Every parent wants to believe their child is simply quiet, or late to talk, or just not interested in what is being said. But in Pakistan, thousands of children every year are living with undetected hearing loss — not because the warning signs were absent, but because families did not know what to look for.
Hearing loss in children is not always obvious. A child with partial hearing loss may respond to some sounds and ignore others. They may seem to hear fine at home but struggle in school. They may be labelled as inattentive or slow when the real issue is that their auditory brain pathway is not receiving sound clearly.
The BERA test Brainstem Evoked Response Audiometry is the most accurate and reliable tool available today for detecting hearing problems in children who are too young, too fearful, or too cognitively limited to cooperate with standard hearing assessments. At Islamabad Hearing Center, it is one of the most important diagnostic tests we perform and it changes lives when used early.
This guide is written for parents, grandparents, and caregivers who want to know: does my child need this test?
What Is a BERA Test?
A BERA test measures how the auditory nerve and brainstem respond to sound. During the test, small electrode stickers are placed on your child’s scalp and earlobes. Soft clicking sounds are played through earphones, and the electrodes record the electrical activity that travels from the ear to the brain in response.
The result tells the audiologist not just whether a child can detect sound, but how clearly and efficiently the auditory pathway is transmitting that signal to the brain. This distinction matters enormously a child can have normal outer ear function but still have a significant neural hearing problem that only a BERA test can reveal.
Unlike a standard PTA test or audiometry, the BERA test requires no active response from the child. There is no button to press, no instruction to follow. The child simply rests often sleeping naturally or under mild, supervised sedation while the equipment does the work. This makes it uniquely suitable for infants, toddlers, and children with developmental conditions.
You can learn more about how we conduct BERA testing at Islamabad Hearing Center and what the process involves from start to results.
7 Warning Signs Your Child May Need a BERA Test
The following signs are not guarantees of hearing loss but any one of them, and certainly two or more together, should prompt a professional evaluation without delay.
1. No Response to Loud Sounds or Being Called by Name
This is the most commonly reported warning sign, and often the one that parents first notice. A baby who does not startle at a loud noise in the first few weeks of life, or a toddler who never turns when their name is called from across the room, may have a significant hearing deficit.
Note: some children with hearing loss do respond to very loud sounds because residual hearing picks up the vibration as much as the sound itself. This can create false reassurance. If your child responds to very loud noises but seems not to hear normal conversation, this still warrants investigation.
2. Delayed Speech or Language Development
Speech develops in direct response to what a child hears. If a child cannot hear clearly, speech and language development slows or stops. By 12 months, most children should be saying simple sounds and attempting words. By 18 months, a vocabulary of 10–20 words is typical. By age 2, two-word combinations should be emerging.
Speech delay is one of the most significant indicators of hearing difficulty in Pakistan, and one of the most frequently missed because many families attribute it to bilingualism, shyness, or being a “late talker.” A BERA test rules out hearing as the cause and can redirect appropriate therapy much sooner.
3. Frequent Ear Infections or Fluid in the Ear
Recurrent middle ear infections (otitis media) are extremely common in children in Pakistan and are a leading cause of temporary conductive hearing loss. When fluid builds up behind the eardrum repeatedly, it muffles sound reaching the inner ear and can, over time, affect auditory processing development.
A child who has had three or more ear infections in a year, or who has had persistent fluid in the ear for more than three months, should have a formal hearing evaluation. A tympanometry test can check middle ear function, and a BERA test can assess the deeper auditory nerve response.
4. Not Startled by Loud Noises in the First Months of Life
In the first six weeks of life, babies should show a startle reflex (Moro reflex) to sudden loud sounds. They should also begin to quieten or turn toward familiar voices particularly the mother’s by around 3 months. Absence of these responses is a red flag that warrants immediate newborn hearing screening.
5. Constantly Asking People to Repeat Themselves
An older child who repeatedly asks “what?” or “huh?”, who turns the television volume up very high, or who consistently mishears words saying “ban” for “van,” or “key” for “tea” may have a high-frequency hearing loss that is easy to overlook because they can still hear many sounds.
