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Audiology

Audiology clinician with therapy patient

Hearing and speech are essential to learning for children. Most babies are born with normal hearing but every year three out of every 1,000 babies are born with hearing loss. This loss can be in one or both ears. Hearing loss in children can affect the way their brain develops causing far-reaching effects. These may include difficulties with speech and language, impaired social emotional development and reduced academic performance.

Signs and symptoms of hearing loss in children can be different for every child. If your child was born with hearing loss, it is most often discovered during a newborn hearing screening in the hospital shortly after birth. Most of the complications of hearing loss can be prevented if your child is diagnosed by 3 months of age and appropriate treatment begins before your child is 6 months old. If the hearing loss happened after your child was born, you might be one of the first people to notice hearing or speech difficulties.

Pediatric audiology services

At Cook Children's, our audiologists have doctorate level degrees in audiology and are uniquely trained to provide skilled and compassionate care for your child. Our team works closely with your family, speech pathologists, school personnel and physicians to ensure you child's success.

Our outpatient rehabilitation clinics provide diagnostic hearing and vestibular testing as well as hearing aid and cochlear implant testing and programming services.

We also have an audiology team at the main hospital providing the ability to complete hearing evaluations during your child's inpatient stay if needed.

With in-house audiology services available at all our Ear, Nose and Throat (ENT) clinics, our team of audiologists work collaboratively alongside our physicians to provide comprehensive information regarding hearing levels for children with a variety of conditions from ear infections and eustachian tube dysfunction to atresia and hearing loss.

You can be confident your child will receive expert clinical care at Cook Children's from audiologists trained to diagnose and assist children and families towards health and success.

Hearing testing

  • Behavioral audiometry
  • Auditory brainstem response
  • Otoacoustic emissions
  • Infant newborn hearing screenings

Vestibular testing

  • Videonystagmography (VNG)
  • VHIT
  • Vestibular-evoked myogenic potential (VEMP)

Find more information on vestibular disorders here

Evaluation and selection of assistive devices

  • Hearing aids (includes dispensing, testing and repairs)
  • Bone conduction hearing devices
  • Cochlear implants
  • FM systems
  • Other assistive listening devices
  • Custom ear plugs for swimming and noise protection

Types of hearing loss and causes

There are three main types of hearing loss. These types of hearing loss can be present at birth or acquired after birth.

Sensorineural Hearing Loss (SNHL): This type of hearing loss is related to the inner ear or the neural connection to the brain.

Conductive Hearing Loss (CHL): This type of hearing loss occurs in the outer or middle ear.

Mixed Hearing Loss (MHL): This is simply a combination or mix of both SNHL and CHL.

Causes of hearing loss

Hearing loss in children can be present at birth (congenital) or acquired later in childhood.

Possible causes of congenital hearing loss

  • Infection from the mother (examples: cytomegalovirus, herpes, syphilis, rubella toxoplasmosis)
  • Low birthweight
  • Syndromes
  • Hereditary/inherited problems
  • Malformations of the outer ear
  • Malformations of the middle ear (ear drum or bones of the middle ear)

Possible causes of acquired hearing loss

  • Medications that can be harmful to the ears
  • Loud noise exposure
  • Trauma
  • Infections
  • Ear wax blockage
  • Middle ear infections
  • Perforation of the eardrum
  • Tumors in the middle ear
  • Problems with the eustachian tube
  • Foreign objects in the ear canal

Noise exposure in children and teens

Loud noise and sounds can be damaging to a person's hearing. The level of noise and the length of time you listen can put your and your child at risk for noise-induced hearing loss. Sound levels are measured in decibels (dB). The higher the decibel (dB) number the more at risk you are for this type of hearing loss. Sounds that are louder than 85 dB can cause permanent hearing loss.

Things to watch to prevent noise exposure in your children:

  • For young children it is important to watch out for loud toys. Many toys are designed to be played at a distance from the body but a young child will often hold toys close to their face and ears.
  • Use hearing protection when playing musical instruments and attending concerts, Cook audiologists can help you find the right hearing protection to keep ears safe but keep musical quality.
  • Use hearing protection when hunting, firing guns, mowing, or using power tools.
  • Limit your tween and teens time and loudness when using personal headphones to listen to music or games.

