This page is designed for parents/carers of children and young people who are scheduled to attend the paediatric audiology department for a hearing assessment. It outlines the various tests that may be conducted during the appointment.
The Paediatric Audiology Department at the Royal National ENT and Eastman Dental Hospital offers a comprehensive range of assessments to facilitate accurate clinical diagnoses for various hearing-related conditions.
Our aim is to ensure the assessment is as enjoyable as possible for your child. Please let us know prior to the assessment if there is anything that might make your child more comfortable during testing. Remember, children often require several visits before it is possible to get a complete picture of their hearing levels.
To prepare your child for these tests prior to their appointment, visit our ‘useful links’ section for access to child-friendly videos, which display how behavioural testing will be conducted at their audiology appointment.
Please note it may not be necessary to conduct every listed assessment. We will determine which tests are most appropriate for your child during the appointment.
Otoscopy is the examination of the external and middle ear used to identify potential concerns, such as ear infections, wax build-up, foreign objects, fluid, or damage to the eardrum.
Tympanometry is a painless diagnostic test that assesses the function of the middle ear by measuring the movement of the eardrum in response to changes in air pressure.
It is commonly used to identify middle ear conditions such as a build-up of fluid (glue ear), eustachian tube dysfunction, or damage to the eardrum.
This is a non-invasive painless procedure used to assess the function of the outer hair cells in the cochlea. It is typically used to screen for reduced hearing levels and to monitor cochlear function.
A small soft probe is gently placed at the entrance to the ear canal. Your child will hear clicks and humming sounds. They will need to stay still and remain quiet throughout the test, which usually lasts for approximately one minute in each ear.
Acoustic reflex testing is a quick and painless diagnostic test that measures how the middle ear muscles react to sounds of varying intensities.
A small soft probe is gently placed at the entrance to the ear canal and sounds are transmitted through it. The test helps to determine the integrity of the auditory pathway from the ear to the brainstem, as well as to identify possible disorders related to the middle ear, cochlear, or auditory nerve.
Your child may be referred to the paediatric audiology team for a specialist hearing (electrophysiological) assessment, known as an Auditory Brainstem Response (ABR) test.
This painless test measures how well sound signals travel through the ear to the midbrain. It helps to check the health of the hearing system, including the inner ear, hearing nerve, and brainstem. The test procedure is non-intrusive and will cause your child no discomfort. Your child must be asleep for this assessment; therefore, we recommend bringing things that will help them to settle.
To prepare for testing, small sticky pads (electrodes) are placed on their head. ABR testing is highly sensitive to both noise and movement. Therefore, it is important that both the parent and child remain as still and quiet as possible throughout. The length of the test is dependent on these factors, as well as the results that are obtained. For this reason, the length of your child’s appointment can range from 2 to 4 hours, or longer if a hearing loss is identified.
Please note that often several appointments are required to complete the full hearing assessment. ABR testing can be performed under natural sleep, melatonin-induced sleep or under general anaesthetic, facilitated by our medical teams.
This is an objective electrophysiological test used to estimate hearing thresholds. It is a painless non-invasive test, which measures the brain’s responses to sounds presented at certain frequencies at pre-defined modulated rates.
ASSR testing can be performed whilst your child is asleep or awake but sitting still. The length of the test is dependent on the child's cooperation and their test results. Therefore, the length of the appointment could range from about 1-3 hours.
Behavioural audiometry can be used to assess a child’s hearing starting from around 6-8 months of age and requires the child to be awake and engaged in the testing method. The type of behavioural test attempted is dependent on a child’s developmental age and their interest. A combination of testing methods may be used in some cases to ensure the reliability of results.
Testing takes place in a soundproof room, which is a controlled environment. Too many people in the room could potentially affect results or be a further source of distraction for the child, making testing less reliable and more difficult to interpret. Therefore, we often request for one parent/carer only to enter the testing room with the child.
Testing can be completed through speakers (to check for overall hearing) or with headphones/insert ear tips to test each ear separately. We recommend getting your child used to wearing headphones prior to the assessment to help with obtaining as much information as possible during their appointment time. Different types of behavioural hearing tests are listed below.
Visual Reinforcement Audiometry (VRA)
VRA is a type of behavioural assessment that can be used to assess a child’s hearing from around 6-8 months of age and is usually effective up to the age of 2.5 years. VRA can also be useful in older children, especially children with complex needs, depending on their interest and developmental stage.
During the test, sounds at various frequencies are presented through speakers or earphones. When a child hears the sound, they are conditioned by the audiologists to turn their head for a visual reward (e.g. a puppet or cartoon on a screen).
Play audiometry
Play audiometry is another type of behavioural assessment which is often attempted from as young as 2 years old. Audiologists condition the child to complete an action (e.g. throw a toy into a box) when they hear a sound presented. We have a variety of toys that can be used; however, the audiologists may choose toys that are less engaging to ensure your child remains focused and does not get distracted during testing. At times, a combination of play audiometry and VRA testing is used to confirm results or maintain a child’s interest.
Pure tone audiometry
Pure tone audiometry is also a type of behavioural assessment; school age and older children can usually reliably respond to sounds using a response button. This test is usually completed with headphones or insert ear tips.
At times, a combination of play audiometry and pure tone audiometry is used to confirm results or maintain the child’s interest.
It is possible for us to modify behavioural hearing assessments based on your child’s individual needs; this may include using familiar music and familiar visual rewards. We can also use a tablet to assist us with testing or to settle your child during their assessment.
Our aim is to keep your child as comfortable as possible, do not hesitate to suggest anything that you think may help them during testing.
If behavioural testing is unsuccessful or your child is finding it challenging to participate in the assessment, they may be referred to our advanced electrophysiology clinic if there are concerns regarding their hearing pathway or to diagnose specific types of hearing disorders.
Children with APD have normal hearing but may have difficulties interpreting and processing the information being heard. APD can co-exist with other conditions a child may have.
A series of tests can be used to assess your child for signs of processing difficulties. An audiologist will guide your child through a battery of listening assessments. During the assessments, your child will be asked to listen to different sounds or words.
The full appointment takes approximately four hours which includes consultation with a paediatric AVM consultant. We recommend your child arrives having had something to eat, as testing often requires high levels of concentration.