Alisha Smith, Author at Hear and Say

An audiogram is a graph that displays the results of a hearing test. It shows the softest sounds someone can hear at different pitches (low, mid, and high frequency sounds), including those required to hear and understand speech (the major speech frequencies). Where the results fall on the audiogram reflects how loud a sound must be for someone to hear it and which speech and environmental sounds can be heard and not heard at their normal volume.

If you or someone you know has had their hearing tested, you might have seen a chart like this:

How is an audiogram done?

The type of hearing test depends on the person's age and abilities. Sounds are played through the speaker, headphones, ear plugs, or headband in a quiet listening environment. The person must indicate that they have heard it in some way - options includes pushing a button, raising a hand, playing a piece in a game, or turning their head to a puppet. The volume of the sound is changed until the softest sound is determined. This is called a hearing threshold. Then different pitches are tested. Adults and older children are tested on six to eight pitches while young children complete four pitches.

Typically, the right ear and left ear is tested separately. When working with young children, sometimes the ears are tested together as they are unable to wear headphones or ear plugs

Air Conduction Testing – Testing starts by measuring the whole ear system working together, via the speakers, headphones, or ear plugs. This is called an air conduction test, because the sound travels through the air, via the ear canal, ear drum, and middle ear bones.

Bone Conduction Testing – If a hearing loss is found, then testing aims to identify what part of the ear is not working. A vibrating box on a headband is used. This is called a bone conduction test because the sound travels through the bones of the skull, directly to the hearing organ or cochlea.

When the sound is played loud enough, both cochleae will hear it, regardless which ear is being tested, as they are close together in the skull. Therefore, whooshing or rain sounds will be play into one ear to distract it while the other ear is tested. This is called masking.

The ability to hear speech is then assessed. The person is asked to point to pictures or repeat words or sentences. This tell us how well a person can hear and understand speech to see how much a hearing loss is impacting a person’s communication.

What are the different types of hearing loss an audiogram will measure?

An audiogram will help identify not only if someone has a hearing loss, but the type of hearing loss they have. Knowing the degrees of hearing loss, which ear or ears the hearing loss affects, and if the hearing loss is conductive, sensorineural or mixed helps inform what treatment options are best.

Conductive hearing loss

Conductive hearing loss occurs when sound is unable to travel through the outer or middle ear. This could be due to earwax or a foreign object blocking the ear canal, a ruptured ear drum, fluid or infection in the middle ear space, or damage to the middle ear bones. Often conductive losses are temporary and will resolve when the obstruction is removed, the ear drum heals, or the middle ear fluid clears. This can require medical treatment. Some conductive hearing losses are permanent, so it is important to recheck hearing after any medical treatment.

Sensorineural hearing loss

Sensorineural hearing loss occurs when the cochlea cannot detect sound and/or send it via the hearing nerve to the brain. It is often due to the hair cells in the cochlea being absent or damaged. This can be due to an inherited genetic condition, excessive noise exposure, aging, injury, or disease. Sensorineural hearing losses are often permanent.

Mixed hearing loss

Mixed hearing loss is a combination of both conductive and sensorineural hearing loss. In these cases, there is damage to both the outer/middle and inner ear/cochlea.

How long does an audiogram take?

This depends on the person's age and hearing ability. A full hearing test can take between 40 to 90 minutes. This will likely be longer if a hearing loss is found. This includes about questions about your hearing concerns, hearing history, and general health or lifestyle. It is important to mention any previous ear infections/surgeries, if you experience any dizziness/balance issues, if you have seen an Ear, Nose, and Throat Specialist (ENT), or if you have a family history of hearing loss (particularly if it is permanent or acquired from a young age). Parents will also be asked if their child passed their newborn hearing screening and about their speech and language development.

How do you read an audiogram?

The horizontal axis of the audiogram represents the sound’s pitch or frequency range, ranging from 250 to 12,000 hertz (Hz). Most speech is within 250 to 6,000Hz. Vowels are typically low pitch while consonant are typically mid or high pitch. Soft high pitch sounds such as ‘s’, ‘f’, ‘th’ and ‘t’ are often the most difficult to hear because high frequency hearing losses are most common.

The vertical axis shows the sound’s loudness or volume, ranging from -10 to 120 decibels (dB). The closer to the top your results are, the better you can hear sounds.