Resources for noise-induced hearing loss:

Hearing tests

Hearing tests for newborns

Test What it measures How it's done
Tympanometry This test helps find problems with the eardrum and middle ear. This test does not measure hearing but it can detect the possibility of changes in pressure of the middle ear, fluid behind the eardrum, or a hole in the eardrum. A small earphone is placed in your baby's ear. The earphone measures how well sound enters the middle ear at different air pressures.
Otoacoustic emissions (OAE) This test looks at the hair cells of the cochlea. The cochlea is the organ of hearing. A small earphone is placed in the ear. Your baby will need to remain still and quiet for a few minutes. Sounds will come through the earphone and then a response from the hair cells will be recorded.
Auditory Brainstem Response (ABR) This test measures the response of your baby's hearing nerve and the lower part of the brain. It can tell us the type and degree of hearing loss. This test must be performed while your baby is asleep or sedated. Sound is presented to each ear and we measure the brainwaves that are related to hearing.

Hearing tests for infants and toddlers

Test What it measures How it's done
Tympanometry This test helps find problems with the eardrum and middle ear. This test does not measure hearing but it can detect the possibility of changes in pressure of the middle ear, fluid behind the eardrum, or a hole in the eardrum. A small earphone is placed in your child's ear. The earphone measures how well sound enters the middle ear at different air pressures.
Visual Reinforcement Audiometry (VRA) This test determines the quietest levels your child responds to various sounds. For this test, your child will to look toward a toy or video screen in response to a sound made from a speaker or earphone.

Hearing tests for preschoolers

Test What it measures How it's done
Tympanometry This test helps find problems with the eardrum and middle ear. This test does not measure hearing but it can detect the possibility of changes in pressure of the middle ear, fluid behind the eardrum, or a hole in the eardrum. A small earphone is placed in your child's ear. The earphone measures how well sound enters the middle ear at different air pressures.
Conditioned Play Audiometry (CPA) This test determines the quietest levels your child responds to various sounds. During this test, your child is asked to respond to sounds by playing a simple game, such as throwing blocks in a bucket or stacking blocks to make a tower. Testing is done with earphones on each ear.

Hearing tests for school-aged children

Test What it measures How it's done
Tympanometry This test helps find problems with the eardrum and middle ear. This test does not measure hearing but it can detect the possibility of changes in pressure of the middle ear, fluid behind the eardrum, or a hole in the eardrum. A small earphone is placed in your child's ear. The earphone measures how well sound enters the middle ear at different air pressures.
Conventional audiometry This test determines the quietest levels your child responds to various sounds. For this test, your child is asked to respond to sounds played through earphones. It requires your child's cooperation to either raise their hand or say 'yes' when they hear a beep. This is like a traditional adult hearing test.

Treatments for hearing loss

Hearing aids – These electronic, battery-operated devices can amplify and modify for your child. A wide variety of colors and styles are available for you and your child. A Cook Children's pediatric audiologist will be there to guide you in this process.

Cochlear implants – This is a surgically placed device that helps to transmit electric stimulation to the inner ear. Only certain types of children are candidates for this type of device, the most likely candidates are children with severe to profound sensorineural hearing loss (SNHL). Find more information about cochlear implants.

Bone anchored devices – This is a device for children with conductive hearing loss, mixed hearing loss, or single sided deafness (SSD). A bone anchored device can be utilized after birth like a hearing aid or it can be implanted later by an otologist.

Meet our audiologists

Bari Pham, Au.D.

Bari Pham, Au.D.

Bari Pham, Au.D., began her career at Cincinnati Children's Hospital Medical Center and has worked at Cook Children's since 2003. Dr. Pham played an integral role in the launch of the Cochlear Implant program at Cook Children's in 2006. Dr. Pham has a Certificate of Clinical Competence in Audiology through the American Speech Language and Hearing Association. She is also a fellow of the American Academy of Audiology. Dr. Pham strives to provide family centered care. Her interests include pediatric diagnostics and all types of surgical and non-surgical amplification options for children.


