Pediatric Conditioned Play Audiometry (CPA)

Conditioned play audiometry (CPA) allows an audiologist to test the hearing of very young toddlers and preschoolers. CPA uses behavioral conditioning to get kids to respond to sounds. It is designed for children between 2 and 5 years of age.

What is Pediatric Conditioned Play Audiometry (CPA) testing?

Conditioned play audiometry (CPA) uses a machine known as an audiometer to test a child's hearing threshold levels. A pure tone audiometer usually relies on a user feedback button and, so, isn't practical for younger kids. CPA makes a game out of the hearing test by replacing the feedback device with activity-related toys such as blocks or pegs.

CPA measures hearing sensitivity to determine both a child's type and degree of hearing loss, if any. The audiologist can then refer parents to another specialist, if necessary.

What can I expect with Pediatric Conditioned Play Audiometry (CPA) testing?

Tests and Diagnosis

Conditioned play audiometry (CPA) uses a machine called an audiometer to assess a child's hearing threshold levels. A standard pure tone audiometer uses headphones and a feedback device so a patient can respond to different sound levels. Because the test is too hard for young children and preschoolers to understand, CPA replaces the user feedback button with an activity instead.


Conditioned play audiometry may rely on one or more of the following games:

  • Blocks or balls: Using positive reinforcement, the screener "trains" the child to place blocks or balls in a basket whenever he hears a tone.
  • Pegs: As with blocks, the screener teaches the child to place pegs in a hole whenever she hears a sound.
  • Rings: Like the above, the screener teaches the child a simple game. In this case, the child places a ring over a cone when he hears the beep.
  • Tablet games: A 2013 study found that a tablet-based audiometer might give audiologists another way to perform hearing tests on young kids in the future. The child plays simple games on an iPad or other device and receives rewards similar to the above.


Conditioned play audiometry takes place in a soundproof booth or sound-treated room. There are two parts to CPA:

  • Conditioning: During this phase, the audiologist will tell your child that they are going to play a game. She will begin by pressing the tone and getting the child excited by saying, "Wow, you get a block!" The screener then gives the child the toy. She then tells the child to place the block in a basket every time she hears the beep. She will then work with your child to perform the task as quickly as possible. Once the child understands the game, screening can begin.
  • Screening: For screening, the audiologist will place headphones (or earphones) on your child. If necessary, bone conduction testing may be employed (in the case of wax or fluid in the ears). The test continues as above, while the audiologist reduces the intensity of the sound until the child's minimum hearing threshold is achieved.

Tests continue using different frequencies until the audiologist has a complete set of data about your child's hearing in both ears.

Ideally, all children will respond well to CPA testing. Unfortunately, very young children can become easily distracted or bored. Breaks are sometimes needed to keep kids interested and on task. Also, some kids won't be able to use the headphones. In those cases, the audiologist will rely on earphones or bone conduction instead.

Pediatric Conditioned Play Audiometry (CPA) Doctors and Providers