What to expect at your child’s appointment
When you arrive at the audiology department, let the staff in reception know you are here and take a seat in the waiting area.
When it is your child’s turn to be seen, the clinician will call you and your child into the department.
As it is important to reduce background noise as much as possible during hearing assessments, it is helpful if as few relatives or carers as possible accompany the child during the test and no other children if possible.
- We will ask about your child’s medical history, health and development, with particular interest in speech development, ear infections, educational progress and family history of ear and hearing problems
- A hearing test, which will be developmentally appropriate for your child. For younger children, this is carried out in the form of a game. None of the tests are painful
- Examination of your child’s ears which will again be carried out in a child friendly manner
- Explanation of the results of the test and arrangements for further appointments as needed
- A report letter will follow the appointment explaining results and onward plan
Why do I have a telephone appointment?
For pre-school children, or children with noted additional needs who are new to the audiology service, an initial telephone appointment will be arranged so we can take a full history and discuss with you what the best approach to testing may be for your child, based on their development and needs.
Face-to-face appointments are then booked during the telephone consultation wherever this is appropriate and any specific information regarding clinic attendance arrangements will be explained.
How long will the appointment last?
Face-to-face appointments are usually booked for a 30 minute period. The time spent in the department may vary within this time frame.
Telephone appointments are booked for 15 minutes.
How will my appointment be arranged?
Initial telephone consultations will be arranged in the soonest available slot and you will receive notification of the date and time by letter or SMS confirmation.
Parent and/or carers of school aged children who are new to the service can arrange their appointments over the phone, or via email. We may also send an ‘opt in’ letter to you once we have received a referral.
For review patients, face-to-face appointments will be arranged by an ‘opt in’ service so you can choose a time and date to suit you and your child.
Types of assessment
Multiple methods can be used to test a child’s hearing. Tests will be selected on an individual basis, to suit your child’s age and development.
Behavioural assessment
Behavioural hearing tests require your child to do something in response to sounds. Different behavioural hearing tests may be used for your child depending on their stage of development.
The three main behavioural tests used in audiology are:
- visual reinforcement audiometry (VRA)
- performance/play audiometry
- pure tone audiometry (PTA)
Visual reinforcement audiometry (VRA)
VRA is usually used to test hearing in children from approximately six months of age and relies on the child being able to sit up demonstrating strong head control.
During the test, your child will sit on your lap or a chair while sounds are presented initially through speakers in the room. We will condition (teach) your child to turn for the sounds and introduce a visual reward when they turn towards the sound. Once conditioned, we then change the timing of the rewards, so they will see it only after they turn for a sound. The sounds will be adjusted for pitch and volume to determine the quietest sounds your child is able to hear.
Where possible, we will try to obtain some information from each ear and may introduce soft in the ear type ear phones or use over ear headphones to introduce the test sounds.
Play audiometry
Young children who are developmentally between the ages of two and six years old may have a play audiometry test.
During the test, sounds will be played through headphones or speakers and your child will be asked to perform a simple task when they hear the sound, for example putting a block on a tower. We will support your child to do this initially before relying on them to respond on their own.
As with VRA, the volume and pitch of the sound will be varied to determine the quietest sounds your child is able to hear.
Also on the FAQ’s page, could this be updated? I also think if we don’t have the troubleshooting page, or videos this should probably be removed from the top question
Pure tone audiometry (PTA)
Older children may have a PTA test. During pure tone audiometry, sounds are played through headphones and your child is asked to respond when they hear them by pressing a button. By changing the level of the sound, the tester can work out the quietest sounds your child can hear.
Objective assessments
Objective hearing tests do not require a behavioural response from the child. They are most commonly used for younger babies but can also be useful for older children who are not developmentally ready for behavioural tests.
Otoacoustic Emission testing (OAEs)
An OAE is an echo generated by the inner ear in response to a sound stimulus. It is measured by a soft tip which is placed into the ear canal. OAEs are usually used as part of the newborn hearing screening programme on newborn babies but can be used on older children and adults too. This test can be affected by wax in the ear canal and middle ear problems such as glue ear.
Tympanometry
Tympanometry is a test of the middle ear status and eardrum movement. It measures the response of the ear drum and middle ear to a change in pressure. A soft tip is placed into the ear canal to record the response. This test is usually used to assess for glue ear which is common in young children.
Babies under the age of three months
What to expect at your baby’s hearing test appointment
Often clear responses will not be obtained from the neonatal hearing screening program in either one ear or both ears. This does not always relate to a significant hearing problem, but does require further testing and follow up.
For a large number of well babies, i.e. babies who did not spend more than 48 hours in special care or have complicated health needs, we will perform immediate follow up to the neonatal hearing screening before four weeks of age.
Appointments will be booked for 45 minutes to allow a little time for babies to settle in cases where they do not arrive asleep
We will take a note of pregnancy issues, birth history and family history of ear or hearing problems to determine if there are any risk factors of hearing loss for your baby
We will perform a test known as Transient Evoked Otoacoustic emission testing. This involves placing a soft tip in your baby’s ear which produces a click sound. The machine then measures the response of the cochlear (the organ for hearing) to the click stimulus
We may perform another test on your baby to determine how well the middle ear is functioning
If we obtain clear responses in both ears for this test we can discharge your baby from audiology
The response recorded is very small so we do require your baby to be asleep or rested. It is always a good idea to try and work feed times around the appointment to ensure your baby is asleep. It is recommended that the environment is relaxed, so we recommend not bringing additional children to the appointment if possible.
If we do not obtain clear responses for this particular test, more testing is required using a test called auditory brainstem response (ABR) testing, and your baby will be referred to James Cook University Hospital for this to be carried out.
More information about the newborn hearing screening programme