https://www.gosh.nhs.uk/wards-and-departments/departments/what-expect-your-dual-sensory-clinic-appointment/

What to expect from your dual sensory clinic appointment

An appointment date and time will be agreed with you in advance. Appointments are longer than some other hospital appointments – lasting three to four hours.

The assessment usually involves the following eye assessments, some of which your child may have had previously:

  • Measurement of focus (visual acuity) and eye shape (orthoptics)
  • Standard examination of inside of the eyes using a slit lamp
  • Ultrasound scan of the eyes – a gel is placed on the outer surface of the eye and a probe is rested on the child’s closed eyelids, which shows the size and structure of the eyeball (globe)
  • Specialist eye photography – this takes digital photographs of the retina (back surface of the eye)
  • Further specialist eye tests may be performed as necessary such as electrophysiology.
After these assessments, your child will have the following hearing assessments:

  • Standard ear examination (otoscopy) with a light
  • Middle and inner ear pressure (tympanometry) to check if there is fluid behind the ear drum. Your child will feel slight pressure in each ear but this only lasts a few seconds.
  • Hearing reflexes to check that the muscle in the ear is working. A soft probe is placed inside the ear canal – again your child will feel a slight pressure and hear a noise but only for a few seconds
  • Otoacoustic emissions to check that the inner ear (cochlea) is working. A small earpiece which makes clicking sounds is placed inside the ear canal and the responses from the cochlea are recorded
  • Audiogram to measure the level of hearing using headphones, speakers or headbands. This test is done in a soundproof room and we adapt this test to your child’s age and needs..
  • Auditory brainstem response to check the nerve pathways from the ears to the brain. Small sensor stickers are placed on the skin to detect the electrical signal sent by the hearing nerves. Sounds are played through headphones, earphones or through a sound conductor placed behind the ear.
The last set of assessments are to check your child’s balance and include the following:

  • Rotation chair test to record eye movements during movement. Your child will sit either on their own or on your lap, in a chair that swings and spins towards the right or left. Eye movements are recorded using camera goggles or sticky pads placed next to the eyes and forehead. 
  • Vestibular evoked myogenic potential (cVEMP) assessment looks at how the neck muscles react to sounds played through earphones. Sticky pads are placed on your child’s head and neck to record the muscle response. 
  • Video head impulse test (VHIT) measures how your child’s eyes move when their head is moved quickly in different directions.
  • Caloric test to check for dizziness when cool and warm water is trickled into each ear. Your child will lie down for this test
  • We aim to carry out all these assessments in the one clinic appointment. It helps if your child is as relaxed as possible – ask for our suggestions for getting your child used to headphones before the appointment. If we cannot finish all the assessments needed in one appointment, we will book another appointment to complete them.