Aided cortical auditory evoked response (CAER) testing plays a crucial role in confirming whether a baby’s hearing aids are giving them access to the sounds needed for speech and language development. At the Children and Young People’s Audiology Centre at Vr Speech And Hearing Clinic, paediatric audiologists carry out this test with great care, expertise, and plenty of creativity to keep babies engaged.
In this article, we take you through a real-life aided cortical testing session with a four-month-old baby who was referred to the clinic after the Newborn Hearing Screening Programme. She received her hearing aids at eight weeks of age, and this appointment marked her first aided cortical test.
Contents
Preparing for the Appointment
Before starting the test, the audiologists met with the baby’s parents to learn more about her preferences. They discovered that she enjoyed watching “dancing sensory fruits”, so these visuals were planned to help maintain engagement during testing.
A fresh Real Ear to Coupler Difference (RECD) measurement was taken using her current earmoulds. This ensured her hearing aids were optimally fitted for her ear acoustics, allowing the cortical test to measure her true aided access to sound.
Because she has a multimodal hearing loss, the team began with a high-frequency stimulus presented at conversational level (65 dB).
Keeping Baby Engaged: The Real Challenge in Cortical Testing
Cortical testing in infants requires not only technical skill—it also depends heavily on the baby’s alertness and engagement.
Throughout the appointment, the audiologists used a range of techniques to keep her awake and focused:
Sensory fruit animations
Tickling games
Books and face-to-face interaction
Switching between toys
Comforting with milk and a pacifier
Gentle massages during electrode placement
Despite best efforts, she became quite sleepy at times, causing her attention—and therefore the test response quality—to fluctuate. The team adapted continuously, shifting between stimulation methods to maintain just the right level of alertness.
Ultimately, the breakthrough came when her own Minnie Mouse toy captured her attention long enough to push the test “over the line”, allowing the audiologists to record a clear and reliable cortical response.
Interpreting the Results
Even though her attention varied, the audiologists were able to obtain:
✔ A clear cortical response to a high-frequency sound at 65 dB
✔ A reliable response to a mid-frequency sound at the same level
These results showed that:
Her hearing aids are providing good access to the speech frequencies that matter most.
Her brain is detecting and processing important speech-related sounds.
She is receiving the auditory input needed for healthy speech and language development.
The family received reassurance that her hearing aids are performing well and that she is responding to crucial communication-level sounds.
What Happens Next?
The next step in her audiology care plan is behavioural hearing assessment at around 7–8 months of age. This will help cross-check her auditory development and ensure that her hearing aids continue to meet her needs as she grows.
Why Aided Cortical Testing Matters
Aided cortical testing is an essential tool for infants who are too young for behavioural testing. It helps audiologists determine:
Whether hearing aids provide adequate access to sound
How the auditory brain responds to amplified speech cues
Whether further adjustments or investigations are required
For parents, it offers early reassurance that their baby is hearing the world in a way that supports learning, bonding, and communication.
Final Thoughts
This appointment is a great example of how paediatric audiology blends science, skill, and creativity. By adapting to the baby’s needs and keeping her engaged, the team at Vr Speech And Hearing Clinic was able to collect high-quality data and provide valuable guidance for her ongoing hearing care.