Paediatric Audiology

The paediatric Children's Audiology Service can be split into three main areas:

  1. Electrophysiological hearing assessment
  2. Behavioural hearing assessment
  3. Paediatric hearing aid provision

Electrophysiological hearing assessment (Chester)

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 of hearing.
  • 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 recorded.

For more information on hearing screening, see the NHSP website at   

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 Port)

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 ear.
  • 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

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 months old.

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 or contact the local Chester Deaf Children's Society on 01829 781194 or email:

Multidisciplinary working

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.

Investigation Clinic

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:

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