Your Audiology Service

This page answers some of the common questions about audiology services that we are asked. It explains some of your rights as a user of NHS audiology services, and also has links to the Quality Standards and Good Practice Guidelines in use across the UK that audiology services should be working to.

This page was updated April 2013 to reflect changes in the NHS in England resulting from the Health and Social Care Act 2012 that came into effect on 2nd April 2013.

If you have any queries or concerns about the information below, or have any problems accessing services you believe your child is entitled to please contact our Freephone Helpline.

 

What happens at the audiology clinic?

Audiology is the science of hearing and balance. Most audiology clinics undertake a range of test techniques to measure the ear, hearing and balance system. They also fit and maintain hearing aids and provide other rehabilitation support for patients with these problems.

Usually children are seen in their nearest audiology clinic. Permanent deafness is a life-long condition and particularly in the early years there are multiple appointments to attend at the clinic which means that the more convenient it is to attend, the better. However, there will be occasions when your child may need to visit a specialist centre further away. Some reasons for this may be because they are: 

  • still very young and require very specialist test techniques
  • having their very first hearing aids fitted
  • having specialist medical tests done to determine the cause of the deafness
  • having specialist balance testing done or
  • being assessed for implantable hearing devices, such as cochlear implants or bone anchored hearing aids.  

It is recommended that audiology clinics work in a ‘network’ arrangement which means that the two centres will work very closely together, will share information about your child and may even share facilities and staff. The team of professionals you see will work with you to develop and carry out your child’s ‘care management plan’. Your child’s care management plan will say who your Lead Clinician and/or Keyworker is so you should always know who to contact and how. They will be responsible for co-ordinating your child’s care.  

For more information on the different hearing tests and assessments that will be carried out at the clinic you can read our booklet Understanding your child's hearing tests. 

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Who will I see in the clinic?

There are a range of medical and non-medical staff who work in audiology clinics. Often their roles may overlap and exactly who you see will depend on local arrangements. The professionals most likely to be involved include: 

In some areas joint clinics are held and your teacher of the deaf or educational audiologist will be invited to attend the appointment with you.

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Who else will be involved in my child’s care?

All children who wear hearing aids are supported by a teacher of the deaf. Additionally other professionals may be involved depending on your child’s needs. These may include a speech and language therapist, educational audiologist, educational psychologist, clinical psychologist, physiotherapist etc.

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Do I have to be seen by my local hospital?

In England you have a right to choose any hospital that offers a suitable service that you require. This means your GP can refer you an audiology or ENT service of your choice. 

For more information see NHS Choices and the NHS Constitution.


 

 

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Can I get help with travel costs to the hospital?

You may be entitled to help with your travel costs through the 'Healthcare Travel Cost Scheme' (HTCS) if you are under the care of a consultant and receive either Income Support, Income-based Jobseeker's Allowance, Pension Credit Guarantee Credit, are named on a NHS tax exemption certificate or qualify under the NHS low-income scheme.

Further information here.



 

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How long will I have to wait for an appointment?

Each country in the UK has a maximum waiting time target set for the first assessment as well as any eventual treatment. The assessment target is counted as part of the overall treatment target, not in addition to. The term ‘treatment’ includes hearing aid fitting, grommet surgery and cochlear implant surgery. The current waiting times are:

  • England - first assessment 6 weeks; treatment 18 weeks
  • Wales - first assessment 10 weeks; treatment 26 weeks
  • Scotland - first assessment 7 weeks; treatment 18 weeks
  • Northern Ireland - first assessment 9 weeks; treatment 18 weeks

You do not have to go ahead with any treatment options in these timescales if you need further time to think about the options (for example during cochlear implant assessment), or when your consultant advises a period of monitoring first (for example prior to grommet surgery).

In most cases it is good practice to see children with permanent hearing difficulties much sooner than the overall NHS waiting time targets. For example in England you can expect your first audiology assessment within 4 weeks and if hearing aids are needed for them to be fitted no more than 6 weeks later.

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How are hearing aids and cochlear implants funded?

Most deaf children use hearing aids, bone anchored hearing aids, or cochlear implants provided by the NHS. Hearing aids, batteries and accessories are available free of charge to anyone normally resident in the UK. Your local health authority must provide the most appropriate hearing aids for your child's needs. In England hearing aids will either be funded by your local Clinical Commissioning Group (CCG) or NHS England. The funding is paid directly to your audiology service; you will not have to apply for funding. Implantable hearing devices (such as bone anchored hearing aids or cochlear implants) are funded centrally by NHS England (and equivalent bodies in Scotland, Wales and Northern Ireland). Provided children meet the identified candidature criteria as set out by NHS England funding will be paid directly to your specialist service and individual families should not have to apply for funding. Candidature is often identified using recommendations made by the National Institute for Heath and Clinical Excellence (NICE). If a child does not exactly meet the criteria but it is still felt that an implantable device is the most appropriate clinical option for them, then an individual funding request may need to be made. 