Caitlin Gerhards, Au.D., CCC-A

Caitlin Gerhards, Au.D., CCC-A

Caitlin Gerhards, Au.D., CCC-A, has been a pediatric audiologist at Cook Children's since 2019. Dr. Gerhards completed her doctorate education with an emphasis on pediatric audiology at the University of Washington in Seattle. Since that time, she has continued to focus her career on the pediatric population with a special interest in diagnostic evaluations, high-risk audiologic monitoring and amplification services. Dr. Gerhards' aim is to provide comprehensive, evidence-based care to each patient and assist families in making the best decisions for their child's hearing health care needs. She enjoys the caring, family-centered environment of Cook Children's and partnering with patients and families to help achieve their goals.


Carmen B. Landry, Au.D.

Carmen B. Landry, Au.D.

Carmen B. Landry, Au.D., has been part of the Cook Children's family since 2007. Her specialty is diagnostic evaluation in the ENT clinic, hearing evaluations under anesthesia and part-time juggler/performer. She enjoys working at Cook Children's because of the fun atmosphere, friendly staff and adorable patients. When she isn't working, you can find her crafting and enjoying time with her husband and three children.


Emily Harris, Au.D., CCC-A

Emily Harris, Au.D., CCC-A

Emily Harris, Au.D., CCC-AEmily Harris, Au.D., CCC-A is a Pediatric Audiologist and has worked at Cook Children's since 2019. Dr. Harris earned her Bachelor of the Arts degree in Communication Sciences and Disorders from LSU and her Doctorate of Audiology from University of Tennessee. As a board-certified Doctor of Audiology she is vested in providing patient and family-centered care to help children with hearing loss thrive in their world. Dr. Harris holds her Certificate of Clinical Competence in Audiology from the American Speech Language and Hearing Association. She enjoys working with her colleagues in a positive and welcoming atmosphere at Cook Children's.


Jennifer McCliment, Au.D.

Jennifer McCliment, Au.D.

Jennifer McCliment, Au.D., has worked at Cook Children's since 2001. She is an ASHA-certified audiologist and is a member of the Texas Academy of Audiology. Her areas of interest are pediatric diagnostic evaluations and amplification. She has had years of experience caring for patients at many of the Cook Children's inpatient and outpatient rehab settings. Dr. McCliment enjoys seeing many of her patients grow up and thrive over the years.


Josh Spann, Au.D.

Josh Spann, Au.D.

Josh Spann, Au.D., joined the Cook Children's Audiology team in 2016. A native of Arkansas, Dr. Spann worked in the aviation industry before pursuing a career in audiology. His motivation stemmed from his own experiences with hearing loss that began as a child.

Dr. Spann's professional interests include cochlear implants, interdisciplinary care, precepting future audiologists and process improvement. Outside of work, he enjoys spending time with his family in Arkansas and his dog, Tessa, fishing, overlanding and riding motorcycles.


Kaitlyn M. Kennedy, Au.D., ABAC

Kaitlyn M. Kennedy, Au.D., ABAC

Kaitlyn M. Kennedy, Au.D., ABAC, has been an audiologist at Cook Children's since 2017. She graduated from Missouri State University and has been involved in leadership for national and state audiology organizations, currently serving as chair of the New Professionals Committee for the American Academy of Audiology. Dr. Kennedy is originally from Missouri and enjoys St. Louis sports, including Cardinals baseball and Blues hockey. She enjoys working with her patients and families, helping them on their hearing journeys.


Katherine Schaars, Au.D.

Katherine Schaars, Au.D.

Katherine Schaars, Au.D., is a pediatric audiologist and has worked at Cook Children's since 2013. Dr. Schaars is a member of the American Board of Audiology, a Fellow of the American Academy of Audiology and a Certificate Holder - Audiology Preceptor. She earned her B.S. in Communication Sciences and Disorders from the University of Oklahoma and her Doctorate in Audiology from the University of North Texas. Dr. Schaars takes special interest in diagnostic testing, vestibular evaluations and supervising graduate students. In her free time she enjoys baking and traveling.


Kelli Billups, Au.D.

Kelli Billups, Au.D.

