Paediatric testing

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Within audiology we can provide diagnostic paediatric assessments carried out by fully qualified audiologists in sound proof rooms.

We have a variety of paediatric tests at our disposal depending on the childs chronological and developmental age.

We will see a child within two weeks of receiving a referral.

A letter will be forwarded to the GP after the appointment informing them of the results and any ongoing investigations that are needed either by ourselves or ENT.

The tests that we provide are as follows:

Visual Reinforcement Audiometry (VRA)

A behavioural test for children of around 7 months old up to 2 1/2yrs depending on the child, which can be performed using either loud speakers to test the better hearing ear or if tolerated, inserts/headphones which are ear specific and can be used to test both ears individually.

The child sits on a parent/carers lap, when a sound is introduced they are conditioned to turn to the sound, when they do so they are rewarded by an animated toy. The child is then distracted back to the centre in preparation for the next sound.

Distraction testing

Generally used from 6 – 18months and if the child is difficult to condition to VRA. The child is sat on the parents knee facing forwards, a distracter will sit in front of them playing with toys and then a second audiologist will make sounds from behind to see if the baby responds. Some babies respond better to this as different types of noises can be used such as environmental sounds eg drums, cymbals and animal noises. Ling sounds can also be used to check their response to speech sounds across the frequency range. This type of testing cannot check individual ears.

Performance Audiometry

As with VRA testing but is generally used with slightly older children (30 months +) as it is more interactive. Instead of just turning to the sound they are asked to place a man in a boat, or a ball on a stick. Again this can be freefield through the speakers or inserts, to gain information from the 2 ears separately.

Conditioned Play Audiometry

Similar to Pure Tone Audiometry but aimed at younger children, it can be attempted at around 36 months. Instead of pressing a button, they are conditioned to place a brick in a box, or a ball on a stick when they hear a sound. At first the headphones are put in front of them to provide the sounds freefield to help condition the child, when they are able to respond to the sound themselves, with no prompting from the audiologist, the headphones are put on to the child’s ears and an audiogram is completed as fully as possible depending on the child’s concentration.


This evaluates the function of the middle ear. It provides a result of the relationship of air pressure in the external ear canal to impedance of the tympanic membrane and middle ear system. In a paediatric setting it is mainly used to check for otitis media or Eustachian tube dysfunction.

Diagnostic Pure Tone Audiometry

This is the same test as used on adults. It is a full diagnostic test, using headphones for air conduction, to test both ears independently. Bone conduction can be tested if needed, to help diagnose a conductive or mixed loss. Also if needed and the child is able, we can introduce masking to determine whether a loss is conductive or sensorineural.

Speech Discrimination

Depending on the childs age we can perform a freefield speech discrimination test, either using a McCormack toy test, where the audiologist will say a word and the child will find the corresponding toy in front of them, we now have this in picture form where a Parrot testing unit will say the word and the child will point to the corresponding picture in a book,  we reduce the volume until a threshold is found. For older children, they wear headphones and listen to a CD of word lists and they repeat what they hear after each word, the words are all phonetically balanced with 3 phonemes to each word. The gain is reduced after each word list until they can no longer hear what is being said. This test is marked by the amount of phonemes that they have repeated correctly.

We can also determine the benefit of a childs hearing aids, by testing there freefield responses with and without the hearing aids, to make sure that they are hearing better with the aids on.

Oto-Acoustic Emissions

OAEs are low intensity sounds that are generated by the cochlear. The presence of Oaes indicate that the outer hair cells are active.

It does not give an actual threshold of hearing but oae’s are absent if a hearing loss is greater than 30-35dBHL. OAE’s are abolished if glue ear is present. It is generally a quick and easy test to administer as long as the baby/child is settled and still.

Auditory Brainstem Response

A diagnostic test generally used to test babies who have failed their neonatal screen. The baby needs to be asleep throughout the test which can take up to 2 hours. The sounds introduced to the ears are frequency specific and can be used to test air and bone conduction to determine the threshold of hearing. The ABR is a measure of the response of the auditory pathway from the cochlea up to the brainstem. We can also, if necessary, do sedated ABR’s on older children who are suspected of having a severe loss, but for what ever reason are too difficult to test using other methods.

Neonatal Screen

We now screen all babies born at Worcestershire Royal Hospital before they go home, meaning any possible hearing problems can be diagnosed and treated earlier.

The service will be run seven days a week by a dedicated team of screening staff at Worcestershire Acute Hospitals NHS Trust. Where screeners aren’t available prior to discharge (for example, discharge at night), an appointment will be offered at the nearest hospital or GP surgery to the baby’s home as soon as possible.

The test is called the automated otoacoustic emission (AOAE) test. A small soft-tipped earpiece is placed in the baby’s ear and gentle clicking sounds are played. When an ear receives sound, the inner part (called the cochlea) responds. This can be picked up by the screening equipment.

Auditory Neuropathy Spectrum Disorder

Someone with ANSD has difficulty distinguishing one sound from another and trouble understanding speech clearly. In some cases, ANSD causes only mild hearing difficulties and is only a problem in noisy situations. In the majority of cases, however, it leads to significant hearing loss.

The causes of ANSD are unknown, but children who are born prematurely or have a family history of the condition are at a higher risk for it. Symptoms can develop at any age, but most children with ANSD are born with it and diagnosed in the first months of life.

Children can be referred to us for ANSD testing from ENT, if it is suspected. If a newborn baby is found to have a hearing loss after having an ABR, we automatically look to see if a cochlear microphonic is present, which indicates ANSD.

Auditory Processing Disorder

Auditory processing disorder is not a hearing impairment, as many people with APD will have normal hearing with audiometry, but the inability to process what is heard. They may even be able to repeat what was said, but the meaning of the sentence can be lost. It can exist along with other conditions such as dyslexia and ADHD.

At present APD is difficult to diagnose as a standardised batch of tests have not been agreed upon by our professional body.

Until further notice, please refer to ENT or straight to audiology if no other symptoms are noted, for preliminary testing.