The CE provider will describe and discuss as appropriate:
a. Examination of the ears, nose, and throat;
b. An otologic examination:
1. The external ears (pinnae and external ear canals) and the tympanic membranes;
2. Any middle ear abnormalities
c. Hearing loss:
1. The condition that causes the hearing loss; and
2. Whether the hearing loss is sensorineural, conductive, or mixed.
d. All audiometric testing performed where no cochlear implant or bone-anchored hearing
aid (BAHA) is present should be conducted unaided.
e. For children without a cochlear implant(s) from birth to the attainment of age
6 months, physiologic testing, such as auditory brainstem response (ABR) testing.
f. For children without a cochlear implant(s) who are age 6 months to the attainment
of age 2, air conduction thresholds determined by a behavioral assessment, usually
visual reinforcement audiometry (VRA) or ABR testing, if the behavioral assessment
cannot be completed.
g. For children without a cochlear implant(s) who are age 2 to the attainment of age
5, 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.
h. For children without a cochlear implant(s) who are age 5 and older:
1. Pure tone air conduction and bone conduction testing, speech recognition threshold
(SRT) testing, and word recognition testing;
2. Testing must be done in a sound-treated booth or room;
3. Testing must be done in accordance with the most recently published standards of
the American National Standards Institute (ANSI);
4. Each ear must be tested separately; and
5. If the SRT is not within 10 dB of the average pure tone air conduction thresholds
at 500, 1,000, and 2,000 Hz, document the medical basis for the discrepancy.
i. For children with a cochlear implant(s) who are age 5 and older:
1. Sentences presented at 60 dB hearing level and without any visual cues;
2. In a quiet and sound field; and
3. With the cochlear implant in place, functioning properly, and adjusted to the child's