Kelli Billups, Au.D., is an inpatient audiologist and has worked at Cook Children's since 2017. As a board-certified Doctor of Audiology she takes special interest in diagnostic testing, particularly electrophysiological testing for pediatric patients. Dr. Billups is a Certificate Holder - Audiology Preceptor and volunteers with many organizations in the DFW area. She loves many things about working at Cook Children's, specifically the patients and Warm Cookie Wednesday where hot cookies are served in the medical center's Camelot Court Food Court.


Kristi Reed, Au.D.

Kristi Reed, Au.D.

Kristi Reed, Au.D., is the audiology program clinical coordinator at Cook Children's and has been a part of the Cook Children's family since 2011. She earned her doctorate in Audiology at Texas Tech University Health Sciences Center. Dr. Reed is board certified in audiology and a Certificate Holder - Audiology Preceptor. She loves many things about working at Cook Children's including all of the sweet patients and their families, her amazing coworkers and the friendly, caring environment at Cook Children's.


Lisa Christensen, Program Manager

Lisa Christensen is the audiology program manager at Cook Children's Medical Center in Fort Worth, Texas. Dr. Christensen has devoted a large amount of her professional career to osseointegrated devices in children. Her research in this area has led to several peer reviewed publications and lectures around the world on this topic. Her other interests include pediatric diagnostics and amplification, and acquired hearing loss in children and adults.

Throughout her career, Dr. Christensen has served on numerous committees for the American Academy of Audiology and has been involved in several state academies. Dr. Christensen has also served as the President of the American Academy of Audiology.


Mandy Pendleton, Au.D.

Mandy Pendleton, Au.D.

Dr. Mandy Pendleton is a member of the American Academy of Audiology and American Speech, Language, Hearing Association. Dr. Pendleton has been an audiologist at Cook Children's since 2015 and works out of the South Rehabilitation Center. Dr. Pendleton earned her B.A. in Communications Disorders from Truman State University in Kirksville, Missouri and her M.S. in Audiology and Au.D from the University of Tennessee Health Science Center in Knoxville, Tennessee. She enjoys many facets of audiology, but has special interest in cochlear implant, electrophysiology and supervising graduate students.


Marie Mahoney, Au.D.

Dr. Marie Mahoney

Dr. Mahoney joined the Cook Children's Audiology team in 2015. She earned her doctoral degree at Kent State University, and completed her fourth year externship at the Cleveland Clinic in Cleveland, Ohio. She is board certified by the American Board of Audiology, and is a fellow of the American Academy of Audiology. Dr. Mahoney takes special interest in working with children who have traditional hearing aids, bone conduction devices and cochlear implants. She believes that collaborating with families is important for helping each child reach desired communication outcomes. Outside of working in the clinic, she enjoys traveling, running and espresso.


Megan Mansfield, Au.D.

Megan Mansfield, Au.D.

Megan Mansfield, Au.D., is a pediatric audiologist who began working for Cook Children's in 2012. After moving to England in 2015, she was happy to be welcomed back to the Cook Children's family in 2018. Dr. Mansfield received her Bachelor of Science in Communicative Disorders and her Doctor of Audiology from Utah State University. During her doctorate program she was selected as a trainee in a unique pediatric speciality program requiring additional graduate coursework and clinical training in both pediatric audiology and auditory-verbal therapy. She loves learning and strives to support all children in their lifelong journey to do the same.


Skyler Barnes, Au.D.

kyler Barnes, Au.D.

Skyler Barnes, Au.D., is a pediatric audiologist and has worked at Cook Children's since 2018. Dr. Barnes received her Bachelor of Science in Speech Language Pathology/Audiology and Doctorate in Audiology from the University of North Texas. She takes special interest in diagnostic testing, hearing aids and assistive technology. Dr. Barnes began her career at Cook Children's as a student where she completed her fourth year externship. She loves the sweet families at Cook Children's and looks forward to serving their hearing health care needs.


Sophie Jakubowich, Au.D., CCC-A

Sophie Jakubowich, Au.D., CCC-A

Sophie Jakubowich, Au.D., CCC-A, is an inpatient audiologist and has worked at Cook Children's since 2018. Dr. Jakubowich graduated from the University of Texas at Dallas. As a board-certified Doctor of Audiology she takes special interest in diagnostic testing and helping in early identification of childhood hearing loss. She loves many things about working at Cook Children's, specifically the wonderful patients and their families.