This pattern is particularly important to catch before school age, as children with undetected high-frequency hearing loss struggle disproportionately in classroom environments. Our article on 10 early signs of hearing loss you should never ignore expands on these patterns in detail.
6. Family History of Childhood Hearing Loss
Approximately 50–60% of congenital hearing loss has a genetic component. If a parent, sibling, grandparent, or close relative was diagnosed with childhood hearing loss particularly if it was present at birth the child’s risk is meaningfully elevated. In Pakistan, where consanguineous marriages are relatively common in some communities, the inherited risk of certain types of sensorineural hearing loss is higher than global averages.
A family history alone is not a diagnosis, but it is a strong enough reason to request a BERA test proactively rather than waiting for symptoms.
7. Premature Birth, Low Birth Weight, or Neonatal Intensive Care Admission
Premature babies and those admitted to the neonatal intensive care unit (NICU) are at significantly higher risk of hearing problems. Risk factors associated with hearing loss in this group include low birth weight (below 1,500g), prolonged jaundice requiring phototherapy, use of certain antibiotics (aminoglycosides), and oxygen deprivation during delivery.
In these cases, a BERA test or ASSR test should be considered part of standard follow-up care not an optional extra.
What Causes Hearing Problems in Children?
Understanding the underlying cause helps parents and clinicians choose the right response:
Congenital sensorineural hearing loss occurs due to genetic factors, in-utero infections (rubella, cytomegalovirus), or complications at birth. It affects the inner ear or auditory nerve and is typically permanent but manageable with early intervention.
Conductive hearing loss involves a blockage or damage in the outer or middle ear often caused by ear infections, fluid accumulation, earwax impaction, or a perforated eardrum. This type is frequently treatable or reversible.
Auditory processing disorder (APD) is a condition where the ear itself functions normally but the brain does not process sound correctly. APD often goes undetected for years children pass standard hearing tests but struggle to understand speech in noise or follow complex verbal instructions. The BERA test can detect abnormalities in auditory brainstem processing that point toward APD.
For a deeper understanding of how hearing loss develops in younger populations, our guide on causes of hearing loss in young people is a valuable resource for Pakistani parents and educators.
How the BERA Test Works: Step by Step
Step 1 – Preparation. The audiologist will clean small areas on your child’s scalp and earlobes with a mild abrasive gel to ensure good electrode contact. No cutting or shaving is involved.
Step 2 – Electrode placement. Small, sticky electrode patches are placed on the forehead, mastoid bones (just behind each ear), and earlobes. The electrodes are painless and do not deliver any electrical current they only record.
Step 3 – Sound delivery. Soft clicking sounds or tone bursts are played through insert earphones placed gently in the child’s ear canals. The sounds are quiet around 30-40 dB and the volume is adjusted during testing.
Step 4 – Recording. The equipment records the electrical waveforms generated by the auditory nerve and brainstem in response to each sound. The audiologist analyses these waveforms particularly a wave called Wave V to determine hearing thresholds.
Step 5 – Results and consultation. Results are usually available immediately after the test. The audiologist will explain the findings, what they mean for your child’s hearing, and what the recommended next steps are.
The entire process takes between 30 and 90 minutes. Children who cannot remain still or fall asleep naturally may require mild, supervised sedation, which is arranged and monitored safely by our clinical team.
Is the BERA Test Safe for Babies and Newborns?
Yes completely. The BERA test involves no radiation, no needles, no invasive procedures, and no pain. The electrodes record passively; they do not emit any electrical signal. The sounds used are well below the threshold that could cause any hearing damage.
Newborn BERA testing is performed routinely in international healthcare systems as part of universal newborn hearing screening programmes, and is endorsed by the World Health Organization as a safe and reliable diagnostic tool. According to the WHO’s global ear and hearing care action plan, early hearing detection ideally within the first month of life dramatically improves language, educational, and social outcomes for children with hearing loss.
If sedation is required for a child who cannot stay still, this is performed under medical supervision with appropriate monitoring, following standard paediatric anaesthesia protocols.
What Happens After the BERA Test?
The BERA test result tells the audiologist the type and degree of hearing loss present or confirms that hearing is within normal limits. From there, the path forward depends on the findings:
Normal result: No further action is required unless symptoms recur or change. Periodic monitoring is recommended for children in high-risk groups.
