Initially, you will have a conversation with your audiologist focusing on your child’s hearing, understanding and speech development. We will discuss any medical history and any family history of hearing loss.
The audiologist will then complete a hearing assessment with your child to gain an understanding of their hearing levels. Depending on your child’s age we will try and test their hearing by getting them to respond to sound in some way. None of the tests are invasive.
Please note, 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.
After the tests, the audiologist will discuss the results with you and decide if any further appointments are needed. They will answer any questions that you might have and work with you to develop an individual management plan for your child. We work collaboratively with professionals and the management plan might include referrals to other specialities such as ENT or suggestions for referrals to other agencies.
Types of Testing
Depending on the age and developmental of your child, there are a range of tests that might be appropriate. Testing might include a mixture of objective and behavioural testing. More than one appointment might be required to get the full picture of your child’s hearing levels.
Objective testing
These tests work by recording the responses to sounds from various parts of the hearing system without the child having to actively cooperate. They do, however, often require the child to be asleep or still for a period of time. Testing can include:
- Tympanometry – Tympanometry assesses the middle ear status and eardrum movement. This is achieved by placing a soft tip at the entrance of the ear canal. The pressure is then gently changed in the ear canal and the movement of the eardrum is measured via the tip and displayed on the machine. This test is quick and painless.
Tympanometry is often used in children as it will highlight whether they have middle ear effusion (e.g. glue ear) which is a common cause of hearing difficulty in children. - 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. Whilst the child sleeps, different pitches of sound are then played using headphones and the activity of the auditory nerve is picked up. The test enables us to accurately assess the whole hearing pathway up to the brainstem.
Behavioural Testing
During these tests, the audiologist will be carefully observing how your child responds to certain sounds. The type of test selected by the Audiologists is very much dependent your child’s developmental age. These tests are used for older children and require your child to be awake and co-operative as they are carried out using toys and listening games. Testing can include:
- Visual Reinforcement Audiometry (VRA) – This assessment technique is used for babies or 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 through a loudspeaker or headphones and the child turns to the sound. Once they have turned the sound, the child is given a visual reward.
The audiologist will ensure that your child can complete the task. The volume and tone of the sound is then varied to determine the quietest levels your child can detect, 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 ball into a tub.The audiologist will ensure that your child is able to cooperate with the game and ensure they are able to wait for the sound. The volume and tone of the sound is then varied to determine the quietest levels your child can detect, which are important for speech understanding.You can prepare your child for these this test by introducing “Ready, Steady, Go” games at home prior to their appointment. Using the same principle, 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 ability to hear and process speech sounds. This may involve asking them to pick out toys or repeat sentences in a quiet or noisy environment. The type of test will depend on the child’s developmental age.
What happens if my child has a hearing loss?
The assessments performed will help us to diagnose what is causing the problem and we will discuss the possible management options. Depending on the nature of any hearing loss identified, appropriate support and management will be provided. This may involve monitoring of your child’s hearing, referral to our colleagues in the ENT department to discuss any medical or surgical options or having hearing aids fitted.
There are many reasons why a child’s hearing is impaired. In children, this is often due to middle ear problems, such a glue ear which is usually temporary or due to a wax blockage which can be cleared with olive oil or sodium bicarbonate drops from your pharmacy.
What if a hearing aid is needed?
Hearing is imperative to speech and language development. If a persistent or permanent hearing loss is present which is impacting on your child, we will discuss the use of amplification. Hearing aids will help maximise a child’s access to speech.
Hearing aids are set, taking into account the size and shape of your child’s ear and the hearing test results. This means that the hearing aid is personalised for your child’s level of hearing difficulty.
We regularly monitor, evaluate and support you and your child, ensuring we closely work with a range of other professionals to best meet the needs of your child.
The range of hearing aids that our team can provide are worn behind the ear (BTE) with either an earmould or with a slim tube fitting. The type of ear piece will depend on the age of your child.
Hearing aids can be personalised for your child by choosing from a range of colours and earmould designs.