Hearing aid fitting information

Your child’s hearing aid is made up of the following components:
(their hearing aid may look different to the one shown, but the components will be similar)

A red marker indicates the right hearing aid, a blue marker indicates the left hearing aid. Your Audiologist will signpost to these markers on your child’s hearing aids, as the location of the markers varies between hearing aid models.

It is important to get the earmould into the ear properly, or it may be uncomfortable or emit a whistling noise. The Audiologist will demonstrate how to do this and provide time to practice with you during the appointment. However, it will likely take additional practice at home before you are an expert.

If the hearing aid is whistling, ensure it is fully inserted (as illustrated in the final image below). It may need one extra push (try pulling down on the ear lobe to help).

Parents have found the following hearing aids bands helpful for keeping hearing aids on their children.

Some parents have made their own using material, Alice Bands and small hair ties. The hair ties act as loops on the band to hold the hearing aids in place.

Other families have purchased them online from Etsy. You may find other retailers available online.

You may also want to use double-sided tape, which we provide. This can help adhere the hearing aid to the skin behind the ear.

You will need:

Your child’s hearing aids may have been fitted with a ‘tamperproof’ battery compartment, which is designed to ensure batteries stay out of reach from children. This is a requirement for all children under the age of 5, or for children who have a sibling under the age of 5 at home. Here are some examples:

Please note: If your child has a hearing aid/s which does not have a tamper proof door, but you feel this would be beneficial, please contact us urgently for a request for a tamperproof door.

As children move around a lot, it is common for their hearing aids to dislodge from behind their ears. This retention clip can be used to prevent losing their hearing aids. Please note, this clip is not suitable for children between 0–3 years of age.

Batteries

Batteries are supplied free of charge by the NHS, these can be collected when you attend your child’s Audiology appointment or posted home.

To request batteries in the post, please send us an email, which we will aim to respond to within 3 working days.

Please contact us for further information.

Telephone: 020 3456 5115
Email: uclh.enquiry.chad.rntne@nhs.net

Make sure that you

• Don’t leave the battery in a hearing aid that you are not using regularly, as it might damage the aid;
• Keep the batteries clean and dry and away from extreme heat or cold;
• Never throw old batteries into a fire (they may explode);
• Batteries should be recycled. If you do not have local facilities for this, please bring used batteries with you on your next visit to Paediatric Audiology and we will recycle them for you.
• When changing batteries, remember to remove the sticker and to make sure that it has been placed in the battery compartment the right way around (match the ‘+’ on the battery with the ‘+’ on the battery compartment). If the battery compartment does not close, don’t force it - the battery is probably in the wrong way around.

Battery safety Alert

Please read the safety guide (see inside the back cover of this guide) for important information about button (hearing aid) batteries.

Before using your child’s hearing aid for the first time, it is recommended to charge it for 3 hours.

After placing the hearing aid/s in the charger, the indicator light will show the charging state of the battery until the hearing aid is fully charged. When fully charged the indicator light will be solid green.

To turn your child’s hearing aid on manually: Firmly press the lower part of the hearing aid button for 3 seconds until the indicator light blinks green.

To turn your child’s hearing aid off manually: Firmly press the lower part of the hearing aid button for 4 seconds until the indicator light blinks red.

On: Indicator light is solid green.

OFF: Indicator light is solid red.

Please note: If the hearing aid does NOT turn on, place it in the charger.

The hearing aids charge fully within 3 hours; they fast charge the first hour and then the last 2 hours is trickle charge.

The charger can be used as a case; you cannot over charge the hearing aids as they turn off in the charger once fully charged.

Your child’s earmoulds will need replacing from time to time. The time frame for this will depend on several factors, including how quickly your child is growing.

You will know when new earmoulds are required, as they may appear visibly loose in the ear, or the hearing aids may make a ‘whistling’ noise even when inserted correctly.

Should new earmoulds be required, please contact us to arrange an appointment time for ear impressions to be taken.

