Most children who are born with a hearing loss can be diagnosed through a hearing screening. In other cases, hearing loss in children is caused by factors like infections or trauma, and the problem doesn’t emerge until later. At Nemours, we take a team approach to caring for your child, using the most innovative pediatric assessment techniques to determine a child’s hearing needs.
Early identification and management of hearing loss in children is crucial to minimizing delays in speech, language and cognitive development. Team members from different specialties across Nemours collaborate to create solutions to treat and meet your child’s needs.
Health professionals who may be involved with diagnosis and treatment of hearing loss in children include:
- ear, nose and throat (ENT) doctors
- speech and language pathologists
- behavioral health experts
- deaf educators
- neurologists (doctors who treat problems of the nervous system)
We also strive to make things as easy and convenient as possible for you and your child. For example, because our doctors and therapists are all under one roof, your child can often have multiple appointments scheduled in one day.
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Hearing loss in children can be temporary or permanent. It can be partial or total. People also may use the words deaf, deafness, or hard of hearing when they're talking about hearing loss in children. Nemours audiologists are specially trained to evaluate children with hearing, balance and other ear-related problems.
Hearing Loss in Children
Hearing screening begins at birth. Even if your newborn passes his or her first hearing screening, it’s important to track hearing milestones your child should reach in the first year of life:
- most newborn infants startle or "jump" to sudden loud noises
- by 3 months, a baby usually recognizes a parent's voice
- by 6 months, an infant can usually turn his or her eyes or head toward a sound
- by 12 months, a child can usually imitate some sounds and produce a few words, such as "Mama" or "bye-bye"
As your baby grows into a toddler, signs of a hearing loss may include:
- limited, poor, or no speech
- frequently inattentive
- difficulty learning
- often increases the volume on the TV
- fails to respond to conversation-level speech, or answering inappropriately to speech
At Nemours, we use state-or-the-art equipment, innovative pediatric assessment techniques, multi-disciplinary input, and a family-centered focus to obtain a comprehensive view of your child’s individual hearing capabilities and management needs. The onsite availability of nationally-recognized, Nemours professionals allows multi-disciplinary input from the fields of genetics, imaging, speech-language pathology, psychology as well as other specialties on a case-specific basis.
It’s important to remember that we speak, because — and as — we hear. Even a mild hearing loss in a child can cause speech and language development to be affected. Proper diagnosis and management of hearing loss are critical to providing your child with the most optimal listening capability.
Types of Hearing Loss
Conductive Hearing Loss occurs when sound is mechanically blocked from reaching the inner ear. Generally, this type of hearing loss is temporary. Common causes of conductive hearing loss include otitis media with effusion (i.e., fluid behind the ear drum), “congestion” in the middle ear space (i.e. Eustachian Tube Dysfunction), wax build-up, or a structural problem such as very narrow or closed ear canals or a hole in the eardrum.
When your child has a hearing evaluation that shows conductive hearing loss, a medical evaluation should be conducted by a physician to determine the cause and appropriate treatment. In most cases, if and when the problem is resolved (i.e. middle ear fluid dissolves, wax is removed, etc), the child’s hearing will return to normal. This should be verified by repeating the hearing evaluation. In some cases, conductive hearing loss in children may be permanent, and careful monitoring by the audiologist is necessary. Depending on the child and the hearing loss, amplification may be recommended.
Conductive hearing loss in children typically ranges from mild to moderate degree, and this can fluctuate from day to day as well. When communicating with a child that has a conductive hearing loss, it may be helpful to reduce background noise as much as possible and maintain eye contact (i.e. talking from “room-to-room” should be avoided when possible). Keep in mind that speech sounds may be muffled or inaudible to your child at times therefore, using the above mentioned communication strategies, will likely help improve communication. It is important to follow the recommendations given by the Physician, including any medications or instructions.
Sensorineural Hearing Loss (SNHL) occurs when there is damage to the inner ear, or the pathways from the inner ear to the brain. There are no medical or surgical treatments for SNHL, and typically, this type of hearing loss is permanent. Common causes of sensorineural hearing loss in children include hereditary factors, ear trauma, noise-induced, syndrome-related or from certain illnesses.
If your child is diagnosed with sensorineural hearing loss, a medical evaluation should be conducted by an Ear, Nose, and Throat (ENT) physician to determine the cause and appropriate treatment. In addition to the ENT evaluation, imaging of the ear to look for structural problems and a genetics evaluation may also be requested. Close monitoring by the Audiologist is necessary, and serial appointments are critical to determine if the hearing loss is stable or progressive (worsening). Depending on the child and the hearing loss, amplification may be recommended. It is important to diagnose and treat hearing loss in children as early as possible, as it can affect speech and language development, general learning skills, and overall well-being.
SNHL hearing loss in children typically ranges from a mild to profound degree. Even with appropriate amplification, speech may sometimes still be difficult to understand for the child. When communicating with your child that has SNHL, it may be helpful to reduce background noise as much as possible and maintain eye contact (i.e., talking from “room-to-room” should be avoided when possible). Keep in mind that speech sounds may be muffled or inaudible to your child at times, and therefore using the above mentioned communication strategies will likely help improve communication.
Mixed Hearing Loss occurs when both conductive and sensorineural hearing loss are present at the same time. In most cases, a permanent sensorineural hearing loss is present, and then a temporary conductive overlay that is typically short-lived (such as an ear infection) may appear, causing the hearing loss to be worse. Once the conductive issue is resolved, the hearing typically goes back to the baseline point.
