Hearing Screening E-Learning Course

Hearing Screening E-Learning Course

Play Audiometry Procedure

Little girl sitting in a chair, wearing headphones for the hearing screening procedure.


Children who are difficult to screen due to age or developmental level


To obtain valid results with very young children (ages three to four years) or those children who have difficulty with standard pure tone audiometric methods


Is a modification of standard pure tone screening; play audiometry conditions the child to respond to the sound by placing a toy in a container, rather than raising their hand


Pure tone audiometer, stickers, and small child-safe toys such as animals, airplanes, cars, clothes pins, nested boxes, or pegs and pegboard


Appropriate size table and chairs in a quiet, comfortable setting with limited distractions


  • First, practice without the headphones on.
  • Lay headphones on the table, facing the child, with audiometer set at 2000 Hz and maximum dB level to ensure the sound is audible.
  • Hold the toy near your ear; assume a “listening” attitude and present sound.
  • Indicate through facial expression the sound was heard and then drop the toy in a container, such as a pail; repeat as often as necessary until the child shows interest.
  • Offer the toy to the child and place your hand on theirs to guide the first responses; encourage the child to wait until they hear the sound.
  • When the child appears ready, present the sound and guide the child’s hand to put the toy in the container.
  • The child may give consistent responses after only one demonstration or may need several demonstrations to respond on their own.
  • Once the child understands the play audiometry technique use the audiometric procedure as described in the pure tone audiometry screening section.
  • Reward the child with praise after initial responses. If this is not effective, a tangible reward like a sticker may be given.
  • If the child still is unable to do the screening after re-instruction, stop and document “unable to screen.”


  • The sound to response time varies between children; some children will drop the toy as soon as they hear the sound; others will wait until the sound goes off before dropping the toy.
  • If the child does not accept the headphones, the screener should try putting them on for only one or two seconds, removing and rewarding the child. Slowly increase the time with the headphones on.
  • A timid child will often benefit from watching other children successfully complete the screening.
  • If the child is unable to screen, refer to Rescreen and REFER criteria.


Same recommendations as pure tone audiometry screening: a child who responds to all sounds in each ear does not require rescreening or referral.


Same recommendations as pure tone audiometry screening: if the child does not respond to one or more sounds after immediate rescreen, schedule the child for pure tone audiometry rescreening in 14 to 21 days; refer to Rescreen and REFER criteria for further information.

For complete information on Hearing History documentation, refer to the C&TC Documentation section.


Introduce play audiometry as a game

Do a few control trials with the child to ensure that the child is only dropping a toy into the bucket when a sound is presented.

The response interval (sound to response time) varies between children. Some children will drop the toy as soon as the sound is heard; others will wait until the sound goes off before dropping the toy.

Instead of asking “Do you want to...” say “Now I am going to let you...”

Note: You must answer the following questions to continue with the course.

Question 1: Complete this phrase: Play audiometry is:

Question 2: You have demonstrated the play audiometry technique to a three-year-old child. The child has the headphones on and you are about to present the sound. The child raises his hand before you present the sound. The parent looks at you and sighs. What would be your next step? (Choose only one response)

This concludes the Play Audiometry Procedure segment of the Hearing Screening Procedures section. You may return to the Table of Contents or continue with the next section Results Interpretation and Follow-Up. If you do not plan on completing the entire web training, please fill out the evaluation form, C&TC Children's Hearing Screening Web-Based Training Evaluation.

<< Previous