Audiology clinics carry out a range of services, including:
- performing hearing tests
- telling you about the type and level of hearing loss that your child has
- finding out if hearing aids will be useful and, if so, supplying them
- providing earmoulds for your child’s hearing aids
- helping you maintain your child’s hearing aids
- monitoring your child’s hearing levels
- referring you to education support services for deaf children
- working with other professionals, such as ear, nose and throat (ENT) doctors and Teachers of the Deaf, to provide support to you and your child.
In England you have a right to choose any hospital that offers a service that your child requires. Your GP can refer you to an audiology or ENT service of your choice. As permanent deafness is a life-long condition and will require multiple clinic appointments, the nearer it is, the better.
In Wales, Scotland and Northern Ireland you will normally be referred to your nearest audiology clinic.
There will be times 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 specialist test techniques
- having their very first hearing aids fitted
- having specialist medical tests done to determine the cause of their deafness
- having specialist balance testing done
- being assessed for implantable hearing devices, such as cochlear implants or bone conduction hearing implants.
In 2000 the NHS made a commitment to patients and carers to receive copies of all letters written about them. Parents have a right to be offered copies of letters between clinicians that are written about their children. These letters should contain clear information that explains the results of any hearing assessments that have been carried out.
Hearing test results are commonly plotted on a graph known as an audiogram. NHS guidance says that raw data (test results) should be explained in person and not copied to the patient. Parents therefore don’t have a right to copies of the audiogram/other test results. However, most audiologists are more than happy to print off an extra copy at the time of the appointment if parents ask. NDCS believes that it is good practice for parents to be given copies of audiograms along with a full explanation of what they mean.
Sometimes parents require an audiogram or copy of a letter for another purpose (such as a Disability Living Allowance application). The NHS is legally entitled to make a 'reasonable' charge for providing copies of anything in the patients files that isn't already a 'right' for them to have. The charge covers admin time, photocopy and postage charges.
An individual management plan (IMP), sometimes known as a care management plan, is an agreement between you and your audiology service that helps you to manage your child's deafness and ear health day-to-day. You should be given a copy of your child's IMP when the contents have been agreed.
If your child is being seen by a specialist auditory implant centre as well as a local audiology service then they will work closely together, sharing information about your child. The team of professionals will work with you to develop and carry out your IMP.
The IMP will set the goals you want to work towards, these may include:
- how many hours a day your child will wear their hearing aid
- reporting or understanding of new words and sounds heard
- reporting when the batteries stop working
- being able to take the hearing aids in and out themselves
- becoming independent in the care and cleaning of the hearing aids
- using the 'T' programme and other technologies with the hearing aids
- meeting with other deaf children or adults
- transitioning to adult services.
An IMP should also include:
- Who your lead clinician is and/or keyworker (responsible for coordinating your child’s care) and how to contact them.
- Contact numbers for the audiology service.
- Any other support services your child needs such as referral to a Teacher of the Deaf, speech and language therapist, cochlear implant team etc.
When developing your child's IMP your audiologist can advise on goals for your child and when they can expect to achieve them, but it’s important that you mention things that are important to you or your child and any goals you want to work towards as well. Your audiologist will also use information from your Teacher of the Deaf to help inform the IMP.
Your IMP won’t be shared with anyone else without your consent. Let your audiologist know of any other professionals working with your child who it would be useful to share the information with.
Your IMP should be reviewed regularly to assess progress and update goals. You can also ask for a review earlier than planned if you feel it isn't working or when other things in your child's life have changed.
A range of staff work in audiology clinics including audiologists/clinical scientists (audiology), paediatricians, ear, nose and throat (ENT) consultants and audiovestibular doctors. Their roles may overlap and who you see will differ from area to area.
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.
For more information on the various professionals you and your deaf child may come into contact with go to People you may meet.
Each country in the UK has a maximum waiting time target for the first assessment and treatment. The assessment target is counted as part of the overall treatment target, not in addition to.
NOTE: The term ‘assessment’ includes hearing tests. The term ‘treatment’ includes hearing aid fitting, grommet surgery and implant surgery.
Current waiting times:
- England – first assessment six weeks, treatment 18 weeks
- Wales – first assessment eight weeks, hearing aid fitting 14 weeks, other treatment 26 weeks
- Scotland – first assessment 12 weeks or less (varies by Health Board), treatment 18 weeks
- Northern Ireland – first assessment nine weeks, treatment 18 weeks.
You don’t 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).
It’s 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 four weeks and if hearing aids need to be fitted, this is likely to be no more than six weeks later.
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 frequent 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.
Information about when your child will transfer to adult audiology services, differences between children’s and adult’s audiology and what happens if your child goes to university.
When will my child transfer to the adult audiology service?
Some services specify an age between 16 and 21 years to transfer but usually this will be flexible and your family should be involved in the decision on when it’s the right time for your child to transfer. You should be offered an appointment with the adult service before the paediatric service discharges your child from their care so that you have time to ask any questions or raise any concerns beforehand.
What are the differences between the children’s and adult’s audiology services?
Once your child has transferred to the adult service it’s unlikely that they will be offered routine appointments. However, they 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, including how to get replacement batteries etc.
What happens if my child goes to university?
If your child goes on to study at university or other full-time education away from home they will normally remain under the care 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 get batteries in an emergency. The two audiology services would normally share information during this time.
If you’re unhappy with your child’s audiology service we encourage you to express your opinion and to explain how services could be improved.
What you can do if you feel your local NHS is not meeting your child's needs
The route you take if you are not happy with your child’s care will vary depending on the nature of the problem. Families are often concerned that by telling their service that there is something they are not happy about will affect their child’s care negatively.
