Hearing Loss

A mother and an infant with hearing loss

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.

Read More About Hearing Loss in Children

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:
  • audiologists
  • ear, nose and throat (ENT) doctors
  • speech and language pathologists
  • behavioral health experts
  • deaf educators
  • neurologists (doctors who treat problems of the nervous system)
  • geneticists

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.

Nemours Children's Specialty Care, Jacksonville

807 Children’s Way
Jacksonville, FL 32207
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For Appointments: (904) 697-3707

Hours: Monday–Friday, 8 a.m. to 5 p.m.
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  • Christine Cook MS, CCC-A
  • Lauren Corn AuD, CCC-A
  • Anne Mull AuD, CCC-A
  • Sharon Nazemi AuD, CCC-A
  • M. Rita Newby AuD, CCC-A
  • Stacy Payne MA, CCC-A
  • Lauren Stack AuD, CCC-A
What to Bring
  • photo ID
  • medical and pharmacy insurance cards
  • preferred pharmacy name and phone number
  • names and dosage of all medications, including over-the-counter medication, your child is currently taking
  • guardianship and custody papers, if a legal guardian rather than a parent accompanies your child
New Patients
  • Patient Registration (PDF)
Returning Patients
  • Release of Information (PDF)
    English | Spanish
  • Patient Presents Without Legal Guardian (PDF)
    English | Spanish
    Note: A parent or legal guardian must be with a child for a first visit.
Forms & Resources
New Patient Forms
  • Patient Registration (PDF)
Returning Patient Forms
  • Release of Information (PDF)
    English | Spanish
  • Patient Presents Without Legal Guardian (PDF)
    English | Spanish
    Note: A parent or legal guardian must be with a child for a first visit.
Resources for Patients & Families

A child with hearing loss or impairment may be able to hear some sounds or nothing at all. Impairment means something is not working correctly or as well as it should. People also may use the words deaf, deafness, or hard of hearing when they're talking about hearing loss in children. At Nemours, we have board-certified audiologists who are specially trained to perform evaluations on children with hearing, balance and other ear-related problems.

Signs of Hearing Loss in Children

Hearing screening should begin 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

Nemours audiologists will assess a child's hearing by doing different types of tests. If it’s found that a child has hearing loss, the audiologist will recommend treatment and suggest the family work with a special team. This team will figure out the best way for a child with hearing loss or impairment to learn and communicate.

How Hearing Loss May Affect a Child’s Speech Development

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 care and management of hearing loss is critical to providing your child with the most optimal listening capability. Most children will perform to the best of their ability when they can understand and can communicate.

Types of Hearing Loss

Conductive Hearing Loss

Conductive Hearing Loss occurs when sound is blocked from traveling through the hearing pathway, from problems such as middle ear fluid or wax build-up. Generally, this type of hearing loss is temporary. Common causes of conductive hearing loss include otitis media with effusion (i.e., fluid), “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 your child that has a conductive hearing loss, it may be helpful to reduce background noise as much as possible and allow for facial cues to help get the message across (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, as well as gaining the child’s attention, and keeping good eye contact, 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)

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.

When your child has a hearing evaluation that shows 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, sounds 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 allow for facial cues to help get the message across (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, as well as gaining the child’s attention, and keeping good eye contact, will likely help improve communication.

Mixed Hearing Loss

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

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. This concept is important because there are no signs of damage while the damage is being done. Therefore we must use education as our tool to parents and children, 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:
  1. Limit the daily listening time, and include listening breaks for quiet time
  2. Turn down the volume  (half volume is recommended)
  3. Be a good role model to others by modeling safe listening habits
(Central) Auditory Processing Disorder (CAPD)

(Central) Auditory Processing Disorder (CAPD) can involve many different symptoms and behaviors at home and in the classroom. The most common complaints involve difficulty listening or focusing when there is background noise, and difficulty quickly and accurately understanding and responding to what was said orally. Some children with CAPD many experience challenges with attention, reading or writing, or expressive and receptive language skills. Screening tests may be performed at your child’s school or doctor’s office, but only an Audiologist can diagnose a Central Auditory Processing Disorder.

If CAPD is diagnosed in your child, 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.

How We Treat Hearing Loss in Children

If your child is diagnosed with hearing loss or other hearing impairment, our audiologists will make appropriate recommendations based on each individual child and his/her impairment.

Hearing Aids

If hearing aids are necessary, Nemours audiologists are qualified and experienced in the fitting of hearing aids for children of all ages, including young babies. Our program is designed to closely monitor each and every child with their hearing loss and hearing aid care.

Hearing aids are the primary nonmedical treatment for hearing loss in children. The most common type of hearing loss involves cochlear 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; although the most common for children are behind-the-ear hearing aids. 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 (both ears) hearing loss, two hearing aids are usually worn.

There are few styles of hearing aids. They include:
  • Behind-the-Ear (BTE): These hearing aids are most often used with children because of their flexibility for ear growth and they 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 the world, including speech, will also likely 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.

Frequency Modulated (FM) Systems

For some children with hearing loss or hearing impairment, 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 (also called auditory trainers) increase the Signal 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.

FM systems consist of a microphone, a transmitter (or mic-transmitter combination), a receiver, and some method of routing sounds from the receiver to the child’s ear.

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.

Implantable (surgically-placed) Bone Conduction Hearing Devices

We offer two implantable hearing devices for children — age 5 years and older — with conductive or mixed hearing loss. These devices can also benefit children with single-sided deafness, and both devices can be worn in a softband prior to age 5 years or if implantation is not desired.

BAHA (Bone Anchored Hearing Aid)

The BAHA is a surgically implanted system that works through direct bone conduction. The system works by enhancing natural bone transmission as a pathway for sound to travel directly to the inner ear, bypassing the outer and middle ear. The implant is placed during a short surgical procedure. The implant integrates with the skull bone over time, usually 3-6 months, depending on the age of the child. Once integrated, the processor is worn on the external abutment and transmits sound vibrations via the abutment to the implant. The implant vibrates, sending vibrations within the skull and inner ear. Hair cells within the inner ear stimulate nerve fibers, allowing hearing to occur.

Sophono Bone Conduction Hearing System

The Sophono is an innovative, new abutment-free device. This system eliminates the need for a protruding abutment by utilizing a magnetic titanium implant, which securely holds the external processor in place through intact skin and hair via an external spacer magnet. The Sophono is implanted in a short, single-stage procedure. The processor can be fitted for the patient in about four weeks after surgery or once the incision has healed. Like the BAHA, direct stimulation to the cochlea via vibrations allows for hearing to occur.

Cochlear Implant

A cochlear implant provides a recipient with improved hearing perception so that they can acquire speech and language but it does not restore hearing. The cochlear implant transmits sound information past the damaged cochlea directly to the nerve of hearing. It is intended for children with severe-profound hearing loss who receive little to no benefit from hearing aids.

Nemours Children’s Clinic has developed a comprehensive multidisciplinary cochlear implant program for children between the ages of 12 months and 17 years. Cochlear implants provide many children with the assistance they need to hear conversation and environmental sounds so that they can obtain hearing and spoken language abilities.

Our implant team, which is comprised of experienced medical and clinical professionals, conducts evaluations, provides surgery and pre- and post-implant care including programming and rehabilitation. The Nemours Cochlear Implant Team is dedicated to providing the best care for recipients and their families.

Auditory Based Therapy

For many children diagnosed with hearing impairments, speech-language therapy or auditory based therapy is recommended to help them develop their hearing and speaking skills. Auditory based therapy 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. Therapists at Nemours Children’s Clinic are specially trained Speech Pathologists 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.