Children's hearing services

How do we hear?

Sound waves vibrate the air which then travel down the ear canal to the tympanic membrane (the ear drum). The vibrations travel across the ear drum and along the bones of the middle ear to the inner ear (the cochlea). Vibrations initiate the hair-like cells in the cochlea to send nerve impulses to the brain, which interprets these nerve messages as sound.

What causes a hearing loss?

Anything that reduces or prevents the sound signal before it reaches the brain can cause some level of hearing loss. Hearing loss can be mild, moderate, severe or profound. The types of the hearing loss can be described as:

Conductive hearing loss is a problem with the outer or middle ear. This can be temporary or permanent
Sensorineural hearing loss is permanent and can occur if the cochlea (inner ear) isn't working properly
Mixed hearing loss is when conductive and sensorineural losses occur together

What to expect if you have been referred to Audiology

Our paediatric audiology team provide a comprehensive hearing assessment and hearing aid service for children from birth onwards. Our team has considerable knowledge and experience in the assessment of children's hearing and the appropriate management of those children identified with a hearing impairment. We also provide advice on external agencies, locally and nationally, who may offer support alongside our management advice, and work closely with the sensory support team throughout the area. Appointments are available at a number of sites across County Durham and Darlington. If you are concerned about your child's hearing, we accept referrals from:

GP
Paediatrician or consultant
Health visitor or school nurse
Speech and language therapist
Other health professionals

About the appointment

When your child attends their appointment they will see one or two members from our paediatric team of specialist audiologists who are fully trained in testing children's hearing. The appointment will usually last 30 minutes. Sometimes you may need to come back for further appointments. We will ask you some questions about your child's hearing, speech, general development, birth, medical history and any family history of hearing problems.

The hearing test needs to be carried out in a quiet room, therefore it is helpful if as few relatives or carers accompany the child during the test and try to attend without any other children or siblings. It is not possible to leave children unsupervised in the waiting area, but they are welcome to wait there if they are accompanied by an adult. All children 16 years and under must be accompanied by an adult.

Children's hearing can be assessed in a number of different ways depending on the child's age and ability. None of the tests are painful and more details about each test are shown below. You will be told the results of the hearing test the same day.

Subjective hearing tests

This test is suitable for infants from six months to two years old. If successful, we can measure the level of your child's hearing across the speech range in each ear separately.

The child is presented with a sound from one of the loudspeakers from the left or right, as the child turns to the sound they are presented with a visual reward in the form of an illuminated cartoon on a TV screen. In order to obtain ear specific hearing thresholds the child may wear headphones or have small insert phones placed in the ear canals to generate the stimulating sounds.

Play audiometry is suitable for pre-school children of 20 months to five years old (developmentally). The child must be able to understand simple instructions and commands.

A game is played in which the child must perform an action when a sound is heard. This could take the form of putting toy people in a boat or stacking rings on a tower. The child may listen to sounds from a loudspeaker, wear headphones or small insert phones into the ear canals during the test. Sounds at various frequencies are presented to the child and gradually reduced in loudness.

School age children are generally able to manage this test. Tones of varying frequency and intensity are played through headphones or insert phones. The child must press a hand held button for as long as they can hear a sound. The loudness of the sounds are reduced until the child stops responding, this is the threshold of hearing. The threshold of hearing is plotted creating an audiogram.

We may carry out a test to see if there is any congestion behind your child's eardrums. This involves placing a small tip into the edge of the ear and puffing a small amount of air into the ear canal. The test takes a matter of seconds to perform, however your child needs to remain still during the test. Part of the test may involve introducing a short sound into the ear.

Objective hearing tests

This is the same test that most newborn babies have as part of the new born hearing screen. Your baby needs to be settled and the room very quiet for this test which takes just a few minutes. The audiologist will explain what the results mean after the test.

Your baby will need to be asleep for this test and the test room kept very quiet throughout the test. The test may take up to 2 hours. Please bring everything you need to settle your baby / child to sleep once they have been prepared for the test. We can also perform this test under general anaesthetic if requested by your Ear Nose and Throat doctor.

What to do if my child has a hearing loss

If a hearing loss is identified, appropriate support and management will be provided. Depending on the nature of the hearing loss, this may involve a monitoring period or fitting of a hearing aid.

If your child is found to have a temporary hearing loss, (for example, glue ear, causing a conductive hearing loss) then we may choose to monitor their hearing over a period of time.

If a persistent or permanent hearing loss is identified then we will discuss the use of amplification through a hearing aid. We will refer your child to an ENT consultant for their medical opinion and we work closely with our sensory support team to enable effective communication to assist in development both at home and in the school.

There are many different models of hearing aid available in various shapes, sizes, colours and the way in which they process the sound. We will assess the most appropriate style of hearing aid for each individual, looking at their hearing loss and any additional factors. Most hearing aids fit behind the ear. A custom earmould is manufactured to help hold the hearing aid in place and to carry the sound into the ear canal.

Allow time to adjust to the hearing aid/s. Try and build up use until they are worn consistently for all of the day or as recommended by the audiologist.

Please contact us if you notice any changes in ability to hear with or without the hearing aids. Review of the hearing aid/s is performed after fitting and then regularly until 16 years of age, when they will transition into the adult services.

How do I look after the earmould?

Keep it clean by washing it regularly in the following way:

Detach the ear mould from the hearing aid
Remove any debris which is blocking the tube
Wash the ear mould in warm soapy water
Dry it thoroughly and remove any water in the tube by blowing it out using the 'puffer' provided
Re-attach the ear mould to the hearing aid

Changing the tubing

You should change the tubing when:

It becomes hard, discoloured, or twisted
There is a hole or split in the tube
Tubing is too short and needs to be re-measured
The tubing is blocked
If you haven't been shown how to replace the tubing ask at your next appointment

When should I contact the department for new earmoulds?

If the hearing aid is whistling when in the ear
The earmould has clearly become outgrown, so that you can see a gap between the edge of the earmould and the ear
The earmould is split or damaged
The earmould is uncomfortable

Do we need to come to the hospital to collect the new earmoulds?

Your audiologist should have shown you how to trim the tube to the right length. If not, please ask at your next appointment. When you are confident at trimming the tubing we can post the new earmoulds home to you.