Children's Audiology
Our Children’s Audiology service sees patients from new-born to school leaving age. Generally children transfer to the care of the adult team when they are 16-years-old, however, if they have additional needs we may manage them until they are older. Our team has considerable experience in the assessment of children’s hearing and appropriate care of those children identified with a hearing impairment.
We are a family-friendly service that aims to accurately assess children’s hearing to identify any difficulties. If a hearing loss is identified we work collaboratively with professionals, the family and the child to assist the child in managing the hearing loss, reducing the impact the hearing difficulties this has on the child.
We also have specialist services for children who need:
- Tinnitus advice and management
- Auditory processing difficulty advice
- Sensitivity to sound (Hyperacusis) advice
- Bone Conduction Hearing Instruments (BCHI)
For information about the new-born hearing screen please visit: Newborn hearing screening
Referring into our service
Children may be referred to our service for the following reasons:
- Hearing concerns such as:
- Child appears to be mishearing or not hearing when spoken too
- TV volume being increased
- Struggling to communicate with peers
- Speaking loudly
- Changing behaviour and becoming increasingly more frustrated
- Difficulties hearing at school
- A follow up appointment may have been made following the Newborn Hearing Screen
- Delayed speech, language and communication
- Request from another professional, such as a Paediatrician
- A routine check-up due to having an a linked medical condition e.g. a syndrome with risk of developing hearing problems
- A routine hearing assessment for monitoring when having certain medical treatment e.g. certain types of chemotherapy or antibiotic
- For assessment following certain illnesses e.g. bacterial meningitis
Information about your child's initial assessment
During an initial assessment in our Children’s audiology service you will see one or two members of a team of audiologists and clinical scientists who are specially trained to test children’s hearing. The appointment is usually about 40 minutes to an hour. Sometimes we are unable to complete everything in one appointment and we may need to bring you back for a second appointment.
What will we do?
We will ask you some questions about your child’s hearing, medical history and any family history of hearing problems.
Depending on your child’s age we will try and test their hearing by getting them to respond to sound in some way. This often includes some form of play. It is therefore important that if your child is older than 6 months old that they are awake. The hearing test needs to be carried out in a quiet room, so if possible it is best to try to attend with only the child being tested. It is not possible to leave children unsupervised in the waiting area, but they are welcome to wait there if they are accompanied by an adult.
We will also look in your child’s ears and we may do some other tests if required.
None of the tests are invasive and most children enjoy their visit with us. For more details on testing please see Types of testing – Objective testing & Types of testing – Behavioural testing.
We will then discuss the results we find with you. Together with you we will develop an individual plan for your child. This maybe that there are no hearing problems and we agree to discharge your child or that we have identified some hearing problems Please see what happens if a loss is identified or that we need to arrange further follow-up for further assessment or monitoring of your child’s hearing.
Objective tests
We sometimes perform these tests at Children’s audiology but can also refer to the Evoked Potentials Clinic at the QMC for them. Testing involves recording the responses to sounds from various parts of the hearing system without the patient having to actively cooperate. This can also be done as part of the new-born screen. These tests do not depend on the developmental age of the child.
Objective tests include:
- Otoacoustic emissions
- Auditory brain stem response
- Middle ear admittance
- Middle ear reflexes
Otoacoustic Emissions (OAE)
This test is the initial test completed in the Newborn Hearing Screening Programme. However, it can also be used throughout routine Audiology. An OAE is the response from the inner ear to a sound stimulus. This OAE response is measured by a small tip placed at the entrance of the ear canal. The test can be affected by wax and middle ear pathology (such as glue ear). The child will need to be settled and still for us to be able to undertake this test.
Auditory Brainstem Response (ABR)
For this test, the skin is first cleaned with a gel and then sticky sensors are placed behind each ear and on the forehead. Different pitches of sound are then played via small earphones with foam tips. The test enables us to assess the whole hearing pathway up to the brainstem level. Depending on your child’s age they may need to be asleep for this test.
Middle ear admittance
For this test a small soft tip is placed on the outside the ear canal and a gentle pressure is delivered to see how the ear drum is moving. This is a quick and painless check and can be performed even if the child is sleeping.
Middle ear reflexes
In some cases we may check middle ear reflexes. For this test we place a sensor tip on the outside of the ear canal and sounds are automatically delivered into the ear, this allows us to check how some of the ear muscles and nerves are working.
Behavioural tests
These are the main types of hearing tests we carry out at Children’s Audiology. They involve looking at how a child’s behaviour changes in response to certain sounds.
The type of test used by a clinician to assess a child's hearing is much dependent on their developmental age. Behavioural tests require the child to be awake and co-operative, they are carried out as the child gets older, using toys and listening games.
Possible behavioural hearing assessments based on the child developmental are:
- age 0-8 months - behavioural observation
- age 8 - 18 months - Visual Reinforcement Audiometry (VRA) or distraction test
- age 8 - 30 months - Visual Reinforcement Audiometry (VRA); performance test; co-operative speech recognition
- age 30 - 60 months + - performance test; play Pure Tone Audiometry; McCormick toy test; and other kinds of speech tests
Most appointments last for 40 minutes, however specialist clinic and hearing aid reviews can last up to 1 ½ hours.
