How are babies and children tested for hearing loss?
The first hearing screening a child receives is in the nursery at the hospital, ideally 24 – 48 hours after birth. A hand-held computer sends closely matched tones into the baby’s ear and reads if a set of inner ear nerve cells react to the signal. This test is objective, meaning the baby does not show a behavioral response to the tones; at this age the baby definitely will not raise his/her hand to a beep or even turn to a sound even if the sound is heard. If the baby is asleep, the test will go quickly, usually within one minute per ear. If the baby is crying, the test cannot be performed until the baby settles.
This early hearing screening test, called Otoacoustic Emissions (OAE), is designed to rule out moderate to severe hearing loss. The baby could still have a milder hearing loss.
If the infant did not pass the hearing screening, the baby will be scheduled for follow up testing, usually a repetition of the Otoacoustic Emissions test. It is very important to perform the follow up testing.
If the baby does not pass that second test, the child must be scheduled for Auditory Brainstem Response testing (ABR) with an audiologist. This is a lengthier test, typically about one hour if the baby stays asleep. It is best to time this immediately after the baby has eaten so that the baby is asleep. Stickers placed on the head receive nerve responses that the baby’s auditory system makes when tiny insert earphones send rapid clicks or tone bursts into each ear canal. The accumulated, averaged responses give a pattern on a computer for the audiologist who interprets the amount of hearing in a particular part of the speech frequencies.
Because of these tests some parents find out within one to two months of the baby’s birth if the baby is hearing impaired. They will probably not yet have any behavioral clues of a child’s hearing loss at that age. Some parents may notice the absence of the Moro (startle) response to loud sound in the first several months of life (be aware that this response extinguishes in all babies, normal-hearing or hearing-impaired, after the third to fifth month) if there is significant hearing loss. They may also notice the cessation of cooing and babbling after the first six months for babies who are deaf (profoundly hearing-impaired). These are not conclusive indicators, but their absence should alert parents for the need for testing.
Parents should not assume that making sounds with toys or cookware will not accurately test a baby’s hearing. Again, it is appropriate to test any child whose hearing is in question. A child may hear the vacuum but not hear soft speech. An infant may hear your voice when you read because the baby is close to your voice but may still miss some of the speech sounds.
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Will I see signs of hearing loss in my baby or child?
If a child misses follow up appointments or even the initial screening in the hospital, or if the child has a hearing loss that begins at a later age, the parents will not know until they begin to notice that their child is not turning to or reacting to environmental sounds or voices or even intense sounds such as vacuum cleaners and dogs barking. For some babies this will not be apparent for many months, even up to a year or more. For toddlers with hearing loss, there may be a delay of speech, few words understood or spoken, or poor pronunciation (articulation). Older children may complain of ringing in the ears (tinnitus), which often accompanies inner ear hearing loss. Any speech or language issue in a child should trigger a hearing test to confirm that hearing is intact and not contributing to the disorder.
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If I suspect that my child has a hearing loss, should I wait to see if he/she outgrows it?
Some parents may feel that a wait-and-see approach is best, or they may be advised to see if the baby develops speech on his own. Particularly with boys with delayed speech milestones, parents may be advised that boys are slower than girls and that they may safely wait before considering testing. This is not helpful advice. In reality, the earlier a hearing loss is found, including where it is in the auditory system and the determination of whether it is to be medically or rehabilitatively remediated, the better it is for the child and the child’s family. It is better to err on the side of caution and test the baby. No harm will come to a child if normal hearing is found; many difficulties can arise from the delay of diagnosing a hearing loss in a child.
Where can I get hearing testing for my child?
If a parent suspects that their child may have a hearing loss, they should call an Ear, Nose, and Throat (ENT)) /Otolaryngologist’s office or an Audiologist’s practice as soon as possible. The child will receive age-appropriate testing. If hearing loss is found, the family should expect counseling about the choice of recommendations that are available.
For toddlers and older children, a hearing test will be performed in a sound-treated booth. The toddler sits on a parent’s lap facing a pair of speakers and the testing audiologist. When the audiologist’s voice or sound stimuli are presented to the child through the speakers the toddler will turn to the sound. Animated toys reinforce the response. Some toddlers will respond to commands such as, “Clap hands,” or “Where is Mommy?” This does not give ear-specific information. The results will be interpreted for you by the audiologist.