Each ear is recorded as a separate line on a chart called your audiogram. A blue cross symbol is your left ear and the red circle symbol is your right ear. A black box or ‘s’ symbol shows how a child hears when listening with both ears together. Air conduction results and bone conduction results are also marked separately.

Any sounds below the line can be heard while any sounds above the line cannot be heard.

What does normal hearing look like on an audiogram?

Normal hearing for children and adults is between -10 and 20dB.

A hearing loss occurs when hearing is at 25dB or greater. The severity of a hearing loss is determined by how loud sounds must be for them to be heard. The severity of hearing loss may change between different pitches and between each ear.

Mild hearing loss = 25-40dB
Moderate hearing loss = 45-65dB
Severe hearing loss = 70-85dB
Profound hearing loss = 90dB or greater

Who should get an audiogram?

If you are worried about your hearing or suspect you have a hearing loss, a hearing test is recommended. Here are some common symptoms of hearing loss:

Missing what people say.
Asking people to repeat themselves.
Asking people to speak clearer or stop mumbling.
A ringing or buzzing in your ears (tinnitus).
Difficulties following conversations.
Difficulties talking on the phone.
Turning up the volume on the TV or radio.
Difficulties hearing people when it is noisy, for example in a restaurant or at the shops.
Using lots of effort when listening or finding listening tiring.

Children may also show delays in their speech and language development.

What’s next?

Following a hearing test, the audiologist will talk through the hearing test results, including if there is a hearing loss.

If there is a hearing loss, a treatment plan will be discussed. This may include watchful waiting, further/repeat testing, seeing an Ear, Nose, and Throat Specialist (ENT), using communication strategies, trialing hearing aids, or considering a cochlear implant.

For people who require hearing aids, the audiologist will use the audiogram results to determine how to program the hearing aids so that the person can hear clearly.

Hear and Say provides an array of audiology services for people of all ages, including comprehensive hearing tests, hearing aid fitting and management, tinnitus assessments, and hearing/cochlear implant services.

Find out more or book your hearing test today.

Whether it's to listen to music or the TV, for a call at work, or to study, headphones are a regular part of everyday life for many of us. However, for people who also use hearing devices such as hearing aids or cochlear implants, using headphones to tailor your listening experience comes with some careful considerations.

If you have hearing aids or a cochlear implant, the first step is to check with your audiologist if the device has Bluetooth technology. If they do, you can stream sound and play audio directly from your smartphone or another wireless device, cutting out the need for headphones altogether.

"You will get the best sound directly via your hearing aids or cochlear implants, depending on the hearing technology you have for your specific hearing loss“, said Hear and Say Audiologist, Anna Whittington.

Things to consider when buying headphones with hearing aids

For some people with a hearing device, tracking down suitable and compatible headphones can be challenging.

Over-ear headphones, on-ear headphones, bone-conduction headphones, earbuds, in-ear headphones, stereo headphones, and noise-cancelling; there are a lot of options, and it can be a trial-and-error process.

When it comes to wearing headphones and finding the best headphones for you and your individual needs, the main factor to consider is fit.

For hearing aid users, it is important to find headphones that fit comfortably around your hearing aid microphones. If your headphones do not sit up and over the microphones, then you may not pick up any sound, so over-the-ear models can be a great option.

Ensure you also check for audio feedback – that is, listening for a whistling noise coming from the hearing aid – when using this style of headphones. If there is feedback, try repositioning the headphones, or test out a few models to determine what suits you best. Your Hear and Say Audiologist can assist you if hearing aid adjustment is required.

If the hearing loss is mild or in one ear only, some people may also prefer the sound without their hearing aids. Standard headphones can be used in this case, but a number of modern headphones can be customised to exactly match your hearing level. Speak to your Hear and Say Audiologist for more information.

In addition to fit, sound quality, noise isolation, and noise cancellation technology can be important and allow you to enjoy your music at lower volumes. If, however, you need to be aware of ambient sound, bone-conduction headphones may be a great choice for you.

Regardless of whether you wear hearing aids that are in-the-ear or behind-the-ear, there are some great headphones to suit.

Finding suitable headphones for In-the-ear (ITE) hearing aids

Finding the right fit for headphones and hearing aids can be easier for smaller ITE types of hearing aids. These include:

Invisible in the canal (IIC hearing aids);
In the canal (ITC);
Completely in canal (CIC hearing aids); and
Low-profile hearing aids.

