Cook Children's Audiology Program

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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.

The sound of resilience

Toddler Pierce James beat a rare cancer but it cost him his hearing. Now he's teaching us all a lesson in resilience. His story shines a light on the importance of pediatric audiology.

Pierce's story

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 medical center 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 medical center 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

Auditory brainstem response
Auditory Processing Disorder (APD)
Behavioral audiometry
Infant newborn hearing screenings
Otoacoustic emissions

Hearing loss to hearing aids process

Vestibular testing

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

Find more information on vestibular disorders here

Evaluation and selection of protective devices

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

Custom Earplugs for Swimming and Noise Protection

Earplugs that are custom fit can increase comfort levels for sensitive, small ears when exposed to water and/or noise.

More information

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 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.
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.
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.
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.

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.
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.
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.

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.
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.

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.

We know asking a child to get a test done can be scary sometimes. We encourage you to download a fun coloring option for them so it's a little less scary and perhaps even a bit fun!

Download coloring book Download coloring sheet

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.

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., 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, 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., 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., 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.

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 Vaughan, Au.D.

Lisa Vaughan, Au.D., is the audiology program manager at Cook Children's Medical Center in Fort Worth, Texas. Dr. Vaughan 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. Dr. Vaughan’s experience in all of these areas has lead to numerous interviews for outlets such as Sirius/XM Doctor Radio, The New York Times, Consumer Reports, and Parents Magazine.

Throughout her career, Dr. Vaughan has served on numerous committees for the American Academy of Audiology and has been involved in the formation of several state academies. Dr. Vaughan has also served as the President of the American Academy of Audiology in 2018-2019 and the Chair of the Board of Trustees for the American Academy of Audiology Foundation in 2021-2022.

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 MS 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.

Mariana Castle, Au.D.

Mariana Castle, Au.D., is a pediatric audiologist and has worked at Cook Children’s since 2017. Dr. Castle received her doctorate from Lamar University and is a fellow of the American Academy of Audiology. Dr. Castle’s professional interest include vestibular testing and electrophysiology. Dr. Castle draws on her Hispanic heritage to bond with the families she serves. She enjoys working in such a fun atmosphere surrounded by the sweet patients and amazing colleagues. Outside of work, Dr. Castle enjoys spending time with her family, friends and two dogs. She enjoys hiking, traveling and drinking coffee at local coffee shops.

Marie Mahoney, Au.D.

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 Richards, Au.D.

Megan Richards, Au.D., joined the Cook Children’s family as a pediatric audiologist in October 2019. She received a Bachelor of Science in speech language and hearing sciences from Texas Tech University Health Sciences Center with a minor in American Sign Language and went on to receive a Doctorate in audiology from Pacific University Oregon. Dr. Richards currently holds a certificate of clinical competency in audiology through the American Speech and Hearing Association. The thing she loves most about working at Cook Children’s is being able to provide excellent care to her community and the surrounding areas.

Skyler 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.

Virginia "Ginny" Land Leach, Au.D.

Virginia "Ginny" Land Leach, is a pediatric audiologist at Cook Children’s Medical Center. She earned her doctorate in Audiology at the University of Texas at Dallas and is a Board Certified Audiologist. She strives to provide high-quality, evidence-based family-centered care for her patients and their families.

Kyli Schulz, Au.D., CCC-A

Kyli Schulz, Au.D., CCC-A, is a pediatric audiologist who has worked at Cook Children's since 2021. Dr. Schulz earned her Bachelor of Science in Communication Disorders from West Texas A&M University, and her Doctor of Audiology from The University of Texas at Austin. Dr. Schulz holds her Certificate of Clinical Competence in Audiology from the American Speech-Language-Hearing Association. She enjoys the many facets of pediatric audiology and strives to provide evidenced-based care to all of her patients. Dr. Schulz loves several things about working at Cook Children's including her amazing colleagues, the positive and friendly atmosphere, and all of her wonderful patients and their families. Outside of work, she enjoys spending time with family and friends, working out, and traveling to new places.

Marcia Foster, Au.D., CCC-A

Marcia Foster, Au.D., CCC-A, is a pediatric audiologist who joined the team at Cook Children's in 2021. Dr. Foster received her Bachelor of Science in Communication Disorders from Abilene Christian University in 2001 followed by her Doctor of Audiology degree from Texas Tech University Health Sciences Center in 2005. She was on staff in the Audiology Department at Sunshine Cottage School in San Antonio, TX for 17 years. Dr. Foster considers it a true privilege to serve children and their families and believes the possibilities for all children are endless! To date, Dr. Foster has been so appreciative of the incredible and welcoming coworkers and work environment within the Cook Children's system. Outside of work, Dr. Foster enjoys spending time with her family and friends, participating in activities within her church community, and all things football!

Grace Kendrick, Au.D., ABAC

Grace Kendrick, Au.D., ABAC, is a pediatric audiologist who joined the Cook Children's Audiology team in 2021. She earned her bachelors from the University of Florida and her Doctorate of Audiology from the University of Texas at Dallas. She enjoys working as part of an interdisciplinary team to provide the best evidence-based, family-centered care to her patients. Outside of work, Dr. Kendrick enjoys spending time with family, watching Gator football, hiking, and snorkeling.

Kendrick

Rachel Murphy, Au.D., ABAC

Rachel Murphy, Au.D., ABAC, is a pediatric audiologist who joined the team at Cook Children’s in 2022 while completing her fourth year externship. Dr. Murphy earned her Bachelor of Arts in Communication Sciences and Disorders from Baylor University in 2018 along with her doctorate from Nova Southeastern University in 2023. Prior to Cook Children’s Dr. Murphy gained her pediatric audiology experience at Joe DiMaggio Children’s Hospital in South Florida as a student. Dr. Murphy has special interest in early identification, pediatric amplification, electrophysiology, and vestibular testing. You can find Dr. Murphy on the weekends reviewing lobster rolls or indoor cycling.

Maddison R. Hayes, Au.D., CCC-A

Madison R. Hayes, Au.D., CCC-A is a Pediatric Audiologist and has worked at Cook Children’s since 2023. Dr. Hayes earned her Bachelor of Science degree in Speech-Pathology/Audiology at Kent State University in Ohio were she is originally from. She earned her Doctorate in Audiology at Pacific University Oregon in 2023. Dr. Hayes currently holds a certificate of clinical competency in audiology through the American Speech-Language and Hearing Association (ASHA). She is committed to providing evidence-based and family-centered care to children in the community and surrounding areas. Outside of audiology, she enjoys traveling, dancing, spending time with her partner, and finding the best places to eat in Fort Worth!

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 Medical Center location in Fort Worth, Texas. Because of anesthesia, your child will have eating and drinking restrictions for the test. A representative from the medical center 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

Physicians, make a referral or schedule consultation

Refer/consult

Schedule an appointment

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.