Conductive hearing loss detected: Medical referral for ENT (ear, nose, throat) evaluation, which may lead to treatment with medication, grommets, or surgery to restore normal hearing.
Sensorineural hearing loss detected: Depending on the degree of loss, options include fitting with appropriate hearing aids from providers including Phonak, Siemens, Oticon, and Rexton or evaluation for a cochlear implant in cases of severe to profound loss.
Auditory processing findings: Referral for auditory processing therapy, classroom accommodations, and possible use of FM systems that transmit a speaker’s voice directly to the child’s hearing device.
Research published in the Journal of the American Academy of Audiology consistently shows that children who receive hearing intervention before six months of age achieve language outcomes comparable to hearing peers a gap that widens significantly with every month of delayed diagnosis.
When Should You See a Specialist in Pakistan?
If your child shows any of the seven warning signs described in this guide, do not wait for the next routine paediatric check-up. Request a referral directly to an audiologist or visit a specialist hearing clinic.
In Pakistan, awareness of auditory diagnostic services remains lower than it should be many families travel significant distances or wait months assuming hearing testing requires overseas referral. This is not the case. Comprehensive audiology services including BERA testing, ABR testing, ASSR testing, and full hearing aid fitting are available in Islamabad.
Our guide on how to find the best certified audiologist in Pakistan covers what to look for in an audiology clinic and what questions to ask at your first appointment.
The earlier a hearing problem is identified, the wider the window of opportunity for effective intervention. At Islamabad Hearing Center, our audiologists work with children from the first days of life through adolescence and we are here to answer your questions before, during, and after the diagnostic process.
Frequently Asked Questions
What is the BERA test used for in children?
A BERA test measures how the auditory nerve and brainstem respond to sound, allowing audiologists to assess hearing in children who cannot cooperate with standard tests. It is used to detect sensorineural hearing loss, auditory processing problems, and conductive hearing loss and is reliable from birth onwards.
At what age can a BERA test be done in Pakistan?
A BERA test can be performed at any age, including on newborns within the first days of life. It is one of the only accurate hearing assessment methods available for very young babies, making it the cornerstone of newborn hearing screening in international clinical practice.
Is the BERA test painful for my child?
No. The BERA test is completely painless and non-invasive. Electrode stickers are placed on the scalp and earlobes. The child rests or sleeps during the test. There are no needles, injections, or discomfort. The sounds used are very quiet and well below any level that could cause hearing damage.
How long does a BERA test take at Islamabad Hearing Center?
The test typically takes between 30 and 90 minutes, depending on your child’s age, how easily they settle or sleep, and the number of frequencies being tested. Our audiologists aim to make the experience as comfortable and efficient as possible for both the child and parents.
What is the difference between a BERA test and a standard hearing test?
A standard hearing test requires the child to actively respond pressing a button, raising their hand, or pointing to pictures. A BERA test requires no response at all, as it directly measures the brain’s electrical reaction to sound. This makes it far more accurate for babies, very young children, and children with developmental conditions.
What should I do if my child fails a BERA test?
An abnormal BERA result means further evaluation and discussion with your audiologist is needed not that your child has a permanent, untreatable condition. Many causes of hearing loss in children are treatable or well-managed with hearing aids or therapy. The most important step is prompt follow-up action. Early intervention consistently produces the best outcomes.
Early Action Can Change Your Child’s Life
Hearing loss does not announce itself clearly. It hides in delayed speech, in a child who seems distracted, in a baby who sleeps through every sound. But the tools to detect it painlessly, accurately, and even in newborns are available right now.
If you have read this guide and recognised even two or three of the warning signs in your child, please do not postpone evaluation. A BERA test takes under 90 minutes and delivers answers that can redirect the entire course of your child’s development.
At Islamabad Hearing Center, our audiologists are experienced in conducting BERA tests for children of all ages, from newborns to teenagers. We offer a supportive, child-friendly environment and clear, honest guidance on what the results mean and what to do next.
Book a BERA test in Islamabad or learn more about our full range of hearing tests to take the first step today.