These types of hearing aids all fit directly discreetly in the ear canal or in the ear and are generally compatible with on-ear headphones and over-the-ear headphones. Invisible in the canal hearing aid wearers may also be able to wear earbuds.

Finding suitable headphones for Behind-the-ear (BTE) hearing aids

If your hearing aids sit behind the ear, the options for headphones are limited. These include:

Behind-the-ear;
Receiver-in-the-canal (RIC); and
Receiver-in-the-ear (RITE).

Whilst hearing aids range in size, these all have a component that sits behind the outer ear and won’t work with on-ear headphones. Headphones that can be customised to your hearing may be a suitable solution.

Look for large styles that fit comfortably over both the ear and the hearing aid, so that sound can reach the hearing aid microphone without it being covered by the headphone’s cushioning. It is important to try on different models because if they do not fit completely over, the hearing aids will pick up external sound instead.

What are bone conduction headphones?

Bone conduction headphones don't actually rest on the ear, but directly in front on the listener's cheekbones. These specialised wireless headphones are gathering attention because, unlike traditional headphones and earbuds, the eardrum doesn’t vibrate to pass the information along to the cochlea. Rather, the vibrations from the bone conduction bee-lines for the cochlea instead.

With the lack of eardrum involvement, this technology is good for people with hearing deficiencies, as the bone conduction vibration acts in lieu of the eardrum.

These headphones are ideal for in-the-ear hearing aids, in the canal, completely in the canal, or invisible in the canal hearing aid user. Plus, some bone-conduction headphones are waterproof and can even be worn swimming.

Can bone-conduction headphones damage your hearing?

Even though these headphones bypass your outer ear and middle ear entirely, they still send sound to the cochlea and they can still damage your hearing if used improperly or at too high a volume. Like all headphones if used correctly, bone-conduction headphones are safe to use.

If you work in an office space, live in a city, and want to remain aware of background noise like traffic while walking or cycling, bone-conduction headphones may be a great solution!

Audeara A-02 wireless headphones and TV bundle

Audeara A-02 over-the-ear headphones can be programmed for optimal listening for anyone with mild up to severe hearing loss and are available in your nearest Hear and Say centre. As an approved Assistive Listening Device, Audeara headphones may be purchased using Government funding through the Department of Veterans Affairs (DVA) and RAP Program of Hearing Services Program (HSP).

Still not sure which headphones are best suited? Speak with you Hear and Say Audiologist or hearing healthcare professional.

We’re here to help. Book a hearing test or speech and language assessment for your child.

Get in touch

Almost one year old Archibald loves reading books, going on walks, playing at the local park, and playing chase (albeit only crawling away), and of all things – bananas!

Archibald was diagnosed with bilateral profound hearing loss at three weeks old. His mum, Cassandra, said they had mixed emotions, but they were immediately interested in finding out more information.

“We were shocked and overwhelmed as it was quite a sad realisation that he wasn’t going to hear normally however we were also interested to learn more about what this meant for Archibald’s future,” said Cassandra.

“It took us quite some time to process that he couldn’t hear. However, Romans 8:28 says, ‘And we know that in all things God works for the good of those who love him, who have been called according to his purpose.’”

“At 11 weeks old, Archibald was fitted with hearing aids, which due to his profound hearing loss, added limited benefit however gave him some access to sound,” she said.

The family found out about Hear and Say via Hearing Australia when Archibald was fitted with hearing aids.

“Hearing Australia provided options and after talking to other families, we visited Hear and Say and decided that they would be able to best cater for Archibald’s immediate and future needs,” said Cassandra.

“They were also super friendly and helpful during the journey leading up to receiving his implants.”

At nine months old, Archibald underwent cochlear implant surgery and had his implant switched on to sound for the first time two weeks later at Hear and Say’s Ashgrove centre.

“We had the switch on at Hear and Say, and are now continuing to come in regularly for audiology appointments to program the cochlear implant as well as speech therapy fortnightly to help catch Archibald up to his peers in terms of his speech and language,” said Cassandra.

“We are blessed to be in a country that has such fantastic support both financially and emotionally. We are so thankful for the amazing technology available to test and equip Archibald with the ability to hear at such a young age,” she said.

“Hear and Say have been amazing and very caring, and has given our family amazing encouragement for us as parents and helping Archibald reach his best potential.

Cassandra reflected on Archibald’s diagnosis of hearing loss now, nearly one year after finding out.