All NHS hearing aids, bone anchored hearing aids and cochlear implants are compatible for use with radio aids. Most hearing aids require an adapter (known as a shoe) to be fitted to the bottom of the hearing aid that the radio aid receiver plugs in to. The shoes may be provided by either the NHS or the local authority depending on local arrangements.

Some NHS hearing aids are available with an integrated FM receiver option and these may be fitted in partnership with the local authority. The local authority then funds the transmitter part of the radio aid system. In areas that provide integrated FM receivers it is important to check local procedures and responsibilities for replacement or repair of faulty equipment.

Your teacher of the deaf or educational audiologist is usually responsible for setting up the radio aid, ensuring that it works well with the child's hearing aids, and showing mainstream teaching staff how to use the equipment effectively in school.

Hearing aids often have accessories available that enable the wearer to connect easily to other equipment such as mobile telephones, MP3 players, games consoles, TV and computers. These accessories may need to be 'paired' with the hearing aids so that they only work with those hearing aids. Funding arrangements vary by area. Accessories may be available free-of-charge from the NHS in some areas but you may be asked to pay for them if you would like them in other areas. 

For more information on radio aids and other equipment that can be used with hearing aids and cochlear implants see the NDCS webpage Technology.

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How often should my child be seen by audiology?

Children who wear hearing aids should be offered regular routine appointments so that their hearing and ears can be checked, hearing aids adjusted if necessary and their progress with the hearing aids monitored. When children are very young or have complex needs these appointments may be as frequently as every three months. As children get older the number of visits will gradually decrease until school age when they should be seen at least once a year. 

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Can my child choose the colour of their hearing aids?

NHS hearing aids are available in a range of hair colours that can be used with clear earmoulds to blend in as much as possible. NHS hearing aids and earmoulds also come in a very wide range of bright colours so children can choose to match theirs to their favourite colour, school uniform or football team colours etc. Earmoulds are also available in clear with glitter or with pictures or logos inside them.

For more information on decorating or personalising your child's hearing aids see Decorating and customising your child's hearing aids or cochlear implants.


 

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Can my child have in-the-ear hearing aids?

Generally behind-the-ear (BTE) digital hearing aids are the standard issue NHS hearing aid although there are a few health authorities who do provide in-the-ear (ITE) so it can depend on where you live. The primary reason for this is that they are more expensive to buy and upkeep than BTE models. However, even if they are available there may be one or more reasons why they might not be suitable for someone:  

  • ITE hearing aids may not be suitable until a child reaches the teenage years as the ear canal needs to be large enough to take all the hearing aid's internal parts.
  • ITE hearing aids are not suitable for young children as they require very frequent refitting and replacement as the child grows (or as often as they have regular earmoulds re-made) This means that the child is without hearing aids on a regular basis or requires a second set of BTE hearing aids.
  • ITE hearing aids are cased in a hard acrylic (plastic) which is not so forgiving of growth as standard hearing aid moulds and therefore whistling (feedback) becomes more of a problem for them.
  • ITE hearing aids are not suitable for more severe hearing losses as limitations on the technology and battery size mean that they cannot be manufactured powerful enough.
  • ITE hearing aids cannot be used with direct audio input (radio aids) which many children use in school.

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How long should it take to get new earmoulds?

Earmoulds are an integral part of the hearing aid system and if there are problems with them then the hearing aid will not function optimally. The recommended turnaround time for manufacture is less than 3 days and most of the manufacturers are able to do this provided they are told the impressions are for a child and therefore urgent. Some audiology services use these ways to help speed up the process:

  • Sending off individual impressions the same day, rather than sending in bulk weekly, cuts down on postage times
  • If parents supply a stamped addressed envelope the manufacturer will return the moulds directly to their home
  • Some areas have trained parents and teachers of the deaf to take impressions which cuts down waiting times for appointments

 

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Where can I get batteries?

The NHS will provide a supply of batteries free-of-charge for your child’s hearing aids or cochlear implant. These may be disposable or rechargable depending on the equipment being used.

