The HSE provide a comprehensive, family-friendly and integrated screening, diagnostic and habilitative audiology service for babies and children of all ages. This service is free for children from 0 -18 years.
Several methods can be used to test hearing, depending on a child's age, development, auditory attention and health status. Both behavioural and physiologic tests are used in the audiological assessment for paediatric patients.
How do I know if my child has a hearing problem?
Refer to the ‘Childhood Hearing Checklist’ to review what your child should be able to hear. This is available under the useful resources link on the left hand side.
What if my child has a hearing loss?
When you’ve been told your baby has a hearing loss you may have lots of questions. The majority of babies born with hearing loss are born to hearing parents, so you may have very little knowledge or experience of hearing loss. The time of diagnosis can be difficult for some parents and families. You may go through a range of emotions, which could include shock, denial, pain, guilt, disbelief, sadness, fear, adjustment and acceptance. For many parents this is an emotional period, and managing these feelings is an ongoing process.
Be assured that you are not alone and that support is available to you and your family. Many parents have said that once they gained some knowledge of hearing loss, their child’s communication needs and language acquisition, they felt more in control and less fearful of the future.
You may want to talk to other parents who have been in a similar situation or to professionals who have expertise in the area of hearing loss, who will listen to you and support you.
Follow the link on the left hand side ‘Organisations Supporting Children with Hearing Loss’ if want to engage with other parents who have been in this situation, or to professionals who understand your situation, who will listen to you and support you.
Your child may be referred into the audiology service via your General Practitioner (GP), Public Health Nurse, Universal New-Born Hearing Screening Programme or through your Ear Nose and Throat Department.
Follow the link on the left hand side to see the details of the Community Audiology Centres. You must attend the centre assigned to you.
Follow the link on the left hand side to find out more information on the Universal New-Born Hearing Screening programme and to participate in the screening survey.
Follow the links on the left to find out more information about the Children’s Cochlear Implant Programme and the Bone Anchored Hearing Aid programme.
Paediatric Hearing Aid Assessment
The HSE provide a comprehensive, family-friendly and integrated screening, diagnostic and habilitative audiology service for babies and children of all ages. Several methods can be used to test hearing, depending on a child's age, development, auditory attention and health status.
Both behavioural and physiologic tests are used in the audiological assessment for paediatric patients.
Assessment of hearing in children begins with obtaining a detailed history to determine risk factors for hearing loss.
A full audiological assessment is then completed.
If a hearing loss is detected, the audiologist will explain what the results mean and discuss the various options available. It may be that you and the audiologist decided to adopt a 'Watchful Wait Approach' where they monitor your child's hearing closely. Alternatively, it may be best to refer your child to an 'Ear, Nose and Throat' specialist for a medical opinion. The audiologist may also recommend that your child try a hearing aid(s) if the case history and hearing test indicates this to be appropriate. None of these approaches are 'exclusive'. In certain situations, the audiologist may also refer your child to a Paediatrician or a Speech- and Language Therapist if it's necessary.
If a hearing aid is indicated, an impression will be taken of the ear(s). A soft sponge will be placed into the ear canal, followed by putty like material to obtain the shape of the ear. This will be forwarded to be manufactured and an appointment will be mutually arranged for the aid to be fitted within approximately three weeks. Ear moulds can be made in different colours and with designs or logos, such as football team logos or cartoon characters:
Ear Mould Colour Chart.pdf (size 517.5 KB)
Your audiologist will provide you with a DeafHear ‘Understanding Childhood Hearing Loss’ booklet upon initial diagnosis. This is available to view under the useful resources link on the left hand side.
The Understanding Childhood Hearing Loss guide covers:
- coping with the diagnosis
- understanding childhood deafness
- hearing technology and other useful equipment
- financial support – benefits you may be entitled to
- services and professionals who can support you.
The audiologist will also inform you about the services delivered by Visiting Teacher for the Hearing Impaired (VTHI), which is provided by the Department of Education & Science. The audiologist can refer you child to the VTHI service once parental consent has been given.