Professionals working in the NHS work hard to provide a good service for every person who comes through their doors. Usually services welcome feedback as they are keen to improve and do their best for everyone. Occasionally it is necessary to make a formal complaint.
Most families tell us that their motivation for complaining is to ensure that other children and families don’t have to experience the same quality of service that they received, and NHS complaints processes are used to help improve services as well as resolve individual issues. It can be helpful to consider what could have been done differently to prevent the problem arising in the first place as this is very valuable feedback from people who actually use the service.
Don’t forget to give positive feedback when your service has given you a good experience of care and support! You may like to recommend your audiologist or other health professional for recognition locally or even a national award. Local Trusts often have recognition and awards events for staff and you can find out about local awards through leaflets or their website.
The British Academy of Audiology hold an annual award ceremony for audiologists and teams, including Paediatric Audiologist of the Year. You can find out about how to nominate them here. UK Audiologist of the Year is also held each year, nominated by a patient, and put forward to the European finals.
There are a number of ways you can give feedback or get involved in service improvement:
- Suggestion box – all hospital departments have a suggestion box where you can post your comments about the service.
- Questionnaires – audiology services will routinely ask parents, children and young people to complete questionnaires to find out if their users are happy with the service provided.
- Face-to-face – some services arrange events for children and young people to give their opinions face-to-face.
- If your concern is a general one or you have suggestions for ways to improve the service you could also contact your 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 about their service users’ experiences. Alternatively you could give your views to the current representative. It is worth asking this parent about the current situation locally and solutions to the problem that have been discussed. Your audiology service or the Local Deaf Children's Society group should be able to tell you who this is.
If your area doesn't have a Children’s Hearing Services Working Group
If you live in England, contact the hospital Patient Advice and Liaison Service (PALS).
If you live in Wales, contact the Complaints Advocacy Service.
If you live in Scotland, contact the Patient Advice and Support Service.
If you live in Northern Ireland, contact the Patient and Client Council.
Select your nation below for more information about making a complaint about the NHS:
Legally the NHS doesn’t have to provide second opinions, however the British Medical Association advises doctors to provide one if requested and they will rarely refuse.
Usually the doctor in charge of your child’s audiological or ear, nose and throat (ENT) care will arrange a second opinion for you. If you prefer you can ask your GP to refer you for a second opinion.
Where should I go for a second opinion?
Lots of factors will determine where you 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, e.g. via your Local Deaf Children's Society group, NDCS Facebook group, or school. There is frequently further information about the experience and interests of key staff on the hospital’s website. Things you will need to consider include your child’s needs (such as type and cause of deafness, and any related conditions they may have), the doctor’s area of expertise and whether you have a preference about who you want to see, waiting times, and distance to the hospital.
- Paediatric audiologist or clinical scientist (audiology)
- Ear, nose and throat consultant
- Audiovestibular physician
For example, if your child needs surgery you should choose and ENT consultant who specialises in paediatric otology (children’s ear surgery), or if they have longstanding and serious ear infections choose an ENT consultant who specialises in chronic ear disease. This doesn't guarantee the quality of their work but does indicate that they have an interest in this area and are more likely to receive the majority of referrals for this condition.
If your child has complex needs you might consider a specialist children's hospital where they are more likely to come across more unusual conditions.
Can I get a second opinion privately?
If you would like a further assessment of your child’s hearing and hearing aid care the following centres provide independent appointments.
The Portland Hospital, London
Burwood Centre (Mary Hare), Berkshire
Children's Hearing Evaluation and Amplification Resource (CHEAR), Hertfordshire and London
If you would like an independent assessment of your child’s use of and progress with cochlear implants, Sound Advice (The Ear Foundation) provides independent appointments.
The British Academy of Audiology has produced good practice guidance for audiologists on shared care which identifies service users rights and supports professionals to understand their role working together across NHS and private providers.
Professionals working with deaf children, young people, and their families in NHS audiology services are working to provide the best quality of care that they can to achieve the best possible outcomes for their service users. However, no one professional can provide every element of support that families require. Families may be referred to, or may seek further support from other service providers. These services may be other NHS, private, independent, or third sector (charity) providers.
Situations when this might happen include:
- When all audiology services are not available on one site
- When referred for further support (such as the sensory support services or hearing therapy)
- When referred to specialist services (such as to an auditory implant centre)
- When a referral is made for a second opinion
- When a child’s family seek additional or an alternative opinion (such as when considering alternative treatments (such as surgery), or due to concerns about the accuracy of the diagnosis, the benefit of existing hearing aids or current rehabilitation programmes, or with concerns about language or educational progress)
The British Academy of Audiology has produced good practice guidance for audiologists on shared care which identifies service users rights and supports professionals to understand their role in four key areas:
• Working together and sharing information
• Working together for children and young people with special educational needs
• Working together across NHS and private providers
• What to do if there are concerns about care within shared care arrangements
“The NHS works across organisational boundaries and in partnership with other organisations in the interest of service users, local communities and the wider population” (NHS Constitution)
Guidance on the Shared Care of Children and Young People using Audiology Services (BAA 2017)
- Standards used by the Newborn hearing screening programmes across the UK.
- Quality Standards: Transition from paediatric to adult audiology services
- Guidelines written for professionals by professionals regarding digital hearing aid provision and related services.
Child audiology services can become ‘accredited’ (officially recognised as meeting independently assessed standards). This can help to raise standards and reassure parents that their child will receive a high level of care.