“We are excited to see him grow, and experience sounds in our world in a new way. He’s still our beautiful little boy and we love him so much. Even without his implants, this wouldn’t change,” said Cassandra.

“We know that Archibald’s hearing loss is part of God’s plan and purpose, we don’t understand at this point in time for what reason this has happened, but at some point, we will look back and understand as we see him use this as blessing to those around him and for God’s glory.”

Gold Coast toddler Kove is a bit of a groover, dancing and singing to music with his sister. He’s also a big fan of the outdoors from going down the slides at the park to going to the beach. Quiet time is also a fan favourite for Kove, who loves to sit in his parents Jarrad and Kirstie’s laps to read a book.

Kove’s hearing was screened at birth through the universal newborn hearing screening where he received a refer result. Through follow up testing at Gold Coast University Hospital he was diagnosed with a unilateral hearing loss at three months old.

“Kove has a moderate hearing loss in his right ear where he wears a hearing aid, and typical hearing in his left,” said Kove’s mum, Kirstie.

“I found that there was no drastic responses or feelings to this diagnosis as we were well informed by the teams every step of the way. We had an abundance of support from all of the services, so I can honestly say we were at ease with his diagnosis,” she said.

Kove experienced multiple hospitalisations due to illness which caused a mass of fluid to be present until he was almost 12 months old.

“He was then able to have grommet surgery which helped with being more receptive to sounds and also learning to make sounds,” said Kirstie.

“We as a family feel that Kove’s diagnosis is ‘normal’. We haven’t changed our feelings about it. He is still our baby and is still learning to communicate the same way, we just know how to help him understand better,” she said.

The family heard about Hear and Say through the hospital and Hearing Australia, who fitted Kove’s hearing aid.

“We go to Hear and Say’s Varsity Lakes centre on the Gold Coast once a month for speech pathology,” said Kirstie.

“It has been an amazing experience to have Fiona as Kove’s speech pathologist since the early days. It has made some transitions so much easier,” she said.

“It has allowed us to have a better understanding of the way we communicate with Kove as well as others around him. It has also helped support our families and friends in the best way to effectively communicate with Kove.

“Watching the relationship the team has built with Kove has been a heart-warming experience! We have nothing but appreciation for the care and support we have received from the team at the Gold Coast centre!”

Representing Australia in the Deaf International Cricket Cup reinforced for Liam how life-changing sport can be. At 22 years old, Liam played the T20 World Cup in Dubai.

“Competing was an absolute honour and privilege. I had an incredible time with all my fellow teammates. We finished last in the competition, but in a few years’ time I feel as though we will be a team that is hard to beat,” said Liam.

As a young baby Liam was diagnosed with profound hearing loss, and at 18 months old he received his first cochlear implant on his left side. It was common practice to implant on one side only at this point in time. When Liam was in Prep he got a cochlear implant on his right too.

As a child Liam came to Hear and Say for audiology and specialised speech therapy lessons. This early intervention meant that Liam grew up able to hear and speak, which he doesn’t take for granted.

“It’s been a huge effort by the passionate audiologists and speech therapists working at Hear and Say, and by my Mum and Dad. A lot of credit [goes] to them, I get a lot of compliments about how well I’m able to speak,” said Liam.

Growing up Liam went to his local schools and played sport, and as he got older his interest was piqued in Deaf sports.

“I’ve found most of my connections through playing sport. There are so many different sports you can play in the Deaf community and being surrounded by people who are similar to you is actually really, really cool and rewarding,” said Liam.

“With Deaf sports, you can’t actually wear your cochlear implant processors, so to communicate you use sign language.”

The team uses a mix of methods to communicate. There are players like Liam who wear hearing devices and speak, and some teammates hear, speak and use sign language. One player is solely reliant on sign language. In the midst of a game, everyone signs.

“Learning how to communicate via sign and be inclusive of those facing hearing loss challenges is awesome and something that has pushed me to enjoy the game and experience what it’s like in those situations,” said Liam.

“A big part of it is watching your captain and being able to communicate with him. He’s doing a lot of communicating to tell you where you need to be.”

Liam also plays social football and basketball with his mates. During these games he wears his cochlear implants and says verbal communication is critical. When playing Deaf cricket however, Liam explained there is something special about the quiet.

“I feel I have this sense of calmness when I don’t have my cochlear implant processor on because I'm with myself and my thoughts. As a bowler, it's good when I'm at the top of my run up, to be able to focus on one goal and block all the noise out,” said Liam.

