Children

What parents should know about hearing loss

Beyond the test booth

What parents should know about hearing loss

FAQs:

What is hearing loss?
The term "hearing loss" is used when tests demonstrate a child is not responding to sounds that are established as normal hearing levels. It does not necessarily mean a complete inability to hear. There are degrees of hearing loss that range from a very mild hearing loss which may go unnoticed, to a very severe hearing loss which makes it virtually impossible for a child to develop speech and language skills without help. We use the term "deaf" or "profound hearing loss" to refer to a very severe loss of hearing, in excess of 90dB, HL. We use the term "hard of hearing" to refer to a hearing loss less than 90dB. The phrases "hard of hearing” or “hearing impaired" are umbrella terms that are sometimes used. How the child learns to function using his/her residual hearing is more important than the exact degree of hearing loss represented on the child's audiogram.

What about Colds and Ear Infections?
Colds, upper respiratory infections, and ear infections should be treated immediately to prevent hearing loss. When a child has a cold or is congested, the Eustachian tube which connects the middle ear with the back of the throat and nose can become blocked. Fluid cannot drain as easily from the middle ear, and bacteria can grow and cause an infection. Usually antibiotics can kill the infection-causing bacteria. But with some children, the fluid stays in the middle ear for an extended period of time and can cause temporary hearing loss. This "fluid in the ear," or serous otitis media is common in children. Young children may have no symptoms. Older children will be aware of a hearing loss or sense of ear fullness or pressure. While this hearing loss is reversible, if severe enough in degree, can still affect and delay speech and language development as well as interfere with learning in school if not treated promptly. When middle ear fluid persists for months or years, it can lead to irreversible hearing loss and chronic ear infections.

What Can Be Done to Help the Child with a Hearing Loss?
Parents have many important decisions to make regarding their child’s hearing loss. The first very important step is to have a complete evaluation. The child’s capabilities, skills, and needs will be assessed. The results of the evaluations will help to clarify what is the best route to take regarding the child’s mode of communication and therapy, as well as amplification or surgical options. This requires a team approach. The professionals seeing your child should include an audiologist, an otologist, a speech/language pathologist, a psychologist and the child’s pediatrician.

The audiologist is responsible for the clinical measurement of the hearing loss, assists in determining the type of hearing loss, and evaluates the child for the use of amplification (hearing aids or an auditory training FM unit).
The pediatrician evaluates the child for general health problems. At times referrals to other medical specialists may be recommend.
The otologist, a physician who specializes in problems of the ear determines if the hearing loss can be medically corrected and helps determine the cause of the hearing loss.
Some parents choose to consult with a geneticist to help determine the cause of hearing loss.
The speech-language pathologist evaluates language understanding and speech ability, and is responsible for designing and implementing a concentrated program of communication therapies, with appropriate goals and expectations. The speech-language pathologist continues to follow the child's progress and monitor language development, speech production, overall communication skills, and sets new goals over time. The child is helped to develop comprehension or receptive language, spoken language and auditory skills to his/her fullest potential.
The psychologist is responsible for assessing the child's abilities and needs, learning style, interpersonal relationship skills and stage of development. The psychologist also can help the parents develop an understanding of hearing loss, how it impacts on cognitive, communication, social/emotional skills, daily living and academic abilities and can assist in establishing realistic expectations, exploring parental feelings and reactions to the hearing loss.

How important is Early Diagnosis?
It is now possible to screen a baby's hearing hours after birth through automated auditory brainstem response screening (ABR) and/or otoacoustic emissions screening (OAE). Both techniques allow healthcare professionals to determine if a newborn may have a hearing loss and are easy to administer, relatively inexpensive, accurate, and cause no discomfort to the infant. Early diagnosis is of paramount importance. The earlier the hearing loss is diagnosed the better for the child. There is considerable evidence to support the fact that regardless of the type of intervention strategy chosen (e.g. auditory/oral approach or total communication approach), overall communication skills are enhanced in children who have their hearing loss diagnosed and begin intervention within the first six months of life.

