Vol. 7, Issue 2, Part B (2025)

Early detection of hearing impairment in children is essential to prevent delays in speech, language, and cognitive development. This study aimed to evaluate the roles of Behavioral Observation Audiometry (BOA) and Brainstem Evoked Response Audiometry (BERA) in identifying hearing deficits in children, using a sample of 200 cases aged 0-6 years. Both audiometric methods were performed for each child, and results were compared to assess sensitivity, specificity, and concordance. BOA, a subjective assessment based on behavioral responses to sound, identified normal hearing in 60% of children, while 40% showed varying degrees of hearing loss, ranging from mild to severe. The most frequent category of impairment detected was mild hearing loss (20%). BERA, an objective electrophysiological test measuring auditory nerve and brainstem responses, detected normal hearing in 57.5% of children, while 42.5% exhibited hearing impairment. BERA detected a higher proportion of severe and profound hearing losses (10%) compared to BOA (6%), highlighting its superior sensitivity, particularly in cases that are difficult to assess behaviorally. The overall concordance between BOA and BERA was 87.5%, with discordances primarily occurring in children under 1 year, where behavioral responses were often subtle or inconsistent. Using BERA as the reference standard, BOA demonstrated 88% sensitivity and 95% specificity, with positive and negative predictive values of 92% each. Age-stratified analysis revealed that BOA performed reasonably well in infants under 1 year but was less reliable than BERA, which consistently provided accurate detection across all age groups. These findings indicate that while BOA is a useful initial screening tool, especially in very young children, BERA serves as a gold standard for early detection of hearing impairment, providing objective and reproducible results. Integrating both methods in pediatric audiological evaluation can enhance early diagnosis, allowing timely intervention and better developmental outcomes. The study underscores the importance of adopting a combined approach to maximize detection rates and ensure that children with hearing deficits receive appropriate management as early as possible.