Test results are collected throughout the appointment and at the end of the appointment results are discussed with the child’s parent / carers. We will then develop a plan with the parents/carers/child for what needs to happen next.
We generate reports from each appointment and send them to relevant professionals involved in your child’s care. We will also send you a copy.
Visual Reinforcement Audiometry (VRA)
This assessment technique is used for babies / children who are developmentally aged between 8-30 months. The test technique takes advantage of children’s early development of sound localisation. A sound is played via a sound source, such as a loudspeaker or headphones and the child localises the sound. Once they have localised the sound, the child is rewarded with a flashing toy. The Audiologist will initially condition the child to the game to ensure they can complete the task. The intensity of the sound is then varied to determine the quietest levels your child can detect, at varying pitches which are important for speech understanding.
Performance/Play Audiometry
This assessment technique is used for children who are developmentally aged around 30 months and older. The test technique allows your child to interact with the Audiologist and makes the assessment into a game. The child will be presented with a sound and asked to complete a task in response to that sound, such as placing a man in a boat or a ring on a stick. The Audiologist will initially condition the child to the game to ensure they are able to wait for the sound. The intensity of the sound is then varied to determine the quietest levels your child can detect, at varying pitches which are important for speech understanding.
Your Audiologist may have suggested preparing your child for this test by introducing “Ready, Steady, Go” games at home prior to their appointment. Using the same principle, as a parent you can say “Ready, Steady, Go!” and on ‘Go!’ encourage the child to complete a task, such as throwing a block into a box. This introduces the child to the concept of waiting for a stimulus before completing a task. Praising the child for getting it right reinforces and encourages the response and makes it fun.
Speech testing
The department uses a number of different speech tests which look at your child’s ability to detect and discriminate speech. The type of test will depend on the child’s age.
What happens if my child has a hearing loss?
If a hearing loss is identified what can be done?
Depending on the nature of the hearing loss identified, appropriate support and management is provided. This may involve monitoring of your child’s hearing, the fitting of a hearing aid or referral onwards for a medical opinion such as with an Ear, Nose and Throat consultant.
What if my child needs a hearing aid?
If a persistent or permanent loss of hearing is present which is impacting on your child we will discuss the use of amplification. Within our service we fit hearing aids based on the needs of the child. We can also refer the child to ENT for their medical opinion. We regularly monitor, evaluate and support that child, ensuring we closely work with our education team to enable affective communication assisting learning as well as with other medical professionals.
Behind-the-ear aids (BTE) are worn with an open fitting tube or earmould, which not only feed sounds through into the ear but also keep the hearing aid secure behind your ear. We fit this type of aid to children as they grow rapidly and these are more durable. Assistive listening devices, such as FM systems, are easily connected to the aid to improve audibility of sound in difficult listening environments. The model of BTE hearing aid fitted depends on the type and degree of hearing loss.
In-the-ear aids (ITE) function in the same way a BTE hearing aids but fit within the ear. They can still be visible as they sit within the bowl of the ear. We do not fit this type of aid to children as they are not durable and as a child grows rapidly the fitting within the ear cannot be easily modified.
Bone conduction Hearing Instruments (BCHIs) are a specialist type of aid to assist those that are not suited to behind or in the ear hearing aids. They are a type of a bone conduction hearing aid that can be fitted to a soft headband or for older children can be fitted using a surgical implant..
Hearing aids can be personalised for a child by electing colours and earmould designs. We actively encourage a child to have fun and do this if they wish as making a hearing their own can really help encourage them to use it.
Ear Moulds
To ensure the sound is directed into the ear, your child will have impressions taken of their ears to make into ear moulds. This is achieved by a small foam stopper being inserted a short distance down the ear canal and then a soft material gently positioned into the ear, which hardens in a couple of minutes. This is then removed and sent to a manufacturer to make into a soft ear mould.
As a department, we actively encourage children to personalise their hearing aids. There are varying colours or hearing aids and ear moulds your child can choose from.
If your child is under 5 years of age they will require an appointment in Children’s Audiology at Ropewalk house.
If they are above 5 years of age we can arrange an appointment in our Adult Audiology Department.
To arrange an appointment contact us
Support for Children with Glue ear
What is Glue Ear?
Glue ear is one of the most common childhood illnesses, and occurs when the middle ear becomes filled with sticky fluid. It’s usually temporary and often linked with ear infections, but long-term glue ear can affect children's hearing and speech development.
The following video, provided by NDCS, helps explain what glue ear is:
Ninja Pheonix and DJ The Gloopy Glop
How is Glue Ear Treated?
There are lots of different treatments for glue ear, including a small surgery to have grommets fitted or wearing hearing aids until the glue ear naturally clears. You can find more information about treatments on the NDCS website.
Another treatment for Glue Ear is through use of an Otovent. The following video explains what an Otovent is and how it works:
With a variety of treatment options it can seem daunting to choose the right one. The following video, provided by NDCS, shows one child's journey to finding which treatment was best for them:
The following decision support tool has been developed by NHS England and you may find it useful to help you understand Glue ear and to help you decide between treatment options.
Decision support tool: making a decision about glue ear if your child has hearing loss