Audiology

The audiologist will assess the patient’s eardrum movement by placing a small, soft probe tip in the ear for a few seconds. One ear is tested at a time. This test is useful to determine how well sound is passing through the eardrum. For example, if excessive wax or fluid is around the eardrum, it can reduce the sounds a patient may hear. The audiologist may also present sounds to measure a reflex response made by the ear.

For this test, a small, soft tip is placed in the ear.  Soft musical tones are presented.  If the sound is detected, the ear makes an “echo-like” response that is generated when a sound is heard, and this is measured.

The test is quick and painless. One ear is tested at a time. This test is most reliable when the patient is sitting still and the room is quiet.  It can be performed on patients of all ages, and is especially useful for patients who cannot give consistent behavioral responses on other tests, including babies and people with certain disabilities/conditions.

Audiometry Adult

This hearing test is done with the patient seated in a soundproof booth and soft insert earplugs are placed in their ears. The audiologist will ask the patient to indicate each time they hear a sound, usually by raising their hand or pressing a button. The goal of this test is to see how quiet a sound or speech can be so that the patient just barely hears it; this is called a hearing threshold. Hearing thresholds help audiologists determine the severity and type of hearing loss.

Audiometry Children

Children of any age can have their hearing assessed and hospital audiologists are specially equipped and well experienced in the testing of children. Below is a breakdown of different testing methods based on age. Audiologists can test children with different methods if a child is unable to complete the typical testing for their age.  Children of all ages typically have an  Otoacoustic Emissions (OAE) test completed, if applicable, in addition to these methods.

0-6 months:very young children are tested with Otoacoustic Emissions (OAE) and/or and Auditory Brainstem Response-Based Audiological Assessment (ABRA).

6-30 months:Visual Reinforcement Audiometry (VRA) is used for children 6-30 months old. During VRA, the child sits with their parent/caregiver in a soundproof booth. The audiologist watches for the child’s head turn in response to sounds. The audiologist rewards the child for correct responses by lighting up or animating a toy.
30 months-6 years:Play Audiometry is similar to a game. The testing is completed in a soundproof booth and the child indicates when a soft sound is heard (e.g., throw a toy in a bucket; place a peg on a pegboard). The child may also be asked to repeat simple words or point (e.g., “point to your nose”).

6-7 years and older:Testing children 6-7 years of age and older is very similar to an adult hearing test. The child is seated in a soundproof booth and asked to indicate when soft sounds are heard (usually by raising their hand or pressing a response button). They may also be asked to repeat words.

Counseling services provided by the audiologist are focused on providing the patient with the best possible strategies to maintain quality of life while coping with their hearing loss. The audiologist will be there to provide counselling on all hearing health related issues, and address their questions and/or concerns. Hearing aids will be discussed, if appropriate.

When discussing a patient’s hearing test results, the audiologist will inform them whether or not hearing aids will help. If they indicate they would be interested in trying hearing aids, the audiologist can write a hearing aid prescription, which can be taken to any hearing aid dispenser.  Hospital audiologists prescribe hearing aids but they do not sell them.  At some locations, the audiologist will have the patient return for follow-up appointment to have a more detailed conversation regarding things like types and styles of hearing aids, lifestyle and listening needs, and budget.

Hearing Aids – The Basics

Hearing aids are assistive devices that make speech and everyday noises louder so that they can be comfortably heard by the wearer. They are small computer-like devices that are constantly monitoring the environment to provide optimal hearing. For example, when the wearer walks into a crowd of people, the hearing aid may focus its microphones on speech coming from the front and reduce the volume of the background noise. This would help the wearer hear the person they are facing. Hearing aids have many more features that depend on the brand or level of technology of the device.  The main purpose of hearing aids is to help improve communication in everyday life.

Hearing Aid Styles

There are many different styles of hearing aids available, from those that fit entirely in the ear to those that fit behind the ear with a tube or wire leading to an earpiece in the ear. The audiologist considers many factors when recommending hearing aids, such as the amount, type, and shape of the hearing loss; the size and shape of the ear canals; wax issues; and dexterity of the wearer.  Personal preferences for certain features or cosmetic concerns will also be taken into account as the audiologist and patient work together to find the best fit for the patient’s lifestyle.

