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Sensory Inclusion Service

Hearing Impairment

What is a Hearing Impairment?

A hearing impairment (also referred to as a hearing loss) can be permanent or temporary. It can be in one ear (referred to as a monaural loss) or in both ears (bilateral). During a hearing test the audiologist will work out what the quietest sounds are that you can detect over a range of frequencies (from low to high sounds). Normal hearing thresholds would fall between the range of -10dB to 20dB. Hearing thresholds greater than 20dB would be considered outside of normal limits. It is important to remember that in a hearing test, the audiologist is trying to establish your hearing thresholds (quietest sounds you can hear) and not what are comfortable levels for you to hear/listen at.

In order to have normal hearing thresholds, all parts of the ear need to be functioning properly. There are three main parts to the ear: the outer ear (pinna and ear canal), the middle ear (ear drum, the ear bones) and the inner ear (cochlear, semi-circular canals for balance, auditory nerve). There are many different reasons that a hearing loss may occur. Hearing loss may be present at birth or develop later.

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All babies in England are offered Newborn hearing screening and locally this is usually carried out in hospital within the first few days of life. If there is no clear response to this testing, which only takes a few minutes to complete, then a follow up test will be offered to ascertain if there is a hearing loss.

The National Deaf Children’s Society has a wealth of information and support available for families: Information and support | National Deaf Children's Society (

What are different types of Hearing Loss?

Sensori-neural – caused by a problem in the inner ear. Usually, the tiny hair cells within the cochlea are either missing or damaged resulting in a hearing loss. The degree of hearing loss can range from mild to profound.

Conductive – caused by sound being unable to reach the inner ear effectively. It could be a problem with the outer ear, or more commonly a problem with the middle part of the ear. This type of hearing loss can be temporary, e.g. a fluctuating loss due to glue ear that may resolve as the child gets older, or it can be permanent e.g. due to permanent scarring on the ear drum or a problem with the ear bones. With a conductive hearing loss, the person’s underlying hearing (in the cochlea) is usually normal.

Some people may also have a mixed loss or sensori-neural hearing loss with a conductive overlay, meaning that they have a permanent loss in the inner ear, with an added conductive loss on top of that, which may or may not be temporary.

How do we describe hearing loss?

When a hearing test is carried out, an average of the hearing loss is recorded and will fall into one of the following categories:

Mild (21dB-40dB)

Moderate (41dB-70dB)

Severe (71dB-94dB)

Profound (95dB+)

Download - Audiogram of familiar sounds chart

Although an average loss is given, every child has different hearing needs. It is unusual to have the same level of hearing across the frequencies and for many children their hearing is worse in the higher frequencies.  This can make following speech more difficult without the support of hearing aids, other devices and support strategies, such as lip-reading. Generally speaking, someone with a mild hearing loss would struggle to follow quiet speech or find it harder to hear in a noisy environment, whilst someone with a severe or profound hearing loss would not be able to hear any speech at all without the support of hearing aids. Even with a profound hearing loss, it is unusual to have no useful hearing and this residual hearing can be utilised through the use of hearing aids.

Once a hearing loss is diagnosed by an ENT consultant, treatment options are discussed with the family, for example hearing aids will be offered if appropriate. Babies, children or young people are referred to SIS when a hearing loss has been identified.

If hearing aids are offered, the ENT consultant will talk through which hearing aids are appropriate for your child. These will range from more traditional Behind The Ear hearing aids, to bone conduction aids or in some cases a referral to the Cochlear Implant Team. The Teacher of the Deaf will be able to support you through the process of your child being aided, including giving advice to their educational setting about how to support them.

If a hearing loss is suspected, who will you meet?

As a hearing loss can present at any time, children and young people can be referred to SIS at any age. Usually, children would be referred via their GP to audiology for an initial assessment of their hearing.

An Audiologist is a health professional and would conduct any hearing tests needed. They would usually carry out a hearing test that involves identifying the hearing thresholds of the child, including information such as the type of hearing loss they are presenting with.

An Ear Nose and Throat (ENT) Consultant is a specialist doctor who would diagnose a hearing loss and determine (with the family) any treatments that may be appropriate e.g. having hearing aids or in some cases surgery.

SIS links closely with Health and a Teacher of the Deaf attends the Children’s Hearing Services Clinic which is run by an ENT Consultant. When children are referred to us, they are allocated a Teacher of the Deaf and a visit rate (based on national criteria) which is determined by their level of need.

What is an audiogram?

In our reports we always include the latest hearing test results. When the child’s hearing is tested, the results are plotted on a graph called an audiogram. The main two lines for the right and left ear will show what the child can hear when sound is presented to their ears and has to travel through the entire pathway from outer to inner ear and up to the brain. The thresholds (quietest sound that the child responds to) are plotted on the graph across the range of frequencies (from low to high) that are needed to access speech and environmental sounds. The right ear is represented with the circles and the left ear by crosses. The audiologist may also test to see whether the loss is sensori-neural or conductive by doing bone conduction testing, which is represented using triangles and sometimes other symbols. You should always refer to the audiology report for full details of the latest hearing test.

An example Audiogram for someone with a bilateral, moderate sensori-neural hearing loss is given below:

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My child is being fitted with a hearing aid – what will it/they look like?

There are a number of different types of hearing aid your child may be fitted with. The ENT Consultant with Audiology will decide what type of aid would benefit your child. Depending on the hearing loss, they may be fitted with one aid or two. Below are some examples of different types of hearing aids:

Behind The Ear or post aural hearing aids:

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Bone Anchored Hearing Aids:

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Cochlea implant processors:

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Bone conduction hearing aids on a hardband/softband:


What is the role of the teacher of the deaf?

Do you know any deaf awareness strategies?

Although every child with a hearing loss has individual needs, there are some strategies that can support any child or young person with a hearing impairment. Below is a link to some advice from the National Deaf Children’s Society:

Becoming more deaf-friendly | Communicating with deaf children (

Other useful information and contact details

Link to order hearing aid batteries:

SaTH Hearing Aid Battery Order Form

Number for Audiology: 01743 261482 or 01952 282804

National Deaf Children’s Society webpage: National Deaf Children's Society | Supporting deaf children (

Shropshire Deaf Children’s Society: Home | UK | Shropshire Deaf Children's Society (