Older children can drop a block or press a button when they hear the speech stimuli or sound through insert earphones. They can point to pictures or repeat back words. Their testing and results will be much like that of an adult. The audiologist will explain the results and recommendations.
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What causes hearing loss in children?
Hearing loss can be caused by many factors and can range in severity from mild to profound, one ear or both ears, and with a location of outer, middle, or inner ear. All severities of hearing loss will affect a child. Even a mild loss will change how a child hears the speech of family, friends and teachers.
Some of the causes of hearing loss include birth issues such as jaundice (hyper-bilirubinemia) or the momentary loss of oxygen flow for the baby (hypoxia), family hearing loss (inherited), genetic causes, loss from a severe illness or high fever, head trauma, intense noise trauma (such as airbag deployment near the ear), and certain medications. Some children are born with a malformation of the outer, middle, or inner ear. If these children have other affected systems of the body, the child may be diagnosed with a syndrome and he may need to be followed by more than one medical specialist. Hearing loss in a child may be an indicator of other medical needs and issues and should be attended to in partnership with the child’s physician.
Two very common causes of hearing loss are the presence of earwax that occludes the canal, and middle ear fluid, which may or may not be infected. Hearing loss that occurs from outer or middle ear causes tends to be medically remediable. A simple viewing of the child’s ear canals with an otoscope can reveal the presence of earwax (cerumen). Earwax can often be removed safely from a child’s ear canal by the child’s pediatrician or ENT specialist.
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What practices can harm a child’s ears or hearing?
The practice of candling is dangerous for any age, child or adult, and does not remove impurities or earwax as is claimed. It should not be used for anyone at any age. Q-tips can be used along the folds of the outer ear, but they should not be used in the ear canal. Earwax can get pushed in further towards the eardrum causing impaction of the wax and a temporary hearing loss, possible perforation of the eardrum, and a difficult removal process of the impacted wax. If you see wax accumulating in the child’s ear canal, it is wise to see the ENT physician for wax removal. Wax is much easier to remove when it is newer and not yet hardened or impacted in the canal.
How do I prevent hearing loss for my child?
Will using an iPod harm my child’s hearing?
All children need to be aware of the dangers of acquired hearing loss and permanent onset of ringing in the ears (tinnitus) from loud music, sports arenas, firearms, and power tools. Even one excessively loud concert can permanently alter hearing or bring on ringing. The damaging sound from the event may not cause pain or discomfort, so there is no way of judging that it is harming the inner ears. There are special hearing protectors for all loud listening situations; ask your audiologist for information. If a child uses an iPod or listens to music on a phone, no matter what type of ear buds are being used, he or she needs to give the ears a rest. For example if using the iPod for one hour of listening, the child should alternately remove the ear buds for one hour. If someone next to the wearer says they likes that song, the earphones are too loud! There are special inexpensive volume-limiting earphones to help preserve hearing in children during iPod use. Noise-induced hearing loss happens over a lifetime and is sometimes so gradual that a person will not be aware that it is happening for several years or even decades of life. Once an inner ear hearing loss is present, it cannot be reversed. Vigilance with hearing protection is a life-long job.
If my child has ear infections, will he/she have hearing loss, too?
Many children have one or more bouts of middle ear fluid, or otitis media, beginning at any age in childhood, including infancy. Some families will have a propensity for it, with one or both parents having had otitis media as a child. Other families will have just one child with frequent bouts of middle ear fluid. The fluid typically builds up in the middle ear space, behind the eardrum, after an upper respiratory infection and may or may not be painful. The child is not deaf during this period but may have hearing loss ranging from mild to moderate-severe. These children need to be seen by their physician and possibly by an ENT specialist for management of the fluid. Hearing should be tested before and after middle ear fluid management. Periodic checks with a simple eardrum test, called tympanometry, can be performed by an audiologist to monitor for the presence of middle ear fluid. Medical management of the fluid may be accomplished by a period of watchful waiting with the ENT physician, antibiotic administration if necessary, and/or removal of the fluid through the eardrum (myringotomy and pressure equalization tubes).