When Will A Child with a Hearing Loss Start to Talk?
When parents choose an auditory/oral approach, extensive speech and language input is necessary, and this takes time. However, exactly when the child will start to talk depends upon the child, the degree of hearing loss, the family's support system, the child's age when the hearing loss was identified and amplification provided, the benefit received from the amplification, and other factors. Learning to talk is a process that always requires much time and effort, but with the right support, it can and does happen.

What about Hearing Aids?
Hearing aids are a very important part of the program for a child with a hearing loss. Appropriately fit hearing aids allow the child to make contact with the world of sound. There are many technological breakthroughs, but there is no surgery, assistive device or aid currently available that can restore normal/perfect hearing. Unlike eyeglasses which usually restore normal sight, hearing aids do not restore normal hearing. A hearing aid can make things louder but may not always be able to make words and speech clearer. The degree of the loss of clarity may often depend on the degree and type of hearing loss. Through auditory training and speech and language therapy, children with hearing loss learn to make sense out of the sound he/she hears.

Are Two Hearing Aids Better Than One?
For most children, two hearing aids are better. In some cases, when there is a large difference in the degree of hearing loss between the two ears, only aiding one ear is sometimes more beneficial. Your audiologist will help determine which is best for your child.

Can A Hearing Aid Make Hearing Worse?
Hearing aids should not make hearing worse. Trained pediatric audiologists use specific strategies in selecting and fitting hearing aids to ensure that the hearing aids are of an appropriate volume for a child without causing harm.

Can My Child's Hearing Get Worse?
Some children's hearing can get worse over time. This may be referred to as a progressive loss and is associated with some specific causes of hearing loss. All children with hearing loss should have their hearing monitored on a regular basis to evaluate for any progression in hearing loss. If hearing loss progresses, hearing aid fittings may need to be modified and/or new amplification selected.

What is a Cochlear Implant?
A cochlear implant is very small, very complex electronic device that can provide sound to a person who has a severe or profound hearing loss. The implant is surgically inserted under the skin behind the ear and into the cochlea (the snail-shaped organ of hearing). An implant has four parts: a speech processor, worn behind the ear or as a body pack which processes sound picked up by a microphone, a transmitter and a receiver that receives signals from the speech processor and converts them into electric impulses, and the electrodes (implanted in the cochlea) that collect the impulses from the receiver and send them to the brain.

An implant does not create normal hearing. However, it gives a person with a severe or profound hearing loss access to sound, and may help them to understand speech. Cochlear implants compensate for damaged parts of the inner ear. The cochlear implant sends electronic impulses to the brain. The brain interprets these impulses as sound. With the help of intensive speech and language therapy, many children with cochlear implants develop excellent speech and language skills. There is no definitive “best” age for implantation. Some children are being implanted before their first birthdays when a definitive diagnosis of hearing loss has been made.

What are some helpful terms to know?

