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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: when conductive and sensorineural losses occur together

I have been referred to Audiology, what to expect?

The 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 throughout County Durham and Darlington NHS Trust

If you are concerned about your child's hearing we accept referrals from:

o GP

o Paediatrician or Consultant

o Health Visitor or School Nurse

o Speech and Language Therapist

o Other Health Professionals


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/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:

Visual reinforced audiometry (VRA)

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

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.

Pure tone audiometry (PTA)

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.

Tympanometry & Acoustic Reflexes

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:

Otoacoustic emissions (OAE)

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.

Auditory Brainstem Response (ABR)

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 anesthetic if requested by your Ear Nose & Throat doctor.

'Every aspect of my emergency care was dealt with quickly, efficiently and professionally with full explanations and compassion from all staff involved'.

Patient, Emergency Department, Darlington Memorial Hospital