Susanna Saxon, Au.D.

Susanna Saxon, Au.D.

Susanna Saxon, Au.D., is an inpatient audiologist and has worked at Cook Children's since 2018. Dr. Jakubowich graduated from the University of Texas at Dallas. As a board-certified Doctor of Audiology she takes special interest in diagnostic testing and helping in early identification of childhood hearing loss. She loves many things about working at Cook Children's, specifically the wonderful patients and their families.

Frequently asked questions on hearing loss

If my child wears hearing aids, will they learn to talk?
There are many things that determine if your child with hearing loss will learn to talk. First your child must wear their hearing aids or implant processor during all waking hours of each day. Second you must give your child continuous auditory input – talk to your child, describe what you're doing all day, and read to them every day. Other developmental delays can delay your child's speech development despite proper hearing aid use and good auditory input. Your child's audiologist can help you through this process. Cook also offers a parent support group for hearing loss where you can also learn from other families.

Is earwax normal?
Ear wax is normal. It protects and moisturizes your ears. It is completely normal to have a small amount of ear wax in your ears. If ear wax completely fills the ears, it can cause a slight hearing loss. Hearing will return to normal once the wax is removed.

How do I remove earwax?
It is best to let a licensed medical professional remove ear wax from your child's ears. Putting objects in your child's ears can permanently damage their ears and hearing.

How are you going to test my baby's/toddler's/child's hearing?
Cook Audiologists are experts in testing hearing in children. They will customize testing based on your child's developmental level.

How I prepare my child for an ABR?
Auditory Brainstem Response (ABR) testing helps an audiologist get information about the hearing system when infants are too young to respond or previous testing has been unsuccessful for older children. ABR testing requires your child to sleep soundly throughout the test. The appointments for unsedated ABR testing are two hours long to make sure you have time to get your baby sound asleep and ensure good test results. It is important you bring your infant tired and ready for a nap. Feeding right before your appointment time or right when you arrive for your appointment is recommended to help get your baby comfortable and ready for sleep. Sedated ABR tests are completed only at the Main Hospital location in Fort Worth, Texas. Because of anesthesia, your child will have eating and drinking restrictions for the test. A representative from the hospital will call you prior to your appointment with those specific details.

How do I schedule an appointment or follow-up appointment?
Call 682-885-3898 for new appointments or follow-up appointments.

How much does a hearing test cost?
The age and developmental status of your child will determine which procedures are likely to occur during your child's appointment. Once your appointment is booked, the scheduling professional can help you determine an estimated cost for your child's appointment.

How often does my child need to return for follow-up visits after hearing aids are fit?
Once your child is fit with hearing aids, your child will need an initial follow up appointment in 4 to 6 weeks. Depending on the age of your child, follow up appointments will be set at 3 month, 6 month, or yearly intervals.

When will I find out the test results?
Once testing is complete, the audiologist will go over the results with you and make recommendations before you leave the appointment. You will be given time to ask questions and give feedback about the results as well.

Will my insurance cover the procedure and/or hearing aids?
Each insurance company has different coverage for hearing aids. Once your child has been tested and your audiologists makes recommendations our insurance reimbursement specialist can help you determine what your insurance covers.

My amplification is broken, what do I do?
If your child's hearing aids or earmolds are broken, you may drop off the broken hearing aids at your audiologist's office or call 682-885-3898 to make an appointment with your audiologist.

My child needs new earmolds, what do I do?
Please call 682-885-3898 to make an appointment with your audiologist.

How do I let school know the results of today's recommendations?
The audiologist will provide information for your school when hearing aids or other devices are fit on your child. You can also fill out a Release of Information to have copies of your child's results sent to the child's school directly from Cook Medical Records at 682-885-1012.

Can I have a copy of today's test?
Your audiologist will provide a family friendly information sheet of the testing results at the end of the appointment. This information sheet gives the hearing results and recommendations for your child.


Physician referrals/consults

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We're here to help.

If your child has been recommended to us, you probably have lots of questions. We can help. If you would like to schedule an appointment, refer a patient or speak to our staff, please call our offices at 682-885-4063.

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