Napping in car testing for OAE & Acoustic Reflexes

Non-sedated Testing Little Ones
While They are Napping in Car - carseat or at home

Background: Once in awhile a child presents from whom we can only obtain very little or no audiological information (won't condition in booth and is very touch sensitive), yet we would love to get at their ears to obtain acoustic reflexes and OAE's as a possible alternative to needing sedated ABR testing. E.G., the presence of ipsi-lateral acoustic reflexes at 2-separate frequencies, (1000Hz & 2000Hz or other combination) in each ear, rules out auditory dys-synchrony/auditory neuropathy.

Possible Solution: Most little children are notorious for sleeping well in the car. I have successfully tested the few children who need this per year by arranging a time for them to arrive asleep in the family car outside our building. Here's a few - perhaps obvious - tips:

• child a bit worn out before the car trip to your office
• no other children in the car
• advise family that hooded jackets, turtle neck sweaters interfere with access to ears
  
• child not up against a door, i.e. in center of back seat so you can get to each ear with the car/van door closed
• full tummy or snack on trip to your office
• family keeps child awake until about 5-10 min before arriving at your office (if they sleep too long on the way, they will likely wake up when you open the car door)
• have family call you on their cell phone when they arrive with child asleep, or 2nd adult rider comes in to let you know they have arrived
  
• while inserting probe tip, child may reach up in sleep. Be ready to gently place child's arm down, while stroking their head or temple gently as they go right back to sleep
• if successful in one ear and child wakes up while you are turning head to other side, drive around a little and they may go back to sleep to obtain results for other ear - or can obtain other ear results in the same fashion another day.
  

What to take to the car/home with you:

• hand-held, battery-operated tympanometer with acoustic reflexes. The Interacoustics MT-10 will do 4 ipsi-frequencies, at your pre-set dB level with visually readable tracings of acoustic reflexes.

• hand-held, battery-operated OAE

• take a few extra size tips for both tymps and OAE's
  
• notepad for recording results - e.g, recalling log numbers if needed

• otoscope

• bring your non-spillable bubbles along (see bubble distraction post below) because even though this may not have worked with the child on previous visit while awake in your office, it can work in their own environment (their family car or at home while trying to nap)