Telephone: 020 3456 5115
Email: uclh.enquiry.chad.rntne@nhs.net

If the tubing is easily coming out of the earmould then you may simply need to retube the earmould (the instructions for this can be found on a further page in this booklet). The tubing will begin to deteriorate over time, by changing colour and/or losing flexibility, this generally occurs after approximately 6-8 months of use.

On occasion, there may be signs of condensation building up inside the flexible tube. The hearing aid should be blown or puffed with the ‘puffer’ (that you have been provided with) on a regular basis before a blockage of water develops that will prevent sound from entering the ear properly.

Cleaning earmoulds

If your child has two hearing aids (one for each ear), please ensure that you don’t lose track of which earmould is for which ear. The actual hearing aids themselves can be identified by their markers blue (for the left ear) and red (for the right ear ) located on each hearing aid (usually in or on the battery door).

To clean the behind-the-ear section of your hearing aid, wipe it carefully with a soft, dry cloth or tissue. Please take extra care to ensure this part of the hearing aid does not get wet.

Hearing aids function best and have a longer life expectancy when kept dry. They need to be dehumidified regularly. This can be achieved using the drying kit below:

How to use your dry aid kit:

Should you have any further queries which have not been fully answered, or to order replacements please contact us:
Telephone: 020 3456 5115 (Admin Officer)
Email: uclh.enquiry.chad.rntne@nhs.net

This section outlines how to create a good listening environment and develop supportive communication skills to encourage your child’s development.

Create a good listening environment

• Try and keep background noise down, e.g. TV, radio etc.
• Sit opposite and at your child’s ear level during play.
• Choose quiet times of the day to play and talk (about 10 to 15 minutes, two or three times a day).

Encourage communication throughout the day

• Attract your child’s attention. Come close and call them by their name. Gain eye contact.
• Your child may communicate by pointing, vocalising and using facial expressions. Look at what is of interest to the child. Put appropriate language to this communication.
• Build in consistent, everyday language to routines of the house, e.g. meal-time, bed-time and play-time.
• Draw your child’s attention to sounds and the source of those sounds, both inside and outside. You may imitate them and provide names.

Let your child see you actively watching and listening

• Follow your child’s interest. Communicate about what the child is doing at the time or what they are looking at.
• Make comments and give them extra information.
• Show interest by saying, “Oh!” or “Really?” or “Oh no!” This lets your child know that you are watching and listening.
• Look for routines in your child’s play that encourage watching, listening and vocalisation, e.g. toy cars: “stop”, “vroom-vroom”, “crash!”
• Allow your child opportunity to initiate communication. This could be encouraged with a smile or a nod.

Conversational strategies

• Attract your child’s attention by varying the pitch and loudness of your voice.
• Use a variety of pitches to reflect your emotions.
• Rhymes, singing and dancing are good ways to allow you to use your voice and encourage your child to use their own.
• Try and recognise your child’s communication attempts, e.g. looking at something, pointing, leading you to the desired objects etc.

Try to provide and maintain eye contact

• Encourage eye contact by looking at your child as much as possible.
• Call your child’s name and make eye contact before you deliver information.
• Use attention-gaining expressions such as “Oh dear”, “Look!” or “Oh no”, with gesture and body language.
• Be sure your facial expression matches your message.
• Look back and forth between your child and the object you are talking or signing about.

Use situations and language which your child can understand

• Use concrete objects or routines to provide a context for communication.
• Always talk or sign about what your child is interested in.
• It is best to provide one new idea at a time for watching and listening.
• Demonstrate or show what you mean.
• Imitate sounds and add language during play and routine.
• Give time for your child to respond to questions and suggestions.
• Encourage turn-taking.

Try to expand your child’s communicative responses

• Always acknowledge your child’s communicative responses and expand on them, e.g. “Yes, it’s a car - it’s a big car”.
• Do not simply repeat your child’s responses but expand them by adding a little more information or new vocabulary.

You can send the hearing aid to us by post or drop it to us if you live / work nearby. We will provide a replacement hearing aid (or a loan aid to use while your child’s device is in for repair). Remember to keep your child’s earmoulds instead of sending them to us in with the faulty hearing aid.