Air Conduction Test: measures hearing by placing earphones over the child's ear or placing “insert phones” (soft foam ear plugs) in the child’s ear. With this test, sound travels through the outer, middle and inner ear.
Amplification: a) to make louder, increase volume b) a term that may be used to refer to hearing aids.
Analog Hearing Aid: Sound is picked up by a small microphone, converted into electrical impulses and then made louder for the user to hear.
Assistive (Alerting and Listening) Devices: Devices that provides greater and easier access to speech and sounds, facilitating your child’s independence as well as ensuring safety.
Auditory Steady State Response Test (ASSR): measurement of brainwaves in response to sound; can provide objective information regarding hearing sensitivity when this information cannot be obtained reliably through behavioral measures. This test may be able to provide greater frequency specific information regarding hearing as compared to ABR testing. This test also has the capability to be more specific in diagnosing the degree of a more significant hearing loss.
Atresia: absence or malformation of the outer or middle ear.
Audiogram: a graphic description of hearing.
Audiologist: a clinician trained to diagnose, evaluate, and treat hearing loss.
Audiotherapy: a method of training people to use their residual hearing to the best of their ability.
Auditory brainstem evoked response test (ABR) or Brainstem Auditory Evoked Response Test (BAER): measurement of brain waves in response to sound; can provide objective information regarding hearing sensitivity when this information cannot be obtained reliably through behavioral measures.
Aural/oral therapy: speech/language therapy and educational programming to develop maximum use of residual hearing, oral language and intelligible speech.
Bilateral hearing loss: hearing loss in both ears.
Binaural hearing aids: hearing aids in both ears.
Bone Conduction Test: measures hearing by placing a small oscillator (vibrating device) behind the ear and measures sound traveling directly to the inner ear.
Cochlea: the hearing organ within the inner ear.
Cochlear Implant: An electronic apparatus that may benefit those who are not obtaining expected or adequate benefit from hearing aids. The implant consists of a microphone and receiver, a processor that converts speech into electronic signals, and an array of electrodes that transmit the signals to the auditory nerve in the inner ear.
Conductive Hearing Loss: a hearing loss caused by damage or disease of the outer or middle ear.
Congenital: existing at or dating from birth, but not necessarily hereditary.
Cued Speech: a visual communication system using eight handshapes in four different placements near the face in combination with the mouth movements of speech to make the sounds of spoken language look different from each other.
Digital Hearing Aid: Sound is picked up by a small microphone, analyzed by a computer chip and then made louder through digital signal processing for the user to hear.
Earmold: a custom made product that fits in the ear and connects to a behind-the-ear hearing aid.
FM system (auditory trainer): an assistive listening device utilizing wireless technology. This can be used alone or in conjunction with hearing aids to provide the best signal-to-noise ratio for better hearing in adverse listening situations.
Geneticist: a medical professional who reviews a family’s medical history, recommends testing and determines a presence of genetic links to hearing loss. They may also provide counseling regarding family planning.
Hearing Aid: a device that amplifies sound. Hearing aids are available in a variety of sizes and levels of technology; candidacy may be, in part, determined by the results of a hearing test.
Immittance (Impedance) Testing: a test that measures the functioning of the outer and middle ear systems. This test consists of a tympanogram (measurement of ear drum mobility) and acoustic reflexes (presence and level of middle ear muscle contraction).
Speechreading (Lip reading): using visual clues to supplement auditory skills to understand oral language.
Middle Ear: portion of the hearing mechanism between the outer ear and the cochlea, consisting of the eardrum, the ossicles (bones), the opening of the Eustachian tube, the oval window and the round window.
Mixed Hearing Loss: a combination of conductive and sensorineural hearing loss.
Monaural: referring to one ear or one hearing aid.
Neurologist: a medical doctor skilled in the diagnosis and treatment of diseases of the nervous system.
Otoacoustic Emissions Test: (OAE) A test that measures how the hair cells within the cochlea work.
Otolaryngologist (Otologist or ENT): a medical specialist of the ear, nose and throat.
Peri-Natal: occurring at birth.
Pinna: outer ear.
Post-Natal: occurring after birth.
Pre-Natal: occurring before birth.
School Psychologist: A professional trained to perform educational and developmental evaluations to assess areas of strengths and weaknesses and make recommendations.
Residual Hearing: remaining hearing.
Sensorineural Hearing Loss: a hearing loss caused by damage to the inner ear (cochlea, eighth auditory nerve or auditory pathways).
Sign Language: A language that uses a system of manual, facial, and body movements as the means to communicate.
Speech/Language Pathologist: a clinician trained and certified to evaluate, diagnose and treat speech, language and communication problems.
Tinnitus: phantom auditory perception when no external sound is present. It is often described as ringing or buzzing in the ears.
Unilateral hearing loss: hearing loss in one ear.
Visual Reinforcement Audiometry (VRA): a method of evaluating a child's responses to sound by conditioning the child to respond by turning their head. This response is rewarded by the presentation of a visual stimulus (ex: video, mechanical toy)