The pediatric audiologist: from magician to clinician.

The tremendous progress of pediatric-audiology during the past 30 years is reviewed. Early identification of infants with impaired hearing is based on a high-risk register, screening behaviorally and/or brain stem audiometry. Since many hearing losses have a late onset, it is important to cooperate closely with pediatricians and well-baby clinics. To stimulate their interest in detection, use of a calibrated 3000 Hz warble tone instrument is suggested. Diagnostic tests for infants involve respiration, behavioral patterns, middle ear impedance, and brain stem audiometry. For young children, tangible reinforcement operant conditioning audiometry (TROCA) visual reinforcement audiometry (VRA), and play audiometry are the methods of choice. Due to medical progress, many of the high-risk factors have been ameliorated. Assessment of amplification for hearing impaired children is as sophisticated as for adults. The advantage of basing fitting procedures on functional gain is emphasized. Future goals in pediatric audiology are touched upon. Today, pediatric audiology has emerged from a mysterious beginning to a systematic clinical specialization.