Children's Hearing Services

What to expect following a referral from the Newborn Hearing Screening Programme (NHSP)

The Audiologist will explain what will happen in the appointment. They will ask some questions about your baby’s general health and any responses you have noted to sounds.

The Test

• The Audiologist may complete this assessment at your home. To get the most accurate results, the Audiologist will need to set the equipment up in a quiet room. Therefore it is not advisable to have other children in the room at the time of testing.
• The test can take up to 2 hours and, on some occasions, additional appointments maybe required to complete testing.
• To complete the testing your baby will need to be asleep, so if possible try and keep them awake as much as possible prior to their appointment.
• The Audiologist will then place some sticky sensors on your baby’s forehead and behind each ear. Headphones are then placed in or over your baby’s ears and their responses to sound are recorded from the sticky sensors.
• The test is known as the Auditory Brainstem Response (please follow link to find out more).

After the test

• The Audiologist will explain any results they have collected and discuss whether further appointments are required.
• They will also be able to answer any questions you may have.

For further information follow the link Newborn Hearing Screening Programme: https://www.gov.uk/guidance/newborn-hearing-screening-programme-overview 

The Audiologist will introduce themselves and explain the outline of the appointment, which normally lasts between 30-45 minutes.

Initially you will have a conversation with your Audiologist focusing on hearing, understanding and speech development. As a parent, it would be useful to observe how your child responds to sound and report this during the appointment.

The Audiologist will then complete a hearing assessment with your child to gain an understanding of their hearing levels. There are varying methods in which this can be conducted and hearing assessments are often linked to the developmental age of the child.

After the Test

• The Audiologist will explain any results they have collected and discuss whether any further appointments are required.
• They will develop an individual management plan for your child and then answer any questions you may have.
• The management plan may include a referral to different specialities in the Trust, such as ENT.
• They may suggest that your child attends a Speech and Language Therapy drop in session. These sessions are conducted throughout Berkshire and further information can be found on the CYPIT website: http://www.berkshirehealthcare.nhs.uk/ServiceCatInfo.asp?id=128 

There are varying different routes through which children can be referred into Audiology. This might be dependent upon the age of the child and the professionals who are working with them at that point. However, a referral can be made by one of the following:

• Your GP
• Speech and Language Therapist
• From the Newborn Hearing Screening Programme
• Health Visitor
• Ear, Nose and Throat Consultant
• School Nurse*
• Paediatrician

The department provides paediatric hearing assessments at several sites including Royal Berkshire Hospital, Bracknell Healthspace and West Berkshire Community Hospital. If you have obtained an appointment please check your letter to make sure you are attending the correct location.

Unfortunately, we are unable to answer any questions from patients who have not been referred to the service. This is because it is difficult to provide appropriate advice without a full clinical history and test results.

The type of test used by a clinician to assess a child’s hearing is much dependent upon their developmental age.

Objective tests

These tests are mostly carried out on babies and are very similar to those which form part of the Newborn Hearing Screen. They often require the child to be asleep or still.

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).

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, whilst the baby sleeps. The test enables us to assess the whole hearing pathway up to the brainstem level.

Corticals

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 cortex in the brain. This assessment will require your child to be awake and alert, often completing a simple quiet task.

Tympanometry

Tympaonmetry assesses the middle ear status and eardrum movement. This is achieved by a tip being placed 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 by the tip. The Audiologist will review the eardrum movement and collate with your child’s hearing assessment results.

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 and requires active monitoring.

The type of test used by a clinician to assess a child's hearing is much dependent on their development age. Behavioural tests require the child to be awake and are carried out as the child gets older, using toys and listening games.

Visual Reinforcement Audiometry (VRA)

This assessment technique is used for babies / children who are developmentally aged between 6-30 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 24+ months. 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.

Your Audiologist will go through all the assessment results. Should a hearing loss be identified, they may recommend that you child is fitted with a hearing aids to give your child access to sound.

Hearing Aids

Hearing is imperative to speech and language development. Should a hearing loss be found then a hearing aid will provide amplification for the pitches of sound where the testing has shown difficulty. This will help maximise a child’s access to speech. Hearing aids are set using real ear measurements, which takes 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.

Ear Moulds

To ensure the sound is directed into the ear, you 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.

The National Deaf Children’s Society is an excellent informational resource, please follow the link http://www.ndcs.org.uk 

Children’s Hearing Aid Repairs

Should you feel that your child’s hearing aid has stopped working, you can contact us to arrange an emergency appointment through one of the following routes:

• Telephone: 0118 322 7238
• Email: audiology.royalberkshire@nhs.net 
• Drop off the hearing aid at Audiology reception and a clinician will fix and ring the parents to collect it

Out of hours appointments are available at 8.00am and 5.00pm on certain days for children’s hearing aid repairs.

Simple Troubleshooting

• Tube blocked with water bubbles
  • Disconnect the ear mould from the hearing aid and either blow down the tube or use the ear mould puffer to blow the moisture out
• Check the battery
  • Ensure that the battery is inserted the correct way
  • If the battery is out of a new packet then try a battery from a different packet

Battery Warning

Please note that batteries are toxic and should be out of reach from babies and children at all times. Your Audiologist will add battery locks onto the hearing aids to ensure that babies and children are unable to get into the battery compartment.

If the hearing aid wearer has younger siblings in the house, then battery locks can also be added to older children’s hearing aids as well. Please ask your Audiologist. Also ensure that any older relatives or friends who wear hearing aids are aware of the risk should you visit with younger children.