Most audiology services will supply two packets of batteries per hearing aid at any one time. However, for children using very high-powered hearing aids, hearing aids with integrated FM receivers, or cochlear implants that use batteries more quickly a larger supply may be provided.

Your audiologist should explain the ways they can supply batteries. Audiology services usually provide a range of ways to obtain batteries including:

  • providing batteries from a range of local health centres/GP surgeries so that they are nearer to home to collect
  • providing supplies to teachers of the deaf so that they can be provided via school as needed
  • providing a postal system for replacements.
When your child is first fitted with hearing aids you should be issued with a small brown book (or service record). In Scotland this book is yellow. This book is proof that a child has been fitted with NHS (rather than private) hearing aids. It may not be requested often in paediatric audiology services where your child is well known, but will be important when they are grown up as they will need it to access NHS hearing aid services as an adult. The ‘brown book’ will have your address on the front and the audiology service address on the back and has blank pages in-between. If you post this book to the address on the back with a request for batteries they should send you a supply back to your address within a few days. The audiology service will know the size of battery needed from the details of the hearing aid model inside the book so if this information is missing then you will need to request the size battery needed (saying orange, yellow, brown or blue sticker is enough to tell them what size you need). If you've never been given a brown book then you need to ask your audiologist for one.

In an emergency it is possible to purchase batteries for hearing aids from most high street chemists and hearing aid dispensers.

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How should I dispose of used batteries?

All used batteries should be disposed of safely and preferably recycled. Some audiology services will ask you to return old batteries when requesting new ones and they will recycle the old ones. It is good practice to keep your used batteries in the original packaging so that you can be sure that no old batteries have gone missing and to keep the batteries safe. For more information on battery safety see Hearing aids; Information for families. If you are not asked to return old batteries you can safely dispose of them in your household rubbish. However, many local councils now have recycling schemes for batteries including household collection. Alternatively many large stores that sell batteries offer boxes to keep old batteries in and recycling schemes. For more information on recycling batteries in your area visit Battery Back and type in your postcode to find the collection point nearest your home. 

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My child has lost their hearing aids, will I have to pay for them?

The NHS provides all hearing aid equipment on a permanent loan basis and it always remains the property of the NHS rather than the wearer. NHS equipment should always be returned when it is no longer needed.

The NHS is allowed to charge people for the loss or breakage of hearing aids. However, they do have to convene a committee of three people to determine that the loss was negligent so most services do not charge for the loss of children’s hearing aids since this is difficult to prove. If they do charge, they can only request the same amount that they paid for the device (usually between £70-150 for each hearing aid and earmould) and they cannot charge families in receipt of certain benefits.

The NHS cannot insist that parents insure their child’s hearing aids. It is not possible to insure hearing aids since they remain the property of the NHS. However some parents choose to insure against the risk of being charged for its loss. Most household insurance will cover this although you usually have to let the insurance company know and have the hearing aids listed as a named item on the policy. Cochlear implant speech processors and bone anchored hearing aids are particularly expensive (over £1000) and parents may be advised by their specialist team to insure them.

The NDCS policy on lost hearing equipment and insurance can be downloaded here.

Guidance written by the NCPA (National Committee for Professionals in Audiology) for audiology professionals on charges for lost or broken hearing aids are available from the British Society of Audiology. 

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Can I buy hearing aids for my child privately?

All children in the UK are entitled to NHS hearing aids free of charge and the NHS currently uses a range of good quality digital hearing aids from several manufacturers. Your audiologist will advise on the ones most suitable for your child.

If you do decide to purchase hearing aids privately there are a number of things that you should think about. A list of these questions can be found in our booklet Hearing aids; Information for families.

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Can I ask for a second opinion?

Legally the NHS does not have to provide second opinions, however the British Medical Association does advise doctors to provide one if requested and health professionals will rarely refuse. Usually the doctor in charge of your child’s audiological or ENT care will arrange a second opinion for you. If you prefer you can ask your family doctor (GP) to refer you for a second opinion.

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Where should I go for a second opinion?

Often the best way to find a good audiology service or doctor is by word of mouth. Ask other parents in your area, for example via your local Deaf Children's Society group or school.

You can also use the Dr Foster website to look for an ENT consultant. Click on ‘consultant guide’, select body area ‘ears’, select condition or procedure ‘any ear disorder’, speciality ‘ear, nose and throat’ and enter your postcode. A list of doctors will come up with the closest to your home first. If you click on each doctor you can read their listed areas of expertise and/or special interests. Choose ENT consultants who list their areas of expertise as paediatric otology (children’s ear surgery) and special interest in the condition you are interested in (for example chronic ear disease).