• Choose quiet times without distraction.
• Take your time, keep calm. Take the child’s lead and build up frequency of use over time.
• Link hearing aid use to playing with your child’s favourite toy / activity or household routines.
• Build in some “making sound” games. Point out environmental sounds to your child.
• Be relaxed, yet firm.
• If your child is fiddling with the aids, distract them by using play and give them plenty to do with their hands.
• If removed, a helpful response might be, “Oh, one more minute”: reinsert aid and extend activity, then remove. Be in control of insertion and removal.
• If you have no luck, try again another time.
• Try the aids on teddy bears, dolls, yourself etc. then try, “Oh your turn now”.
• Provide plenty of pleasurable and meaningful experiences.
• If the child is of school age, let them take the aids into class after about a week, although you may only need to wait a few days if your child is comfortable with their new hearing aids. Encourage them to tell the class what they are, and why they have them.

It will take time for your child to get used to wearing hearing aids, to get used to the sound and the feel of the aids in their ears. Be prepared to start off slowly and gradually build up the amount of time your child will wear them.

If you find a problem with your child’s hearing aid please read the trouble-shooting guide first (see next page). If the issue persists, then please contact us and we will then arrange a hearing aid repair.

Telephone: 020 3456 5160
Email: uclh.enquiry.chad.rntne@nhs.net

For appointment queries, please contact our dedicated admin team:

Telephone: 020 3456 5160
Email: uclh.paediatric.audiology@nhs.net

Adapted from the American Academy of Audiology and Northern, J.& Downs, M., Hearing in Children, (5th Edition, pg. 18), Lippincott Williams and Wilkins, Baltimore, MD, 2002.

The Paediatric Audiology Department at the Royal National ENT and Eastman Dental Hospital offers a comprehensive hearing aid service for children and young people with deafness or reduced hearing, offering regular follow ups and repairs until 18 years of age (or older under extenuating circumstances).

Please note, if your child has hearing aids, they should be brought to every appointment (even if they are broken or no longer in use).

Hearing Aid Discussion

We use a holistic approach before recommending hearing aids, taking several factors into account, such as the severity and configuration of their hearing levels, the size and shape of their ear canal, their educational setting, developmental stage and motivation to wear the hearing aid. This is to ensure that your child has the best possible outcome with their device.

If recommended, suitable earmould impressions will be taken in preparation for your child's hearing aid fitting appointment. Their impressions are sent to an earmould manufacturer, who will make your child’s earmoulds and send them to us prior to their fitting appointment.

This appointment will be led by a specialist paediatric audiologist and specialist teacher of the deaf.

Joint appointments

On some occasions as well as being seen in Paediatric Audiology (PA) you will also have an appointment with an Audiovestibular Medicine (AVM) physician. If you prefer, you can request to have these appointments on two separate visits rather than on the same day.

Ear impression appointments

If new earmoulds are required between PA/AVM appointments (e.g. whistling hearing aids) then you can contact us to book an ear impression appointment. These are usually 15-30 minutes in duration.

• National Deaf Children’s Society (NDCS)
• NDCS Videos
  Suggested Playlists:
  • “Videos featuring children with hearing loss: 0 - 5 years old”;
  • “How to videos: equipment for deaf children”
• Connevans (Hearing Aid accessories/additional technology)
• Cochlear Implant Children’s Support Group (CICS): Contact: Tricia Kemp

UCLH cannot accept responsibility for information provided by external organisations.

Hearing aids: Parts

Battery compartment/door/drawer (& tamperproof/tamper-resistant/child lock)
The part of the hearing aid where the battery is inserted. If the patient is under 5 years of age, or there is another child in the house under this age, then a special lockable battery door will be used to prevent swallowing of / choking on the battery.

Casing
The coloured covering for the behind-the-ear hearing aid.

Earmould
A piece of plastic or other soft material moulded to precisely fit in the ear and to deliver the sound from a hearing aid into the ear.

Hearing aid
Specifically refers to the amplifying part of the hearing aid that sits behind the ear and carries the battery, microphone and settings of the system.

The term is also used generally to refer to the entire system, i.e. hearing aid and earmould connected together.

Hook / elbow
Clear rounded plastic part that connects the earmould tubing to the coloured part that sits behind the ear.