Liam is studying physiotherapy and has a world of opportunity ahead of him. From his own experience growing up with hearing loss, he shared his advice for parents who have just found out their child is deaf.

“Try and get your kids involved in sports or group activities so they’re in social settings, I think this really helps to build confidence,” said Liam.

“If they can be socially confident it might help build their confidence about themselves as well. Try and get them outside of their comfort bubble, challenge them to do new things,” he said.

After representing Australia in Deaf sports Liam reflected on how important communication was and expressed how lucky he felt.

“To be able to hear and speak means everything [to me]. I think what Deaf sport has also made me realise is that communication is a massive thing, without it you can’t express how you feel,” said Liam.

“To be able to speak is one thing but to be able to hear is a whole other experience in itself. It’s incredible to be able to do both those things.”

Five-year-old Prep student Sam from Bushland Beach, just north of Townsville, was born with mild to moderate mixed hearing loss however hasn’t let it hold him back.

He keeps himself entertained, like any five year old, playing hide and seek and soccer. He enjoys going to the playground or beach with his brother Miles as well as dancing to the Shrek soundtrack, going to the local library and museum.

“Sam was diagnosed with a hearing loss during his newborn screening test. The nurse thought there was an error and ran it a second time with the same result,” said Karen, Sam’s mum.

“She didn’t save the initial test, and came back the next day to run it again to see if new equipment gave a different reading,” she said.

“When the results were the same, she advised that Sam would need further testing and talked us through the referral process and what would happen next.

Sam’s parents hadn’t given any thought to Sam potentially being born with hearing loss as they didn’t have any family members with hearing issues.

“Sam’s hearing journey has been a bag of mixed responses. While in Brisbane, we kept receiving a mild hearing loss diagnosis and were told he should be fine, it’s only mild. Come back for more tests in one year and we’ll check any improvements or declines,” said Karen.

“Over three years, Sam had roughly five hearing tests, most unable to be completed as he’d get restless, yet the results were the same – mild hearing loss, come back next year. We were told Hearing Australia wouldn’t do anything until he was school age,” she said.

The family were then referred to the Childhood Health Hearing Clinic in Brisbane however with a sudden work transfer to Townsville plans changed quickly, which is when they were referred to local Ear, Nose and Throat (ENT) Specialist Dr Shane Anderson for a follow up.

“It was Dr Anderson who referred Sam to Hear and Say as he told me he loved their individual response to children and were great at what they did,” said Karen.

“Due to COVID-19 restrictions, our start with Hear and Say was delayed and we finally found a window of good health for Sam, and met with Liza, Audiologist and Listening and Spoken Language Therapist, a couple of times to complete the testing and assessment,” she said.

In late 2022 Sam was fitted with a hearing aid, and started Prep in 2023 at his local school, and continues to see Hear and Say each fortnight for regular specialised speech therapy.

“Sam has had hearing tests, speech and language assessment and now ongoing speech and language therapy through Hear and Say,” said Karen.

“Liza has been fantastic at being Sam’s champion when it comes to hearing loss. She has advocated for him to get a hearing aid as well as visited his school and met his teacher to talk her through using the remote microphone system technology,” she said.

“It was when we went to Hear and Say that I felt Sam’s hearing loss was deemed ‘real’. Liza acknowledged a hearing loss is a hearing loss, and even mild hearing losses can have consequences on speech and language, education and developmental milestones should be addressed and supported.

“It was such a relief we had finally found someone who supported our views, and actively set out to help Sam with his hearing loss.

“It opened our life to a whole new world of deaf and hard of hearing families. Educating myself at the start of this journey was key, so I armed myself with all the knowledge I could get to be able to support Sam.”

Unilateral hearing loss is when someone experiences hearing loss in one ear only. Generally speaking, if unilateral hearing loss is severe-to-profound, it can also be referred to as single-sided deafness.

The degree of unilateral hearing loss can range from mild to profound. Causes can include genetic disorders, viral infections, trauma or when a someone is born with specific ear abnormalities (for example, microtia and atresia). In many cases, the reason for unilateral hearing loss unknown.

How common is unilateral hearing loss in Australia?

