment of age 6 months.
(i) We need physiologic testing, such as auditory brainstem response (ABR) testing.
(ii) To determine whether your hearing loss meets 102.10A, we will average your hearing
thresholds at 500, 1000, 2000, and 4000 Hertz (Hz). If you do not have a response
at a particular frequency, we will use a threshold of 5 decibels (dB) over the limit
of the audiometer.
d. Children from age 6 months to the attainment of age 2.
(i) We need air conduction thresholds determined by a behavioral assessment, usually
visual reinforcement audiometry (VRA). We can use ABR testing if the behavioral assessment
cannot be completed or if the results are inconclusive or unreliable.
(ii) To determine whether your hearing loss meets 102.10A, we will average your hearing
thresholds at 500, 1000, 2000, and 4000 Hz. If you do not have a response at a particular
frequency, we will use a threshold of 5 dB over the limit of the audiometer.
(iii) For this age group, behavioral assessments are often performed in a sound field,
and each ear is not tested separately. If each ear is not tested separately, we will
consider the test results to represent the hearing in the better ear.
e. Children from age 2 to the attainment of age 5.
(i) We need air conduction thresholds determined by a behavioral assessment, such
as conditioned play audiometry (CPA), tangible or visually reinforced operant conditioning
audiometry (TROCA, VROCA), or VRA. If you have had ABR testing, we can use the results
of that testing if the behavioral assessment cannot be completed or the results are
inconclusive or unreliable.
(ii) To determine whether your hearing loss meets 102.10A, we will average your hearing
thresholds at 500, 1000, 2000, and 4000 Hz. If you do not have a response at a particular
frequency, we will use a threshold of 5 dB over the limit of the audiometer.
(iii) For this age group, behavioral assessments are often performed in a sound field
and each ear is not tested separately. If each ear is not tested separately, we will
consider the test results to represent the hearing in the better ear.
f. Children from age 5 to the attainment of age 18.
(i) We generally need pure tone air conduction and bone conduction testing, speech
reception threshold (SRT) testing (also referred to as "spondee threshold'' or "ST''
testing), and word recognition testing (also referred to as "word discrimination''
or "speech discrimination'' testing). This testing must be conducted in a sound-treated
booth or room and must be in accordance with the most recently published ANSI standards.
Each ear must be tested separately.
(ii) To determine whether your hearing loss meets the air and bone conduction criterion
in 102.10B1 or 102.10B3, we will average your hearing thresholds at 500, 1000, 2000,
and 4000 Hz. If you do not have a response at a particular frequency, we will use
a threshold of 5 dB over the limit of the audiometer.
(iii) The SRT is the minimum dB level required for you to recognize 50 percent of
the words on a standard list of spondee words. (Spondee words are two-syllable words
that have equal stress on each syllable.) The SRT is usually within 10 dB of the average
pure tone air conduction hearing thresholds at 500, 1000, and 2000 Hz. If the SRT
is not within 10 dB of the average pure tone air conduction threshold, the reason
for the discrepancy must be documented. If we cannot determine that there is a medical
basis for the discrepancy, we will not use the results of the testing to determine
whether your hearing loss meets a listing.
(iv) Word recognition testing determines your ability to recognize an age-appropriate,
standardized list of phonetically balanced monosyllabic words in the absence of any
visual cues. This testing must be performed in quiet. The list may be recorded or
presented live, but in either case, the words should be presented at a level of amplification
that will measure your maximum ability to discriminate words, usually 35 to 40 dB
above your SRT. However, the amplification level used in the testing must be medically
appropriate, and you must be able to tolerate it. If you cannot be tested at 35 to
40 dB above your SRT, the person who performs the test should report your word recognition
testing score at your highest comfortable level of amplification.
g. Screening testing. Physiologic testing, such as ABR and —
otoacoustic emissions (OAE), and pure tone testing can be used as hearing screening
tests. We will not use these tests to determine that your hearing loss meets or medically
equals a listing, or to assess functional limitations due to your hearing loss, when
they are used only as screening tests. We can consider normal results from hearing
screening tests to determine that your hearing loss is not "severe'' when these test
results are consistent with the other evidence in your case record. See § 416.924(c).