The paediatric Children's Audiology Service can be split into
three main areas:
- Electrophysiological hearing assessment
- Behavioural hearing assessment
- Paediatric hearing aid provision
Electrophysiological hearing assessment
This type of hearing testing is routinely used for infants under
three months old as it does not require a response or co-operation
from the child. There are three main tests available:
- Otoacoustic emission (OAE) testing: a quick test
lasting up to two minutes. A small tip is placed into the child's
ear and plays a clicking noise at a quiet level. A healthy inner
part of the ear will produce an echo if it detects a sound. A
microphone in the ear tip picks up this response. The results are
displayed on a computer screen for the audiologist to see. A pass
or fail result will be recorded - this test does not give a level
- Auditory Brainstem Response (ABR) testing: a more
involved test that can last up to 90 minutes. This test measures
signals sent from the inner ear (cochlea) along the hearing nerve
to the brain in response to a sound. Three sensors (electrodes) are
placed on the child's head (forehead and behind each ear) to pick
up the brains natural activity. A headphone/earphone plays sounds
into the ear. The sensors pick up the brains responses to the
sounds. The computer records and displays these responses for the
audiologist to interpret. The responses can be traced down to give
a level of hearing.
- Tympanometry: a quick test lasting seconds. It is
not a test of hearing but does check how well the eardrum is
moving. A small earpiece is placed in the ear which changes the
pressure in the ear. The results are displayed as a graph on the
tympanometer which the audiologist can interpret to tell if there
is congestion, such as glue ear, or not.
This type of testing is usually offered to babies/infants who do
not pass their initial newborn hearing screen. Children ideally
need to be asleep or settled for accurate results to be
For more information on hearing screening, see the NHSP website
This type of testing is also useful for older children and
adults where it has been difficult to obtain reliable hearing
information. It can be carried out under sedation or under
anaesthetic after an operation, such as grommets if necessary.
Behavioural hearing assessment (Chester orEllesmere
Unlike the above electrophysiological tests, behavioural hearing
testing relies on a response from the child and so requires the
child to be awake and co-operate in listening "games". The type of
testing carried out depends on the development age of the child.
The main types of behavioural hearing tests are listed below:
- Distraction test: for children aged 6-12 months.
The child sits on the parents lap. Once tester sits in front of the
child and keeps the child's attention with low-level play. The
second tester stays behind the child and makes sounds when the
child's attention is focused forwards. A response is taken as the
child turning to the side the sound was presented. Although the
sounds are played on the left and the right of the child, this test
only checks the child's overall hearing.
- Visual Reinforcement Audiometry (VRA): for
children aged 8-24months. The child sits on parents lap or on a
small chair by him/herself. A sound is made from a loudspeaker or
an earphone. If the child turns to the sound an animated toy is
played to reward them. The child quickly learns to associate the
sound with the toy and will continue to turn when a sound is heard.
The audiologist uses a range of different pitches and loudness of
sounds to find the quietest levels the child will turn to.
- Performance/play audiometry: for children aged 2 ½
years and above. The child is asked to carry out a simple task in
response to a sound, such as putting a peg in a board or piece in a
puzzle. For the child, this is seen as a game and the audiologist
can use a variety of games to keep the child's interest. Sounds can
be played through loudspeakers to test the child's overall hearing
or through headphones/earphones to test the child's hearing in each
- Pure tone audiometry: for children aged 4-5 years
and above. Sounds at different pitches and volumes are played
through headphones/earphones to each ear separately. The child is
asked to respond when they hear a sound by pressing a button. This
is the same type of hearing testing used for adults.
Children may be referred to Audiology at any age by the GP,
health visitor, school doctor or any professional.
For more information on hearing, see the National Deaf
Children's Society website at www.ndcs.org.uk
Paediatric Hearing Aid Service (Chester)
Hearing aids can be offered for permanent or temporary hearing
losses from any age. With the Newborn Hearing Screening Programme
identifying hearing losses soon after birth, the Paediatric Hearing
Aid Service is able to fit hearing aids to babies as young as three
Hearing aids used on the NHS are all digital aids and are
behind-the-ear in style as shown in the photo. All hearing aids and
batteries are offered free on the NHS. The ear moulds as well as
the hearing aids themselves are available in a range of colours and
designs to personalise them as much as possible for the child.
If you are concerned for your child's hearing, please see your
GP or health visitor or school doctor for a referral to audiology.
We will be able to offer an assessment appointment where we can
test your child's hearing and have discussions about further
management such as hearing aids if appropriate.
For more information about hearing aids, see the NDCS website at
www.ndcs.org.uk or contact
the local Chester Deaf Children's Society on 01829 781194 or email:
Professionals from different services may be involved with
children who have identified hearing loss. Multidisciplinary
working is promoted and encouraged in the speciality of paediatric
audiology to achieve a co-ordinated and integrated approach in
service provision to children.
There is good liaison with Audiology and colleagues working in
Health, Education and Social Services (e.g. ENT,
Paediatrics/Community Paediatrics, Speech and Language Therapy,
Specialist Teachers, Deafness Support Network). There are parent
representatives at both local and district=wide multi professional
meetings for services working with hearing impaired children.
A specialist team, HAST (Hearing Advisory and Support Team) is
available to provide support and advice to families who have young
children with permanent deafness.
Families have the opportunity to discuss the cause of their
child's hearing loss with a specialist paediatrician. Routine
investigations can be arranged and further specialist assessment
considered (e.g. genetic counselling). Children with confirmed
permanent deafness can be referred to this clinic directly from
Audiology or by their General Practitioner.
Further information about some of the possible causes of
deafness is available on the NDCS website: www.ndcs.org.uk