Unilateral hearing loss can occur in both children and adults. If a baby has hearing loss at birth it is diagnosed though the newborn hearing screening. As children get older, it is also possible for them to develop hearing loss, with the instances of hearing loss doubling by the time they reach school age. It’s also possible for adults to develop hearing loss, this might be a result of noise induced hearing loss, injury, or illness.

What are the symptoms of unilateral hearing loss?

The signs and symptoms of unilateral hearing loss include:

Favouring one ear when having conversations or talking on the phone
Often asking others to repeat what they’ve said
Feeling tired at the end of the day, likely from straining to listen
Struggling to work out the direction sound is coming from (localisation)
Have ringing in one ear (tinnitus)
Participate less in social situations
Struggling to understand speech in noisy environments

What causes unilateral hearing loss?

Unilateral hearing loss can be caused by a number of factors including:

Genetics
Accident, trauma or head injury
Viral or bacterial infections
Illness during pregnancy (e.g. cytomegalovirus)
Microtia and atresia
Ménière’s disease
Mastoiditis
Excessive noise exposure

What is the impact of unilateral hearing loss?

If unilateral hearing loss is left untreated, it has the potential to impact people’s speech and language, social and emotional wellbeing and educational progress in both children and young adults.

People may have difficulty with:

Sound localisation: the ability to find where a sound is coming from. Sound will appear louder when closer to the better hearing ear. Sounds coming from a variety of directions may also be hard to locate, for example, when a child is playing in a playground or listening to peers in a classroom or in a noisy cafe.

Hearing speech in background noise: someone with unilateral or single-sided deafness will be better able to pick up speech if it’s directed to their better-hearing ear. Separating speech from background noise can be difficult especially hearing in a classroom or a restaurant.

Hearing from a distance: struggling to hear and understand people if they are standing at a distance, for example a farmer or construction working might find it challenging to hearing instructions if the person they’re talking to is not immediately next to them.

How is unilateral hearing loss diagnosed?

Unilateral hearing loss is diagnosed with a hearing test. They type of hearing test can range depending on the age of the person.

For newborn babies they are often diagnosed through the universal newborn hearing screening. If a baby is referred for further testing for one ear, an appointment with an audiologist is made within six weeks. The audiologist will then conduct an auditory brainstem response (ABR) test. This assessment is painless and is conducted while the baby is asleep.

For toddlers and young children, behavioural hearing tests are often used to diagnose hearing loss.

For anyone older children and adults hearing tests take about 60 to 90 minutes and involve a series of non-invasive assessments.

Can unilateral hearing loss be corrected?

For some people their hearing loss is temporary, however often unilateral hearing loss is permanent. Hearing technology, such as hearing aids and cochlear implants, can help correct hearing loss and provide improved access to sound.

What can be done to treat unilateral hearing loss?

Hearing technology, such as hearing aids or cochlear implants, can often improve hearing. The severity of the hearing loss and lifestyle of the individual will help determine what device is best.

Hearing aids

Hearing aids are a common technology used to treat hearing loss. Hearing aids amplify existing hearing and, when worn consistently, can help prevent further deterioration of hearing by keeping the brain's auditory pathways stimulated. In the case of unilateral hearing loss, the hearing aid would only be worn on the poorer-hearing ear. Potential hearing aid options include traditional behind-the-ear; contralateral routing of signal (CROS); and bone conduction models.

Cochlear implants

Implantable technologies, such as a cochlear implant, are suitable for people with permanent, severe to profound unilateral hearing loss. Through surgery, a cochlear implant is implanted – bypassing the normal hearing process. A cochlear implant performs the function of the inner ear by converting sounds to electric signals that stimulate the auditory nerve.

Use of a wireless communication device (WCD) system in the better hearing ear

Working with hearing aids or cochlear implants, wireless communication device systems improve understanding of speech in noisy environments by transmitting the speech signal directly to the better hearing ear, via a remote microphone used by whoever is speaking.

Early Intervention

Early intervention and support from a team of specialists, including audiologists, speech pathologists and ENT surgeons, can help the person with hearing loss to hear and speak to the best of their ability. These professionals work together to help ensure they can reach their full potential. Seeking support as soon as possible is vital to achieving the best possible outcomes.

We’re here to help. Book a hearing test or speech and language assessment for your child.

Get in touch

As every parent knows, a child's development against key milestones can vary and may not always align with key development stages. While every child develops at their own pace, speech and language skills follow a relatively expected development path.

Around the one-year mark, children start to imitate the sounds around them and in the following months, tend to string words together. It's important that during this time you monitor your child's development and encourage speech development.

