Routine hearing tests are offered to newborn babies and children to identify any problems early on in their development.
Although serious hearing problems during childhood are rare, early testing ensures that any problems are picked up and managed as early as possible.
Why hearing tests are important
Hearing tests carried out soon after birth can help identify most babies with significant hearing loss, and testing later in childhood can pick up any problems that have been missed or have been slowly getting worse.
Without routine hearing tests, there's a chance that a hearing problem could go undiagnosed for many months or even years.
It's important to identify hearing problems as early as possible because they can affect your child's speech and language development, social skills and education.
Treatment is more effective if any problems are detected and managed accordingly early on. An early diagnosis will also help ensure you and your child have access to any special support services you may need.
When will my child's hearing be checked?
Your child's hearing may be checked:
Within a few weeks of birth
This is known as newborn hearing screening and it's often carried out before you leave hospital after giving birth. This is routine for all children and even those having a home birth will be invited to come to hospital to have this.
At around 8 months to 1 year old
This is a follow-up to the newborn hearing screen may be required at this time for some children.
From 8 months to 2 and a half years of age
You may be asked whether you have any concerns about your child's hearing as part of a review of your child's health and development, and hearing tests can be arranged if necessary.
At around 4 or 5 years old
Most children will have a hearing test when they start school, this may be conducted at school or an audiology department depending upon where you live.
Your child's hearing can also be checked at any other time if you have any concerns.
Speak to your GP or health visitor if:
- you're concerned about your child's hearing
Your child can have a hearing test at any age.
Newborn hearing screening
Newborn babies can be screened for any potential hearing problems using two quick and painless tests. The tests are normally conducted on the ward before you leave hospital.
Automated otoacoustic emissions (AOAE) test
A soft earpiece is placed in your baby's ear and quiet clicking sounds are played through it. The earpiece picks up the response from the inner ear and a computer analyses the results.
Automated auditory brainstem response (AABR) test
Three small sensors are placed on your baby's head and neck, and soft headphones are used to play quiet clicking sounds. The sensors detect how your baby's brain and hearing nerves respond to the sound and a computer analyses the results.
Many babies will only need to have the AOAE test, but if it's not possible to get a clear result, or there is a possibility they have a problem with their hearing, they may need to have an AABR test as well.
It's common for babies to have a second screening hearing test. This doesn't necessarily mean they have a hearing problem. It may be offered because your baby was unsettled during the first test, or they may just have a temporary blockage in their ear.
If the results are inconclusive or concerns are raised during the screening process, a referral will be made for a more detailed assessment with your local audiology service.
Read more about newborn hearing screening
Hearing tests for older babies and children
A number of different hearing tests may be used to check for hearing problems in older babies and young children. These are usually undertaken at an audiology department.
Some of the main tests carried out are described below.
Visual reinforcement audiometry
Visual reinforcement audiometry (VRA) is usually used to test hearing in children from approximately seven months of age up to two-and-a-half years old.
During the test, your child will sit on your lap or a chair while sounds are presented. Your baby will be taught to link the sound to a visual reward such as a toy or computer screen lighting up.
Once your child is able to associate the sound and the visual reward the volume and pitch of the sound will be varied to determine the quietest sounds your child is able to hear.
Young children between two and five years old may have a play audiometry test.
During the test, sounds will be played through headphones or speakers and your child will be asked to perform a simple task when they hear the sound. This may vary from putting a ball in a bucket to completing a puzzle.
As with VRA, the volume and pitch of the sound will be varied to determine the quietest sounds your child is able to hear.
Pure tone audiometry
Older children may have a test called pure tone audiometry. This is the test often used to screen a child's hearing before they start school, when it is sometimes referred to as the "sweep test". It's similar to a hearing test an adult might have.
During pure tone audiometry, a machine generates sounds at different volumes and frequencies. The sounds are played through headphones and your child is asked to respond when they hear them by pressing a button.
By changing the level of the sound, the tester can work out the quietest sounds your child can hear.
Bone conduction test
In addition to using speakers or headphones, most of the tests above can also be carried out using a small vibrating device placed behind the ear.
This device passes sound directly to the inner ear through the bones in the head, which can help identify which part of the ear isn't working properly if your child is having hearing problems.
Speech perception test
Speech perception tests assess your child's ability to recognise words.
This can be performed in a variety of ways depending on your child's age and ability. Some may be performed using voice and others may involve playing speech through headphones or a speaker. The child may need to identify words they hear by pointing at a toy, picture, or repeating what they hear.
Tympanometry is a test to assess how flexible the eardrum is.
For good hearing, your eardrum needs to be flexible to allow sound to pass through it. If the eardrum is too rigid – for example, because there is fluid behind it (glue ear) – sounds will bounce back off the eardrum instead of passing through it.
During the test, a soft rubber tube will be placed at the entrance of your child's ear. Air is gently blown down the tube and a sound is played through a small speaker inside it. The tube then measures the sound that's bounced back from the ear.
Causes of hearing problems in babies and children
There are a number of reasons why a child may have a hearing problem, including temporary hearing loss from a common illness such as a cold.
Some possible causes of hearing loss that may be detected during routine tests include:
- glue ear– a build-up of fluid in the middle ear, which is common in young children
- infections that develop in the womb or at birth, such as rubella or cytomegalovirus, which can cause progressive hearing loss
- inherited conditions, such as otosclerosis, which stop the ears or nerves from working properly
- damage to the cochlear or auditory nerves (which transmit hearing signals to the brain); this could be caused by a severe head injury, exposure to loud noise or head surgery, for example
- being starved of oxygen at birth (birth asphyxia)
- illnesses such as meningitis and encephalitis (which both involve swelling in the brain)
Spotting signs of a hearing problem
Although your child will be offered routine hearing tests as they grow up, it's still important for you to look out for signs of any problems and seek advice if you have any concerns.
For babies, the checklist in your baby's personal child health record (red book) can be used to help you check your child's hearing as they grow up.
You can also download two checklists produced by the NHS Newborn Hearing Screening Programme: one that tells you what sounds your baby should make (PDF, 28kb) and one that tells you what sort of sounds your baby should react to (PDF, 28kb).
In older children, signs of a possible hearing problem can include:
- inattentiveness or poor concentration
- not responding when their name is called
- talking loudly and listening to the television at a high volume
- difficulty pinpointing where a sound is coming from
- mispronouncing words
- a change in their progress at school