Speech and Audiology Canada
Canadian Academy of Audiology
American Speech-Language- Hearing Association

The ABRA gives information about the brain pathways for hearing. The test can be performed on patients of any age. Very young children may require mild sedation for the test, which is arranged by a team which includes a pediatrician and nurses (these cases are discussed with parents/caregivers before the test is scheduled). The ABRA is performed by placing electrodes on the head (forehead and behind the ears or on the earlobes) and recording brain wave activity in response to sound. The person being tested rests quietly or sleeps while the test is performed. No response is necessary.

What is an Auditory Brainstem Response-Based Audiological Assessment (ABRA)?

An ABRA measurement shows the levels at which your child can detect different sounds. This safe and routine test is done by an audiologist (hearing specialist) when previous measurements cannot conclude that your child has normal hearing. The test can be performed on patients of any age. Very young children may require sedation for the test, which is arranged by a team that includes a pediatrician and nurses (these cases are discussed with parents/caregivers before the test is scheduled). Your child will have sticky sensors on the forehead and behind the ears and earphones in their ears. Sound will be played. The audiologist will measure what level of sound activity your child can detect in response to the sound.  Your child must rest quietly or sleep during the test. No participation is necessary.

Preparing your child for an ABRA

The appointment could take most of the morning or most of the afternoon.

The test requires your child to be sleeping. Some children might get medicine (sedation) to make them calm or sleepy. Come prepared to keep your child comfortable (e.g. extra diapers, extra milk or formula or food, change of clothes, blanket and/or sleeping toy, soother, etc.).

If your child is tested without sedation:

• Avoid feeding your child within 1 hour of the test (unless medically necessary). You may feed your child once they are set up for the test to help them fall asleep.
• Your baby can sleep in your arms during the test.

If your child is tested with sedation:

• You will get instructions about fasting before the test and what to do at home after the test.

Why are ABRAs done?

ABRAs are done when previous measurements cannot conclude that your child has normal hearing.

How do I access this service?

If you are concerned about your child’s hearing, please contact your local hospital’s Audiology department.

How is an ABRA performed?

The audiologist will gently scrub and place soft sensors behind your child’s ears and on the forehead. The audiologist also places small earphones or a headband device on your child. Sounds are presented, and sensors measure response to the sounds.

Can I stay with my child during an ABRA?

If your child is not sedated for the test, you can stay with your child.

If your child has a sedated ABRA, you might need to stay in the waiting room during the test.

What happens after an ABRA?

The audiologist will review the test results with you and discuss the next steps.

If your child was sedated, the nurse will explain what to do over the next few hours. Most sedation wears off within a few hours.

What Is APD
Mandatory Criteria/Characteristics
Flow Chart for Professionals
Local Contacts

What is Auditory Processing Disorder?

An Auditory Processing Disorder (APD) is a deficit in interpreting auditory information. Our ears detect sounds, but it is our brain that helps us figure out what those sounds mean. Typically, a person with an Auditory Processing Disorder has normal hearing, but the brain has difficulty interpreting speech and other sounds in a meaningful way.

What are the Symptoms of APD?

Difficulty attending to and/or discriminating sounds

Difficulty remembering and/or recognizing sounds

Difficulty comprehending auditory information – may require extra time to process information

Difficulty hearing if there is too much background noise

Difficulty following conversations

Difficulty following spoken instructions with many steps (complex directions)

Difficulty with speech and/or language development

Difficulty spelling, reading, and/or writing

May get easily distracted or has difficulty maintaining concentration

Poor listening skills and/or may get tired after listening for long periods of time

Academic performance does not correspond to learning potential

Improved performance in one-on-one situations

Who is a Candidate for APD Testing?

Before booking a patient for APD testing, they must:

Be 7 years of age or older

Be fluent in English or French

Be having difficulty with auditory information that is affecting everyday life and/or productivity in school or work environments

Have intelligible speech

Be able to understand simple instructions

Be able to repeat words/sentences

Have an intellectual potential that appears to be in the normal range

Not present with a diagnosis that could explain the difficulties encountered (e.g., ASD, global developmental delay, various syndromes, language disorder)

Not present with peripheral hearing impairment (e.g., diagnosed hearing loss, wearing a hearing aid, ear infections, etc.)