The audiologist will discuss options with you when you are ready to consider them. This may, with your consent, include onwards referral to other services (Consultant Paediatrician, Ear Nose and Throat Consultant, Visiting Teacher of the Deaf, Cochlear Implant, the Bone Anchored Hearing Aid Programme, DeafHear etc)
Hearing Aid Fitting Appointment
The hearing aids that the HSE fit in Paediatric Audiology are high quality digital 'Behind-The-Ear' hearing aids, that have a mould (or slim tube) that fits in the ear and a hearing aid that sits on top/at the back of the ear. All HSE hearing aids for children are available free of charge.
Below is the current selection of behind the ear hearing aids available for children through the HSE. Please note restrictions may apply depending on the type and degree of hearing loss.
Pictured above Naida Hearing Aid, Nios Hearing Aid and Nios SP Hearing Aid
The audiologist will program your child’s hearing aid(s) to an evidence based scientific prescription, based upon the results of their hearing test. The audiologist will then take measurements of the size and shape of your child’s ears, by placing a thin tube into their ear next to their ear mould. The hearing aid(s) will then be adjusted/fine tuned accordingly, to make sure it is providing the correct level of amplification. This does not hurt, and is an important measurement to make when possible. The measurement allows the aid to be set as accurately as possible, taking into account how the size and shape of that ear affects the sound coming from the hearing aid. For a successful measurement, the ear needs to be free of wax and infection, and the mould needs to fit well.
Additional tests may be used to check how your child is hearing. Speech stimuli, such as the Ling sounds (OO,AA,EE,SH,SS), can be used for functional assessment of the audibility of speech sounds.
The audiologist may provide questionnaires to use at the home/daycare or school setting by parents/teachers/early intervention providers, which are used to measure functional auditory performance based on age. You will find the LittlEars questionnaire and the Childhood Hearing Checklist under useful resources link on the left hand side.
The parent/carer is shown how to insert the ear moulds, operate the aid and understand how the aids work, the cause of feedback, how to perform daily checks and troubleshooting. Parent/carer is provided with a paediatric care kit, including aids to retention (e.g. kiddie clips, huggies); contact names/telephone numbers for support; and written information on hearing aid use.
A follow up appointment is then organised in six to eight weeks time to see how you and your child are getting on with the hearing aid(s).
Follow up appointment
Once your child has a hearing aid, they will attend the Audiology department for regular review of his/her hearing and hearing aid provision.
Routine reviews are carried out at least every 3 months in the first 1-2 years of life, then every 6 months until age 5 and annually after the age of 5 (as long as hearing loss remains stable). Real ear measurements are performed typically every 3 months in the first year of life, and aids adjusted accordingly.
Additional to the schedule of routine reviews there needs to be an arrangement for taking impressions for replacement ear moulds. This may be required approximately every 2-3 weeks in the early months, depending on the degree of hearing loss. It can be helpful to offer the parent/carer the option of setting up a series of impression appointments in advance.
The audiologist will:
- reprogramme your child's hearing aid through a most recent hearing test and repeat probe measurements to incorporate the size and shape of your child’s growing ears.
- check the fit of a child's current ear mould and take an impression of a child's ear to have a new ear mould made.
- aim to establish a child's hearing with their hearing aids 'in and switched on'. This will help us to see how much better a child hears with their hearing aid.
- look very closely at every child's specific situation in order to manage them appropriately with the help of all the people close to him/her.
- give advice and suggest tactics that may help overcome any difficulties/problems/concerns that the child and/or his parents/carers/family members may have. Examples of possible topics can be any problems that relate to the hearing aids themselves or the child's acceptance of them, the schools acceptance/involvement or perhaps some social difficulties resulting from the hearing aids.
- will provide a report for you and, with your consent, share the reports with the range of professionals involved in the care of the child.
Additionally, there are a range of listening devices that can give extra help to a child with a hearing loss. If appropriate, the audiologist will give advice on where and how these can be obtained. Some will be available from the Audiology department itself.
