The Boel test is based on the behavioral response to the perception of sounds and in particular to different tones and frequencies. It provides indications on the auditory, visual, motor and attention skills of children.
The Boel testalso known as “bells test “is a method used to evaluate the hearing ability In infants and in very young boys and girls, generally in the first year of life, but also in subsequent age. This test is based on the behavioral response to the perception of sounds, in particular to different tones and frequencies, for which it is considered a “audiometric behavioral tests“. The examination is based on the observation of the behavioral modifications of the child or girl, clearly related in sound stimuli as standardized as possible.
The ability of Locate the sounds in spacetogether with careful anamnesis, allows early recognition of congenital auditory disorders – especially damage from neonatal infections, such as cytomegalovirus or toxoplasmosis – or temporary which, however, can cause serious auditory and language problems if not early identified.
To date, on average the incidence of hearing disabilities It varies from 1-2 cases of congenital severe deafness for a thousand living births, up to 1-6% of children with auditory problems during primary school. The boys or girls more at risk premature or delaying psychomotor development delay, those who have had neonatal infections and those born from mothers with social situations at risk (poor, drug addicts, teenagers, without partners and so on), which often carry on pregnancy without carrying out the periodic checks expected.
The early identification of these children allows the opportunity for targeted interventions in the secondary prevention of handicaps.
What is Boel’s test?
But what is the “Boel test“? It is an exam generally scheduled during the fourth health balance, which the family pediatrician performs between the seventh and ninth month of life of the children. Was born in the 70s in Sweden and was so called as “Boel“It is an acronym for Swedish words”Blicken Orienterar Efter Ljudet“, Which translates into”orientation of the gaze after sound stimulus “. It is a behavioral test that provides indications on the auditory, but also visual, motor and attention of children.
The sectors explored with the bells test they include:
- the relational dynamics between the child, the maternal figure and foreign;
- the motor skills of the child;
- the child’s concentration ability and its temperament;
- The response to sounds and the ability to locate them in space.
Although the usefulness of Boel test As an hearing assessment tool, it has decreased over the years with the introduction of acoustic othemissions such as Neonatal screening at birth And in the following eras, it remains useful for evaluating some important aspects of children’s development.
How does the Boel test work?
How do you do the Boel test? During the Boel testa series of sounds are presented to the child, which can be represented by bells (from which the name of “derivesbells test“), Tones or other sound stimuli, depending on the kit used. The professional who performs the test Register carefully the reactions to the various sound stimulations.
The kit for the execution of the Boel test Includes a red wooden stick called “gripper”, Two concentrating rings of metal metal called”spinner“And two pairs of silver” bells “equipped with a ring that allows you to put them on the fingers; The first pair of bells called “balls“It emits sounds that have a frequency of 4,000 Hertz; the second couple called “Bells“Issues sounds that have a frequency of 12,500 Hertz; The intensity of the sounds does not exceed 45 decibels at a distance of 20 cm from the emission tool.
The execution of the Boel test It takes place in a quiet and controlled environment, like an soundproof classroom or a silent room in the study of the pediatrician, so that there are no distractions linked to other sounds or external noises. It is important to collaboration of parents Or anyone who accompanies the child: you have to avoid talking or moving during the exam, to prevent the boy or girl from distracting.
To perform the Boel testthe boy or girl is made to sit on the knees of a parent. The pediatrician positions himself in front and shows him the red stick or the driving metal rings. When the boy or girl fixes the object, the pediatrician moves him with both horizontal and vertical movements for evaluate the ability of attention and eye movements in following the movements of the stick or rotating rings. Subsequently, the pediatrician allows the boy or girl to grab the object and, if desired, to bring it to the mouth.
At this point, carefully not to make sudden movements of the arms that can distract the boy or the girl, the pediatrician slips one couple of bells in each hand and positions them at about 20 cm from the ear of the little patient. The bells are played one at a time, first on the one hand and then on the other, with an adequate time interval between a sound stimulation and the other. Theoretically, the child should turn to the side from which the sound comes.
It is important to note that the tests depends on the operator’s skills in leading him and the cooperation of the child, as well as by his ability to maintain adequate attention for the duration of the test. As a result, it may be necessary to repeat it several times.
For this reason, electronic systems have recently been introduced that allow you to carry out the Boel test in a more standardized way. These small devices, which can be held inside the palm of one hand, reproduce with the pressure of a special key a low-frequency deaf-grave sound around 125-150 Hz or a high-frequency-married acute-married sound around 5.0-5.1 KHz, perfectly equivalent to what reproduced by the bells of the traditional Boel test.
The Boel test results are interpreted according to behavioral responses of the boy or girl to the perception of sounds and can be classified in different categories, indicating the presence or absence of an auditory problem. However, it is important to note that the interpretation of the results may vary slightly according to the guidelines and local practices. In general we have:
- Auditory response present, If I am detected during the test in the frequencies and in the levels of intensity tested, it is considered that the boy or girl has a good auditory response in those specific areas. This indicates that the auditory screening test has been passed and there are no evident hearing problems in the tested frequency interval;
- ABSENT OR NON -final auditory responseif auditory responses are not detected during the test in the frequencies and in the levels of intensity tested, further assessments may be necessary to determine the presence or absence of a auditory problem. This could include a repeated auditory screening test, more in -depth auditory tests or a postponement to an audiologist for further assessments.
In the latter case, however the test can be repeated subsequently during the development of the child to monitor any changes in auditory capacitytaking into account that any “mechanical” obstruction against the auditory duct, as an excess of secretions related to an infection that could, for example, alter the outcome of the test.
It is important to underline that the Boel test It is an evaluation tool that is based on behavioral aspects of the baby in response to sound stimuli and does not constitute a diagnosis definitive of hearing disorders. If the test results indicate the presence of a auditory problem or if there are doubts about the auditory answer, it is still advisable to consult a doctor or an audiologist for further evaluations and to determine the possible therapeutic approach to be adopted. Only an expert professional can provide accurate diagnosis and recommend appropriate, if necessary treatment.
When to perform the Boel test?
In general, it does not exist an age for the Boel test defined and precise. You can Perform the Boel test In different moments of life but it is usually done between the seventh and ninth month, until the twelfth. It is important to take into account individual needs and circumstances, as already mentioned.
In case of test with negative outcomethis can be repeated several times, generally one week after the previous one, but it can vary according to the state of health of the boy or girl.
In some cases, Boel’s test can also be performed in more advanced age, if doubts arise on auditory ability or if The presence of any auditory problems is suspected previously not highlighted.
In summary, Boel’s bell or test test is a useful tool for evaluate the behavioral response a of auditory stimuli In very young boys or girls, allowing to intervene promptly to encourage the optimal auditory development of the child in the event of a few anomaly. However, it is always good to emphasize that this test is not a tool for diagnosing a possible condition of deafness, which in this case will require further more specific investigations.