Present with some typical characteristics of APD based on screening and/or case history

Who Can Refer for APD Testing?

Health-care professionals (physicians, speech-language pathologists, psychologists, etc.)

Educational professionals (teachers, resource teachers, etc.)

Parents/caregivers (not available in all Audiology centres)

How Do I Refer Someone for APD Testing?

Send a regular referral to the Audiology Department requesting APD testing. An appointment will be given for a hearing evaluation and APD screening. If a full APD assessment is warranted, it will be arranged through the Audiology Department.
Click here for your local audiology department contact information.

Additional Resources

Nova Scotia Hearing and Speech Centres
Canadian Academy of Audiology
Speech-Language and Audiology Canada

This test is performed to assess parts of the balance system. It helps your doctor understand the cause of your dizziness or balance problem. The test can take up to two hours. During the test, goggles are worn to record your eye movements.

Measurements are performed while seated or while lying down. In the final test, the examiner will present a stream of cool and warm air or water into the ear canals. This may cause brief dizziness but shows how well the inner ear functions.

Before the test: It is recommended to not take sedatives, anti-nausea or anti-vertigo medication 48 hours prior to the test. Before your appointment, you will receive an information sheet with more detailed instructions. If you have any questions about other medications, please contact your ENT physician (ear, nose, throat specialist) or a pharmacist at least 48 hours prior to the test.

We also recommend:
No eating or drinking for 2-4 hours prior to the test (unless you are diabetic or hypoglycemic).

No make-up or mascara (especially around the eyes).

Contact lenses are allowed. Glasses will be removed as they cannot be worn under the goggles.

You will sit and look at dots and stripes, lie down on your back or side, and turn your head from side to side.

To learn more, click here to read the information sheet.

The goal of the Universal Newborn Hearing Screening program is to identify permanent hearing loss in children as early as possible and provide early intervention (e.g., hearing aids). Most newborns have their hearing screening completed before they are discharged from the hospital. The hearing screening (OAE)  test requires a quiet baby.  Iif reliable test results cannot be obtained prior to leaving the hospital, the baby will be called back to the audiology department to repeat the test. A variation of this test is used for newborns in the Neonatal Intensive Care Unit. The program aims to have all newborns screened for hearing loss by one month of age, confirmation of hearing loss by 3 months, and the start of early intervention by 6 months of age.  Early identification of hearing loss is reported to reduce deficits in cognitive, speech, language, academic, and social/emotional development in children.

For further information please visit:  Universal Newborn and Infant Hearing Screening Program, by the Government of New Brunswick.

In New Brunswick, children identified with hearing loss are followed by hospital audiologists who have the specialized equipment and experience for assessing and treating them. Children with hearing loss can also order their hearing aids through the hospital, at manufacturer’s cost, from birth until they are 21 years of age. The audiologist works very closely with parents, speech-language pathologists, educators, itinerant teachers to ensure that any child who has a hearing loss reaches their full academic potential. Children living in Atlantic Canada with hearing loss are followed by an interprovincial co-operative agency called Atlantic Provinces Special Education Authority (APSEA).  More information on APSEA can be found at: www.apsea.ca.  APSEA itinerant teachers (a teacher for the hearing impaired) follow children in the Anglophone school boards while children attending Francophone schools are followed by itinerant teachers through the Department of Education and Early Childhood Development.

This program is for patients that have been prescribed medications, such as Gentamicin and certain chemotherapy drugs like Cisplatin, that can be potentially toxic (damaging) to the ear and cause hearing loss. Audiologists monitor patients in order to prevent the loss of hearing into the speech frequencies, and to provide information on hearing aid options if a hearing loss results. Click here for a handout with more information.