Unable to say previously learned words
Having trouble imitating sounds
Preferring to point or use non-verbal cues instead of calling things or people by name
Strangers finding it hard to understand their pronunciation of words

Signs of possible speech delay at two-years-old

Here is what to look out for in your child’s speech:

Your child found it difficult learning and saying their first words
They struggle to say 50 proper words
They don’t understand simple directions and commands
They can’t combine words to create two-word phrases such as “more food”
It affects their normal routine and time spent with other children
They rarely sing songs

Speech delays can be disheartening for parents however early treatment can help your child reach speech milestones similar to their siblings and peers.

If you have a late talking toddler that is displaying these signs, it is vital you go to see a doctor and get your child evaluated by a qualified speech pathologist so that the problem can be treated accordingly.

Signs of possible language delay in a two-year-old

Different to a speech delay, a child with an early language delay can make the correct sounds and knows the correct pronunciation of words but may struggle to form coherent sentences and words.

Peer reviewed studies show that symptoms include:

Not babbling at 15 months old
Not talking at two years old
Struggling to pronounce words
Leaving words out of sentences and not adding new words to their vocabulary
Not expressing themselves through language
Struggling to converse with other children of the same age because of their lack of communication skills

Early intervention is key for language delays. A speech pathologist can assist with your child’s progress and development.

Possible reasons for the speech delay

There are various risks that should be considered if your toddler is struggling with speech and language delays, including neurological and hearing problems.

Primary risk factors can include:

Developmental Expressive Language Disorder (DELD): a condition that affects a child's ability to express themselves through spoken language, gestures and writing.
Receptive language disorder: a condition that affects a child's ability to understand and process language they hear. This can impact a child's primary speech and means they will struggle to learn new words.

Secondary risk factors may include:

Hearing loss: if you have a late talking toddler, they may need a hearing test. A child’s speech can be largely affected by their ability to hear and clearly understand what other people are saying.
Cerebral palsy: a group of disorders that affects a person’s ability to control their muscles and maintain their speech.
Childhood apraxia of speech: a condition where a child has serious speech and language delays because they have difficulty making accurate mouth and tongue movements when speaking.
Dysarthria: a condition where speech is delayed because of damaged nerves from the brain to speech muscles.
Autism spectrum disorder: a condition that can affect speech and language development, but children with autism tend to meet other communication milestones, such as gesturing. They may have difficulty articulating so it is important to monitor your child’s social skills and if they speak in a robotic or unusual tone – this can be an indication of autism spectrum disorder.

Speech delays can be indications of anything, from regular but slow development to an intellectual disability. As every child is different, it's important to speak to your child's doctor and closely monitor their developmental delays.

Although these factors should be considered, your child may have late language emergence, where no other diagnosed disabilities are evident. In this case, it is still important that you facilitate your child's language development by getting help from a speech pathologist to prevent any future speech disorders that may develop.

What should I do if I am concerned about my two-year-old child's speech and language development?

The number one action you should take is contacting your child’s doctor and speaking with a speech pathologist.

This way your child can be assessed with a speech and language assessment to find out what may be causing their developmental delay.

Your doctor will want to know how your child has been progressing, it is helpful to monitor their development and any specific parts of their speech and language they struggle with.

Assessment and diagnosis

Through different tests and communication tasks, your doctor and speech pathologist will be able to appropriately diagnose your child and their possible developmental disorders.

Think hearing first

Before undertaking a speech and language assessment, it is always recommended that children have a hearing test to confirm whether or not a hearing loss may be impacting their speech or language development.

Early intervention is key and any child with a suspected speech and language delay should see a health professional (such as their GP or speech pathologist) as soon as possible.

Speech and language assessment

The speech and language outcomes of an assessment will assist your speech pathologist in making an accurate diagnosis for your child. This assessment will test your child on:

If and how they make a range of sounds
If they can understand and respond to cues from the speech pathologist
If they can consistently repeat and pronounce words correctly
If they have strength in their speech muscles to speak effectively

Treatment and methodologies

A speech pathologist and a surrounding team of allied health professionals, play an essential role to improving a child’s speech and language skills.

After the diagnosis, an individualised treatment plan will be developed by a speech pathologist to address the needs and concerns of your child.

If the hearing test reveals a hearing loss is present, treatment options such as hearing aids, cochlear implants or bone anchored hearing aids are available, alongside speech therapy depending on the severity of your child’s condition.

