Pure Tone Audiometry (Hearing Tests)
Pure Tone Audiometry (PTA) is a subjective, behavioural response to a range of tones (pitches of sound) at different levels. The quietest level at which the patient can hear each sound is their hearing threshold. The results are plotted on a graph called an audiogram. The hearing test helps provide a diagnostic opinion and determine an appropriate management strategy.
Initial Hearing Aid Fittings
There are two care pathways by which a patient can receive an NHS hearing aid:
- Direct referral from a GP
- Referral from an ENT Consultant
Referral from GP (direct referral)
Patients referred by direct referral must meet certain criteria outlined by the British Academy of Audiology (BAA). Patients with a medical reason for their hearing loss must be referred to the ENT department first.
An Audiologist will take a medical history and carry out a hearing test to determine whether there are any relevant medical issues that require further investigation. The Audiologist will discuss appropriate management strategies, for example hearing aids if they are warranted.
Referral from ENT
Patients referred from ENT to Audiology are tested by an Audiologist, most often on the day of their ENT consultation. The ENT consultant may prescribe a hearing aid or medical treatment.
Starting the Process for an NHS Hearing Aid
A member of the Audiology department will discuss the benefits and limitations of a hearing aid based on the hearing thresholds of the patient. Patients are offered a right and left hearing aid (bilateral amplification) where that is considered the most appropriate based on the results of the hearing test and the difficulties the patient is having.
The impression(s) of the patient’s ear are sent to a manufacturer to be made into earmoulds. Some milder hearing losses may not require an earmould and the patient will be offered an open ear fit. A further appointment will be made for the hearing aid fitting.
At the fitting an Audiologist will programme the hearing aid to a prescription based on the hearing test results and a real ear measurement (REM). During the procedure a small tube will be placed in the ear and a range of sounds will be played from a speaker. This procedure shows how the ear canal affects the amplification of sound so that the Audiologist can make changes to the hearing aid to meet a prescribed target for amplification.
Once programmed, an explanation about controls, programmes, maintenance and additional counselling is given.
Guide for Aid with Open Fitting
Guide for Aid with Earmould
Repairs and Batteries
Patients may sometimes find that the hearing aid stops working, works intermittently, becomes damaged, becomes uncomfortable or begins to feedback (whistle). If this happens patients can contact the repair line – 01482 468356 for an appointment. Alternatively, patients can email audiology@hey.nhs.uk or text 07799895033
A repair appointment can normally be made within 2 days. If patients have a preference to which centre they wish to attend they may have to wait longer for an appointment.
We recommend patients have their hearing aid regularly serviced every 6-8 months. The hearing aid is checked and the tubing is replaced. This ensures the patient receives optimal benefit from the hearing aid.
A charity called Action on Hearing Loss (AoHL) also provide drop in clinics for simple repairs (i.e. re-tubing) and a list of these clinics can be found here.
Batteries can be collected from any of our centres by presenting the record card or book. Information on these clinics can be found here.
Hearing Aid Reviews
Patients fitted with a hearing aid sometimes need to make a review appointment to see an Audiologist. The reason for a review varies; the benefit of amplification may fail to meet expectations (too loud/quiet, unclear), hearing can deteriorate or does not meet their individual needs. The Audiologist may retest the patient’s hearing and reassess the settings that are programmed in the hearing aid.
To make a review appointment it is necessary to ring the repair line (01482 624734). Due to the time and equipment needed for review appointments, patients can wait up to 6 weeks for an appointment.
When a patient is initially issued with a new hearing aid the Audiologist may add the patient to a routine review waiting list. This is to check how well the patient is adapting to the hearing aid and ensure they are getting the optimum benefit. Follow up reviews are generally booked 3 months after the fitting to allow time for the patient to adapt.
Speech Audiometry
Speech audiometry is a diagnostic test performed by an Audiologist. The Audiologist will play a series of words to the patient, instead of pure tones in standard audiometry. This test is generally requested by the ENT department to give the consultant more information about speech perception.
Tinnitus Service
Some members of the Audiology team have a special interest in tinnitus. There is a monthly group offering information regarding tinnitus perception and some of its causes, information on practical measures to alleviate tinnitus, options on further treatment and an opportunity to meet other people affected by tinnitus. There are also free leaflets and CDs to take away.
One of the most effective treatments for tinnitus is relaxation. We run regular relaxation classes throughout the year, each course consists of five sessions each one hour long looking at how tinnitus is linked to stress and relaxation, practical breathing exercises, short relaxes and longer deep relaxes.
There are also one to one counselling sessions tailored to the individuals needs for patients who have been referred by an ENT consultant. These may include Tinnitus Retraining Therapy (TRT) and some Cognitive Behavioural Therapy (CBT).
Balance Assessment
Diagnostic balance assessments requested by an ENT consultant are undertaken by an Audiologist with a special interest in the vestibular system. The Audiologist will take a history of the balance problems experienced by the patient and perform a range of tests.
Video goggles (videonystagmography) record the movements of the eyes to assess the vestibular system during each test. Depending on the results and likely cause of the dizziness, the Audiologist may give the patient some exercises to complete at home or perform a manoeuvre to treat the dizziness.
Paediatric Service
Children’s hearing can be assessed using different procedures based on their age and capabilities. Babies are screened at birth and may be referred to the Audiology department for further testing. Tests include otoacoustic emissions (OAEs) and Auditory Brainstem Responses (ABRs). Older children can be assessed using behavioural tests such as Visual Response Audiometry (VRA) and play audiometry.
Audiologists who have a special interest in this field are able to assess hearing and provide the most appropriate management which may be the fitting of hearing aids.