We provide a comprehensive, family-friendly diagnostic and habilitative audiology service for babies and children of all ages with hearing difficulties. This includes the care of children with multiple disabilities, those who are difficult to assess for any reason and for children who are at increased risk of permanent hearing loss.

We have considerable experience assessing the hearing of children of all age groups (0-16 years).  When testing children’s hearing, it is important that an appropriate method is used based on the child’s age, ability and interest, and one that will give the information that is required. Some tests require children to be alert, awake, co-operative and others require the child to be quiet and still or asleep.

The tests can be put in two main categories:

1. Behavioural tests (subjective tests requiring child’s co-operation)

a) Behavioural Observation Audiometry (BOA): observing a change in physical (e.g. cessation of activity, head turn etc.) or physiological (rise in heart beat or breathing rate etc.) in response to the presentation of a measured sound stimuli. Suitable for neonates, babies and toddlers.

b) Visual Reinforcement Audiometry (VRA): a specialised set-up, whereby child’s response to sound is rewarded by presenting an illuminated toy or animation. It is usually performed on children from 6-30 months of age and requires two audiologists – one to distract the child and encourage him/her to respond to the sounds and other to pilot the the equipment.  The child sits in the care-giver’s lap. It is usually quite good fun for the children to have this hearing test done due the reinforcement present.  Some literature even suggests using a tangible reinforcement like a candy or lolipop. However, we do not know of a department in UK who have tried it.

c) Play Audiometry (PA): This involves modifying technique of response to the sounds presented in child’s ear, according to their ability and interest. E.g. throwing a ball in a bucket or putting a man back in the boat-everytime child hears a sound. Usual age group for this test is 3-5 years olds.

d) Pure Tone Audiometry (PTA): This is more of a standard hearing test for school-age children, where the child is required to press a special button every time they hear a sound.

2. Objective tests (computerised tests that usually do not require child to actively follow commands)

a) Auditory Brainstem Responses (ABR): In this test, special electrical sensors are placed on skin behind the ears and forehead to record the electrical activity of hearing nerve and brain, when a sound is presented in the ear. This is done under natural sleep and is a good way of testing hearing in babies and difficult-to-test children. This can take up to 1.5 hours.

b) Otoacoustic emission (OAE): In this test, a special ear phone called a ‘probe’ is placed in the ear to send a specific sound in the inner ear (known as cochlea). Turns out that our ear, if normal, will reflect some sounds back, which are carried back to the computer by the probe. The analysis of this ‘echo’ of sounds gives an idea about the functional status of inner ear, which can, in turn, indicate if the hearing is within normal range. This test is commonly used in the newborn hearing screening throughout the world. This test takes about 15-20 minutes

c) Tympanometry: This is a test for assessing middle ear function and/or to rule out Glue Ear(hyperlink). The total test time is around 15 minutes.

d) Acoustic Reflex Testing (ART): Just like our eyes have evolved to protect us from sudden bright light (or foreign body) via eye-blink reflex; ours ears are evolved to protect us from loud sounds via acoustic reflex. Interestingly, a sound presented to one ear can cause an acoustic reflex inside the other ear.  The test gives important information about facial nerve, hearing nerve, auditory part of brain and perhaps most importantly, about the status of middle ear and inner ear’s specialised hair cells known as ‘inner hair cells’. Selectively damaged inner hair cells can cause a rather problematic auditory disorder known as auditory neuropathy spectrum disorder.

Glue ear

Glue ear or middle ear effusion is a condition where sterile mucous gets stuck behind the ear drum. The part of the ear behind the ear drum (middle ear) is an air filled chamber. For a continuous supply of the air, it is connected to the nose via a tube called eustachian tube. There are a lots of moving parts in the middle ear (ear drum and tiny bones which carry the sounds to the inner ear) and the body does not like dry air. For this, middle ear cavity is lined with mucous. Extra mucous usually drains out of the chamber via eustachian tube. However, eustachian tube can get blocked due to various reasons. Cold and congestion are perhaps the major reason. This happens more frequently in children as they get episodes of congestion and also due to the fact that there eustachian tube is still developing to take the adult shape in later years.

When the eustachian tube is blocked, the mucous collects in the middle ear chamber, which affects the movement of ear drum. Hence, the sound transmission is affected. So, Glue ear is essentially a drainage issue for the body.

Glue ear is a common childhood problem that 90% of us suffer once before the age of 4. Children above 6 years old have 85% less chances of having Glue ear. By some account, Glue ear is the most common issue why parents take children to their GP’s, throughout the world.  Although some of us go on to have this in the adulthood but adult Glue ear is rare and often pathological, needing medical attention.

Once the eustachian tube congestion goes away- Glue ear disappears. This happens spontaneously in most children. However, a small percentage of children either have a persistent Glue ear or more frequent episodes than others, affecting their hearing, speech/language, academics and behaviour. If the hearing issues diagnosed in subsequent audiological tests (audiometry, tympanometry and sometime otoacoustic emissions) show a significant deterioration along with the accompanying symptoms (speech, behaviour or learning issues)- it is perhaps a good reason to actively seek help for Glue ear. One of the treatment options is something called ‘grommet’. Grommet is a tiny little tube (you can perhaps fit 3-4 of those on your little finger nail), that’s fixed in the ear drum by an ENT surgeon after sucking the Glue out of the ear with a special suction device. It is a very successful operation with reports of 98% success rates. Please speak to your audiologist, GP or ENT surgeon if you are worried about your child’s hearing.

Your audiologist will perhaps monitor your child’s hearing for a few time, before discharging them from the service.

Links:

http://www.ndcs.org.uk/family_support/glue_ear/

http://www.nhs.uk/conditions/glue-ear/pages/introduction.aspx

Video animation: https://www.youtube.com/watch?v=gYrEh025hqU

http://www.nice.org.uk/guidance/cg60/resources/guidance-surgical-management-of-otitis-media-with-effusion-in-children-pdf

Music from personal listening devices

Loud music from personal ear phones or loudspeaker, can be very harmful for the ear. Various European and American studies have shown irreversible changes in teenagers’ hearing who listened to loud music for everyday via their iPod etc. Loud noises cause a permanent ear damage. The slightly more alarming part that we do not usually realise is that they cause permanent changes in the chemical composition of nerve cell causing a wide range of effects on the body.  There is a strong body of evidence suggesting that loud noises affect the brain, heart, stress level and general wellness.

As a rule of thumb, if the person standing next to you can hear the song that you are playing in your ear via the earphone- it is too loud for you. If you listen to music via earphones every day, try this:

6 Steps to save your hearing from loud music:

Step 1: Go in the quietest area of the house

Step 2: Put the music app on your device and plug the ear phones in your ears

Step 3: Set the volume to a comfortable level that is acceptable to you

Step 4: Ask a normal hearing person in the house, if they can hear the song you are playing from 2 feet

Step 5: If they can-reduce the volume and follow step 4. If they can’t-

Step 6. Lock the volume level of your device to this level.

The temptation will be to increase the volume in noisy environment (bus, train, tubes etc.). That is what you have to get used to if you really want protect your hearing and wellness.