Community Audiology may include:

• Education sessions in schools, churches, seniors’ centres, special care homes, and other professionals
• Workplace evaluations to assess acceptable noise levels
• Community hearing screenings in schools and seniors’ centres
• Group aural rehabilitation sessions

*Requests are considered as staffing and clinical workload permits. Resources are very limited in most areas*

Referrals to hospital audiology can be made by anyone: physicians and other health care professionals, educational professionals, parents/caregivers, and patients themselves. Testing costs are covered through Medicare.

Please contact an audiology clinic in your area to make a referral.

Referral forms can be downloaded here:

• Fredericton and Upper River Valley Area
• Miramichi Area
• Moncton Area
• Saint John Area: Please call the Saint John Regional Hospital or Sussex Health Centre directly to make a referral

Referrals are prioritized and scheduled based on urgency. Sudden Onset Hearing Loss is considered an emergency and should be referred to Audiology immediately by phone or fax for urgent booking.

Sudden onset hearing loss, also referred to as sudden sensorineural hearing loss, is a sudden, noticeable change in hearing. It usually occurs in one ear  and is often accompanied by tinnitus and/or vertigo (dizziness).  It is most common in adults between 40 and 50 years old.  In up to 90% of cases, the cause is unknown but commonly believed to be the result of a viral infection.  Other known causes include vestibular schwannoma, Meniere’s Disease, stroke, and head trauma.

If sudden hearing loss occurs, promptly contact an audiologist to have your hearing tested right away.  It is considered a medical emergency until the nature of the hearing loss has been determined by an audiologist or ENT. If the loss is found to be conductive after audiological testing, the urgency of the medical treatment is decreased unless a serious problem is suspected. If the nature of the sudden hearing loss is sensorineural, however, urgent care is required

Finding medical help fast increases the chances for recovery. The most common form of treatment for sudden onset hearing loss is corticosteroids and these should be started as early as possible from onset (within the first few weeks) in order to be effective.

Sudden Hearing Loss Poster (large format)

How do I prepare for my appointment?

In the majority of cases no special preparation is required for basic audiology services other than assuring that your ears are clear of wax prior to your appointment.  Your family physician will likely clean the ear canals if wax is present prior to sending you for a test. If specialized diagnostic testing is required you will receive specific instructions prior to the test.

Are there any risks to testing?

The risk of complication is very low for all tests. Any inserts or probe tips placed in the ear canal are made of soft materials. All of the sounds presented during testing are presented at a safe volume. Patients having a VNG/ENG test may experience some brief dizziness.

How long will the appointment be?

An initial hearing test is generally between 30 – 60 minutes in length. Subsequent visits for rechecks are usually shorter. Special diagnostic tests may be longer, depending on your symptoms or needs:

ABR 45 minutes

ENG/VNG 2 – 2.5 hours

Full APD testing 2 – 3 hours

What will happen when the testing is finished?

In the majority of cases, the audiologist will be able to give you a full report on the status of your hearing at the end of your appointment in terms of type and degree of hearing loss and sometimes will be able to explain the cause. You will receive appropriate counselling on your test results and any relating issues, and have your questions and concerns addressed. The audiologist will usually be able to inform you of any follow-up recommendations before you leave the department.

Who can refer for audiology testing?

Health-care professionals (physicians, speech-language pathologists, psychologists, etc.)

Educational professionals (teachers, resource teachers, etc.)

Self/Parents/Caregivers (self-referrals are now accepted at all sites)

Click here for contact information for each of our facilities

Hearing Aids

• Speech-Language & Audiology Canada – Hearing Aids: A Brief Orientation
• Speech-Language & Audiology Canada – Hearing Aids: Infographic
• American Speech-Language-Hearing Association – Hearing Aids
• American Speech-Language-Hearing Association – Adult Audiologic/Aural Rehabilitation

Sudden Hearing Loss

• American Hearing Research Foundation – Sudden Hearing Loss

Tinnitus Websites

• American Tinnitus Association
• Tinnitus & Hyperacusis Center
• Canadian Academy of Audiology – Tinnitus
• Better Hearing Institute – Tinnitus

If you have questions about Audiology Services in Horizon Health Network, please give us a call, or download our fact sheet.

Click here for contact information for each of our facilities.