Ongoing support

It can be difficult find out that your child has speech and language delays. It’s even harder to know what the next steps are going forward. With the guidance of health professionals, your child will be given the skills needed to reach milestones at the same rate as their peers.

Early intervention

Early intervention often consists of highly specialised speech therapy sessions, with the aim of helping children and families overcome speech and language delays. A qualified team of speech pathologists will carefully follow the progression of the child to ensure milestones are being achieved.

Therapists will also teach families more about their child's specific challenges and provide the necessary resources and skills to improve communication skills.

Families can work one-on-one with a speech therapist, either in-centre or via telehealth, to learn a variety of strategies that will assist a child's speech and hearing development.

Tips for parents of a late-talking two-year-old

“Late talker” is a term used for children typically within 18 and 30 months of age who display late developments in speech with no reason.

For children with hearing loss, most of those who receive early intervention prior to 12 months of age, develop age-appropriate speech and language skills by the time they’re three years old.

Early intervention with a qualified speech pathologist is recommended to encourage speech development amongst late talking toddlers. However, parents can help their children to develop early speaking skills with the following tips.

Avoid excessive questions: Constantly asking questions can be more stressful than encourage for your toddler. Make sure you use a calming tone of voice to avoid the feeling of anxiety.
Speak slowly: Remember to speak slowly to ensure that your child has a better understanding of each word.
Keep responding: It's important to make sure that you continually listen and respond to your child regardless of if they can't speak full words or sentences yet.

In some cases, a speech delay is caused by an underlying condition that requires immediate treatment. Speech or language therapies are available, alongside other therapies to help deliver the best possible outcome for your child.

One in five children learn to talk later than their peers, so it’s not always a cause for concern. If your two-year-old is showing signs of speech delay or you have any questions or concern with their language development, then please seek advice from a certified paediatrician.

Early intervention programs, alongside speech and language are available to help your two-year-old reach milestones.

We’re here to help. Book a hearing test or speech and language assessment for your child.

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The speed of your child's development can certainly vary from other children, and their learning of speech and language is no different.

A speech delay is when a child is not developing speech at a rate similar to their peers, finding the most difficulty in making the sounds that form words.

In some cases, children have no issue speaking however they have trouble developing language skills. A language delay is when a child finds difficulty in understanding and using spoken language; their main challenge is with the comprehension of what they are hearing.

Signs of possible speech delay for a three-year-old

Unable to say previously learned words
Having trouble imitating sounds
Preferring to point or use non-verbal cues instead of calling things or people by name
Strangers finding it hard to understand their pronunciation of words

Signs of possible language delay for a three-year-old

Struggling to combine words into three- or four-word sentences
Showing little interest in books
Cannot follow simple verbal requests
Do not ask questions
Cannot tell a story or repeat a nursery rhyme

Possible reasons for three-year-old speech delay

Hearing problems: A problem with a child's hearing is likely to affect their ability to form sounds and words. This can stem from seemingly small issues like ear infections to a permanent hearing loss. Observing how your child interacts with non-verbal cues like gestures, in comparison to speaking, may give you an indication if this is an issue.

Intellectual disability: Intellectual disability is another common cause of speech delay. Children with intellectual disability can have difficulty understanding social and practical situations.

Physical mouth problems: Delayed speech can come as a result of physical problems with a child’s tongue, lips, teeth or jaw.

Autism Spectrum Disorder: Problems with speech development often come as a result of Autism Spectrum Disorder, along with other delayed development signs such as impaired movement, cognitive and social skills.

Premature birth: Children born prematurely are more likely to experience delayed speech between two and three years old. This is as a result of the lack of development in the auditory cortex, the region of the brain responsible for understanding speech and language.

Cerebral Palsy: Speech delay is a commonly occurring trait in children with cerebral palsy, particularly the athetoid type, due to different levels of mental and physical development.

Other disorders: Other disorders that can account for developmental delay are expressive language disorder (an inability to translate ideas into speech), receptive aphasia (not listening rather than not hearing) or elective mutism (children choosing not to speak).

What should I do if I am concerned about my toddler's speech and language development?

The first step to take when concerned about your child’s speech and language development is to seek professional help, talking to a GP is often a good place to start.

Not only will this provide peace of mind as a parent, but will allow your child to receive the support they need as soon as possible.