Noise Induced Hearing Loss is the result of exposure to loud sounds over a period of time or to an extremely loud blast. The damage occurs to the tiny hair cells in our inner ear, and can create sensorineural hearing loss in children. Often, it is painless, and occurs gradually over time. This concept is important because there are few signs of damage while the damage is being done. Therefore, children must be educated and monitored to prevent the damaging effects of noise to their ears.
Children often do not know how to safely use their technology, such as iPods, mp3 players, gaming devices, etc., and can harm their hearing as a result. On a survey commissioned by the American Speech Language Hearing Association (ASHA), more than half of the high school students polled reported at least one symptom of hearing loss. Another study showed that children’s use of entertainment media is on the rise and listening time is growing each day.
Children can enjoy their devices while protecting their delicate ears.
The three main rules are:
- Limit the daily listening time, and include listening breaks for quiet time.
- Turn down the volume (half volume is recommended).
- Be a good role model to others by modeling safe listening habits.
Children with APD have no problem hearing, but they do have difficulty analyzing or making sense out of what they hear. They may demonstrate difficulties in speech, language, and/or learning. They may also appear hearing impaired and/or be inattentive, easily distractible, hypersensitive to loud sound, or have difficulty following oral directions. These difficulties are compounded under adverse listening situations such as, in the typical, noisy classroom. Frustration may lead to secondary behaviors; i.e., behavioral difficulties (aggression, withdrawal, or impulsiveness) and poor self-concept. These difficulties are compounded under adverse listening situations such as, the typical, noisy classroom. Since children with auditory processing difficulties may have normal hearing, this difficulty will not be picked up during a school hearing screening or even during a comprehensive hearing test.
If your child is diagnosed with APD, recommendations or therapy options will be made that relate to the specific area of disorder that was seen during testing. At this time, CAPD is not categorized as a legally recognized learning disability. This means that your child’s school may or may not be able to provide specific therapy or interventions with a speech pathologist or learning specialist for your child based solely on a diagnosis of CAPD. You will, however, be encouraged to work with your child’s school to ensure that your child has access to the type of listening environment and listening strategies that will be most helpful for your child.
Treatment for Hearing Loss
If your child is diagnosed with hearing loss or other hearing impairment, our audiologists will make appropriate recommendations based on his or her impairment.
If hearing aids are necessary, Nemours audiologists are qualified and experienced in the fitting of hearing aids for children of all ages, including babies as young as three months. We offer hearing aid evaluations, hearing aid fittings, hearing aid repairs, earmolds and assistive listening devices. Our program is designed to closely monitor the progress of each and every child to assure maximum hearing aid benefit.
Hearing aids are the primary nonmedical treatment for hearing loss in children. The most common type of hearing loss involves outer hair cell dysfunction and hearing aids allow an amplification of sound to overcome this problem. A hearing aid's basic components are the microphone, amplifier and receiver.
Types of Hearing Aids
There are several hearing aid styles; some are worn behind the ear and some are worn in the ear. It is common practice to fit behind the ear hearing aids in children. There is no single style or manufacturer that is best. Hearing aid selection is based on the child's individual needs. If a child has bilateral hearing loss (both ears), two hearing aids are usually worn.
There are a few styles of hearing aids. They include:
- Behind the Ear (BTE): These hearing aids are most often used with children and can be used for all degrees of hearing loss from slight to profound
- In the Ear (ITE): ITE hearing aids are custom made to fit into the concha, or bowl of the ear, and the ear canal
- In the Canal (ITC): ITC hearing aids are custom made to fit in the canal only
As a general rule, ITE and ITC hearing aids are typically not fit on children due to their growing and changing ears.
Benefits of Hearing Aids
Hearing aids can provide access to hearing speech and nonspeech sounds that might not be heard without them. Hearing speech as well as environmental sounds will provide increased safety for your child. Without hearing aids, your child may not be able to hear sounds such as smoke alarms, cars approaching, car horns, or other safety warnings. Hearing the sounds of speech and language will improve your child’s speech and language development.
All children with hearing loss should be seen by an ENT (Ear, Nose, and Throat) physician. A doctor will need to provide “medical clearance” for hearing aid use, making sure there is no medical reason why your child should not wear hearing aids. There are several reasons why a device should not or cannot be placed in the ear. In these cases, there are alternative amplification systems.
For children with hearing loss or auditory processing difficulties, background noises and distance can interfere with hearing and understanding. FM amplification systems can be used by children with hearing aids as well as those children who are not candidates for hearing aids.
FM amplification systems increase the signal to noise ratio (SNR) by bringing the speaker’s voice directly to child’s ear, enabling the speaker's voice to be heard above the level of background noise, regardless of the speaker's distance from the child.
Although the configuration of a FM amplification listening system can vary, it generally consists of a MICROPHONE/ TRANSMITTER (worn by the speaker) and a RECEIVER/ TRANSDUCER (worn by or placed near to the child). The microphone picks up the speaker's voice and clearly transmits it to the student's receiver via a specific FM radio frequency.
An FM system may be recommended for use in a child’s school classroom in order to improve hearing in group or noisy environments. It can also be fitted for personal or home use.
For many children diagnosed with hearing impairments, speech-language therapy or auditory verbal therapy is recommended to help them develop their hearing and speaking skills. AVT is a specialized type of therapy designed to teach a child to use the hearing provided by a hearing aid or a cochlear implant for understanding speech and learning to talk. Auditory Verbal Therapists at Nemours are specially trained Speech Pathologists, Audiologists, and Teacher’s of the Deaf, who teach the child to develop hearing as an active sense so that listening becomes automatic. The goal is for active hearing and active listening to become an integral part of communication, recreation, socialization, education, and work.