Bone conduction equipment needs to be properly calibrated.

Testing must include the following.

1. Tympanometry. If tympanometry is abnormal, medical referral is indicated prior to further testing.
2. Perform otoacoustic emissions. If abnormal, proceed to ABR.
3. Perform ascending click-evoked threshold search and 4000 Hz-toneburst ascending threshold search via air conduction. (Normal sensitivity for clicks may be defined as a repeatable wave V threshold of 30 dB nHL.)
4. If either the click ABR or the 4000 Hz toneburst ABR is abnormal, perform ascending threshold search toneburst ABR at 2000Hz and 500Hz.
5. If air conduction click thresholds are abnormal, perform ascending threshold search via bone conduction. Air-bone gaps of 20 dB or more should be considered significant.
6. If time permits, perform click-evoked, neurodiagnostic ABR via air conduction.
   
   • Test at 70-80 dB nHL, to evaluate retrocochlear function.
   • Evaluate absolute latencies for waves I, III and V.
   • Evaluate interpeak latencies for waves I to III, III to V, and I to V.
   • Evaluate waveform morphology.
     
7. Prepare a written report interpreting test results and describing the diagnostic profile.
8. If hearing loss is confirmed, provide the parents with the Oregon Health Services list of early intervention educational institutions.
9. Disseminate written report and other information to the infant's primary care provider and other care providers and agencies as requested by the parents.
10. If test results are inconclusive, further audiological evaluation using appropriate behavioral techniques is warranted, prior to six (6) months of age.