Hearing Aid Repair Service
Follow the link on the left hand side to find out information on the National Hearing Aid Repair Centre.
Behavioural Hearing Tests
Visual Reinforced Audiometry (VRA)
This is suitable for infants from 6 – 36 months old.
The child is seated, typically between, two visual reinforcing reward boxes. These contain either animated toys which sit behind smoked glass or computer generated animations. A loud speaker either sits on top, or next to each one. The child is taught to look for the interesting visual reward whenever a sound is played from one of the speakers located either on the left or right.
After several presentations the child has been conditioned to turn to one of the boxes when just a sound is played. A series of tones or warbles are then played at reducing intensity to obtain a minimal response level.
The sounds can be presented either through the speakers, which test the better hearing ear or using headphones (or insert phones, which are placed in the ear canals) which enables ear specific testing. In some cases a bone conduction vibrator, which looks like a headband is used to assess inner ear function
This is suitable for pre-school children from 30+ months old (developmentally).
A game is played in which the child performs an action when a sound is heard. This could take the form of putting toy people in a boat or building a tower from blocks. The complexity of the task can be changed to be age appropriate and more interesting!
During the test the child wears headphones (or inserts) during the test. Sounds at various frequencies are presented to the child and gradually reduced in loudness. Each time they hear the sound they must perform the action until they can no longer hear the stimulus.
The point at which they stop performing the task is taken to be the hearing threshold at the particular frequency being tested. The process is repeated for a range of frequencies in each ear.
Pure Tone Audiometry (PTA)
Suitable for school age children upwards.
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.
Physiological Hearing Tests
Otoacousic emissions (OAE)
Sound is presented into the ear canal via a probe. The sound wave passes across the ear drum and middle ear then into the cochlear. This stimulates the hair cells in the cochlear causing the outer hair cells to move in response, creating an echo. The echo passes back through the middle ear and ear drum where it is detected by a sensitive microphone situated in the probe. This signal is stored on a computer and plotted on a graph.
Computer analysis of the presence / absence of the echo from these cells can indicate the level of function present in the ear under test.
Auditory Brainstem Response (ABR)
Tones or clicks of varying intensities are presented via probes placed in the ear canal. Electrodes are attached to the mastoids behind each ear and one to the upper forehead. The sound in the ear canal passes to the cochlear which converts the sound waves into a nerve action potential which passes along the auditory nerve.
The signal then travels to the brainstem and on to the cortex where it is processed by the brain. This wave of activity is collected by the electrodes, amplified, and passed to a machine for processing. Presenting progressively quieter sounds enables a response threshold to be obtained.
This test is primarily used to test young babies who cannot respond or for older children who are unable to perform the typical hearing tests. To obtain accurate results in this test, the child needs to be asleep, for older children this may require sedation or in rare cases a general anaesthetic and would be performed in a hospital environment.
Middle ear tests
Tympanometry is not a hearing test but a procedure that can show how well the eardrum moves when a soft sound and air pressure are introduced in the ear canal. It's helpful in identifying middle ear problems, such as fluid collecting behind the eardrum.
A tympanogram is a graphic representation of tympanometry. A "flat" line on a tympanogram may indicate that the eardrum is not mobile suggesting Otitis Media with Effusion (OME), while a "peaked" pattern often indicates normal function. A visual ear examination should be performed along with tympanometry.
Acoustical Stapedial Reflex
When a loud sound is presented to the ear, a protective mechanism is triggered that tightens the small bones (ossicles) that connect the ear drum to the cochlear and reduce the sensitivity of hearing.
This procedure can be used to assess the pathway of the sound from the ear canal, through the middle ear, into the cochlear, up to the brainstem then back down to the muscle that tightens the ossicles.
*Please note that at times HSE services may be outsourced to external bodies.
“The HSE Audiology service is committed to delivering high quality, evidence based and safe services for all patients.For the purposes of quality assurance and service improvement the HSE Audiology service therefore routinely monitors and audits patient data, ensuring at all times that patient data protection rights are ensured.”