To use Dr Foster to look for an audiovestibular physician (a doctor who specialises in hearing and balance disorders but does not do surgery) click on ‘consultant guide’, select body area ‘ears’, select condition or procedure ‘any ear disorder’, speciality ‘audiological medicine’ and enter your postcode.  A list of doctors will come up with the closest to your home first. If you click on each doctor you can read their listed areas of expertise and/or special interests. Choose audiovestibular consultants who list their areas of expertise in paediatrics. 

For rare or unusual conditions you may like to choose a doctor who is employed by a specialist children’s hospital where they only see children and are therefore more likely to come across more unusual conditions.

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Can I get a second opinion privately?

Many doctors undertake private work in addition to their NHS work. You can use the Dr Foster website to find out which private hospitals they work in as well as the NHS ones.

If you would like a specialist assessment of your child’s hearing and hearing aid care these centres provide independent appointments:

The Portland Hospital, London

Burwood Centre (Mary Hare), Berkshire

Children's Hearing Evaluation and Amplification Resource (CHEAR)

Chester Hearing & Balance Services

If you would like a independent assessment of your child’s use of and progress with cochlear implants these services provide independent appointments:

Sound Advice (The Ear Foundation)

 

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When will my child transfer to the adult audiology service?

Some services specify an age to transfer, usually between 16 and 21. Your family should be involved in the decision on when the right time is for them to transfer. You should be offered an appointment with the adult service before the paediatric service discharges you from their care so that you have time to ask any questions or raise any concerns beforehand. Once the adult service takes over their care it is unlikely that they will be offered routine appointments. However, the young person should be given all the information they need to be able to contact the adult service should their hearing aids become faulty or they have any concerns about their hearing. They should also know how to get replacement batteries etc.

If the young person goes into university or other full-time education away from home they will normally remain on the books of their home paediatric audiology service until they leave education. They may find it useful to have the contact details of the audiology service nearest to the university too so that they can get their hearing aid repaired or batteries in an emergency. The two audiology services would normally share information during this time.

Information for young people about moving on to adult services can be found on the NDCS The Buzz website.

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Can I give my opinions or get involved in service improvement?

Yes. All hospital departments have a suggestion box and you can write down any comments you have about the service and leave it there. Audiology services will also routinely ask parents, children and young people to complete questionnaires to find out if their service users are happy with the service provided. Some services also arrange events for children and young people to ask their opinions face-to-face. Most services have a local Children's Hearing Service Working Group (CHSWG) or similar group. This group is made up of representatives from each discipline that works with deaf children (audiologists, teachers of the deaf etc) as well as a representative parent of a deaf child and/or a young deaf person. You may be asked to be a member of this group to help inform them from the service users experience. Alternatively you could give your views to the current representative. Your audiology service or the local Deaf Children’s Society group should be able to tell you who this is.

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What can I do if I am unhappy with my audiology service?

The first step should be to speak to your Lead Clinician, Keyworker or the Head of Service and explain your concerns to them.

If your concern is a general one or you have suggestions for ways to improve the service provided you could also contact your local Children's Hearing Service Working Group (CHSWG). Most areas have such a group which is made up of representatives from each discipline that works with deaf children as well as a representative parent of a deaf child. It is worth asking this parent about the current situation locally and solutions to the problem that have been discussed. Your audiology or local Deaf Children's Society group should be able to supply you with their contact details.

If your area doesn't have a CHSWG then contact the hospital PALS (Patient Advice and Liaison Service) who can discuss the situation with the department for you. Click here to find your local PALS office. Every Hospital Trust has a complaints procedure that is available in waiting areas, from their website or you can ring the hospital and ask them to send you a copy. Trusts are obliged to reply to you in writing within a specified time. For information on the NHS complaints procedure click here.

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What standards can I expect audiology services to be working to?

UK-wide

NDCS publishes a number of Quality Standards documents and these are available to download from our publications section. 

Guidelines written for professionals by professionals regarding digital hearing aid provision and related services

Standards used by the newborn hearing screening programmes across the UK

England

Transforming audiology services for children with hearing difficulties and their families, Department of Health, 2008

Improving Quality In Physiological diagnostic Service Programme (IQIPS) provides accreditation to paediatric audiology services from December 2012 

Scotland

Quality Standards in Paediatric Audiology in Scotland

Wales

Quality Standards in Paediatric Audiology in Wales

 

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