Tubing
Plastic tube that goes through the earmould and connects the earmould to the hearing aid. Older children whose earmoulds last for more than a few months will need to have the tubing replaced as it hardens.

Hearing aids: Other

Acoustic feedback / whistling
This is a high pitched noise from the hearing aid. It is caused by the sound coming out of the canal end of the earmould and going back into the hearing aid microphone. It is normal for the hearing aid to whistle when it is not in the ear, e.g. in your hand. If the hearing aid is whistling whilst in your child’s ear it is because either the hearing aid is not in the ear properly or the earmould is too small. You can try to solve the problem by ensuring the earmould is pushed in all the way.

If the noise is still happening then new earmoulds may be required. A little bit of Vaseline around the ear canal part of the mould (but not covering the sound outlet) can sometimes help to reduce this until the new moulds are ready. Young babies will be likely to have whistling noise when their ears are close to someone, even with good-fitting earmoulds. If this happens, for example, during feeding, then you can remove the whistling aid during this time.

Drying kit / dehumidifier
Consists of a cup/beaker and drying crystals/ capsules. Used to help absorb moisture from the hearing aids to help maintain good function.

Ear impression
A procedure for making an earmould, where silicon putty is inserted into the ear in order to copy the shape of the ear. This is sent to a manufacturer who then makes the earmould and sends it back to the department.

Gain
The amount of amplification/volume put into the hearing aids. This is calculated using the hearing test results.

Programs
Different setting options within the hearing aids. These may be able to offer different overall volume levels or for use in different situations, e.g. to connect a radio aid. The different programs are either automatically detected or can be changed via a button, although this is usually not enabled for young children

Radio aid (also known as FM system)
This is an additional system used with hearing aids. It is used to help the child hear one speaker’s voice better over distance, in the presence of background noise and in echoey places. The child wears a ‘receiver’ and the speaker (e.g. teacher, parent) wears a ‘transmitter’. The impact is that the speaker’s voice will be transmitted directly into the hearing aid, giving a better quality input.

Staff

Audiologist/Audiological Scientist
A health care professional who is trained to evaluate hearing loss and related disorders, including balance (vestibular) disorders and tinnitus (ringing in the ears) and to rehabilitate individuals with hearing loss and related disorders.

Audiovestibular Medicine (AVM) Physician
A physician (doctor) specialising in hearing and balance, including investigation and medical management.

ENT (Ear, Nose and Throat)
A surgeon who is concerned with the diagnosis and treatment of disorders of the ear, nose and throat.

Teacher of the deaf
A specialist teacher who supports children with hearing loss and their families. These may be advisory (local) who may visit a child at home, nursery or school; or provide written information and advice. They may also work in other settings, e.g. at a hospital.

Hearing Assessment

Audiogram
A graph which demonstrates the quietest sound you can hear.

Conductive
Conductive hearing loss is the results of sounds not being able to pass freely to the inner ear. This may be for a number of reasons, including ‘glue ear’ (also known as otitis media with effusion or middle ear dysfunction), hole in the eardrum (perforation), incorrect functioning of the middle ear bones (ossicles) or wax build-up. In some cases conductive hearing loss may be improved or resolved through surgery.

Decibel (dB)
A measurement of volume - the smaller the number, the quieter the sound.

Frequency
The pitch of a sound, measured in Hertz (Hz) - a small number (e.g. 250Hz) is a low pitched, deep sound. A high number (e.g. 4000Hz, usually written as 4kHz) is a high pitched, squeaky sound.

Glue ear
Glue ear is a common childhood condition where the middle ear becomes filled with fluid. The medical term for glue ear is otitis media with effusion (OME).

Hearing threshold
The quietest sound someone can hear at a particular pitch (frequency). Measured in decibel (dB).

Mixed
Hearing loss where both conductive and sensorineural hearing loss is present.

Sensorineural
A hearing loss due to incorrect functioning of the hair cells in the cochlear (inner ear) or in the hearing nerve (or both). This type of hearing loss cannot be resolved through surgery.

Tympanogram
A measure of the function of the middle ear.