During the time that a child has middle ear fluid, his/her ability to hear and understand language is diminished to some degree. This can affect speech production or language learning. Children may not pay attention to parents or teachers. They may turn up the TV very loudly, or their own voice may be louder or quieter than usual. Children may have changes in behavior such as frequent crying, temper tantrums, or being quiet and withdrawn. Once the fluid has resolved the child’s hearing may return to normal, but testing should be used to determine this. For children with recurrent otitis media, hearing loss may develop permanently. Some of these children are candidates for hearing aids.
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Is inner ear hearing loss permanent?
Will it get worse? What can we do to help him?
If is it found that a child has inner ear (sensorineural) hearing loss in one or both ears, the audiologist will advise parents of their hearing and educational options. Inner ear loss is not able to be changed by medical management. The best way to help most children with inner ear hearing loss is through the use of digital hearing aids. The audiologist will advise the parents about which ear(s) will benefit from hearing aid amplification, and the style and level of technology that will best fit the child’s needs. The earlier that amplification is fitted for children with inner ear hearing loss, the more likely they will not fall behind academically, in college, or in the workforce. Educational options will be discussed with parents to determine the optimal approach for each family. A team approach with the parents, audiologist, Ear, Nose, and Throat physician, school counselor or social worker, speech-language pathologist, and teacher(s) helps each family decide the best educational options for the child.
If my child is deaf, will the child have hearing aids or will he use sign language?
Children who are born deaf (meaning no usable hearing, not those with mild to severe hearing loss) may receive no benefit from hearing aids. In cases where the parents wish for the deaf child to be a member of the Deaf community, hearing aids are not a viable option. American Sign Language would be taught to children of the Deaf community. If parents want their deaf child to have the opportunity to hear, they may opt for one or two cochlear implants. These are surgically implanted devices that send electrical signals to the auditory system, bypassing the inner ears that are not sending the signals. One month after the surgery the child is fitted for an external processor. The family and child learn how to use the cochlear implant. The child would receive speech therapy and auditory-verbal therapy to enhance understanding of the incoming signal. Frequent reprogramming, or “mapping,” helps the child have access to more sound. Again, a team approach is necessary to determine if a child is a candidate and the best age and ear (or both ears) for implantation.
Acquired hearing loss that occurs later in a child’s life can cause academic issues, speech and language problems, reading difficulties, attention and processing issues, and other problems. With hearing aids, preferably the earlier the better, children with acquired hearing loss can succeed in school, college, and at work.
If a child has one good ear and a hearing loss in the other ear, or if the child has a mild loss, he/she won’t need hearing aids, right?
For children with hearing loss in one ear and not the other, or if they have a mild loss, that does not mean that there is no need to amplify or provide help in the classroom. These children are at greater risk than their normal-hearing peers for academic difficulty and grade retention because it is widely assumed that they will have fewer difficulties than children with greater hearing loss. They may not be recommended for hearing aids or academic support services, when in fact, they are very much in need of these services. Even a mild loss or unilateral loss causes auditory deprivation to a brain that is still learning how to process language and sound and can have long-term consequences if not treated.
Is it common for health insurance to pay for hearing aids for children?
Hearing aids can be expensive, but help can be found. Health insurance companies may give a benefit, including Grace’s Law which in New Jersey requires insurance companies to provide $1000 per hearing-impaired ear to hearing aid purchases for children age 15 and younger. Some manufacturers of hearing aids have loaner banks to provide hearing aids for children for several months before parents decide to purchase. Help and guidance with these decisions can be made with the audiologist.
What type of classroom assistance will my child need?
Children with hearing loss may be completely self-sufficient in the classroom or they may need assistance to achieve the best education. Children with hearing loss should receive guidance from the Child-Study Team in the school with an IDEA or 504 Plan to guide the professionals in creating a useful IEP (Individualized Education Plan). For example the teacher may need to pre-teach concepts to the hearing-impaired child, or to follow up with each set of directions to make certain that the child understood. The child may or may not require a teacher’s aide in the classroom. Classroom size may need to be modified. All classrooms for the hearing-impaired should have sound-absorptive material and should not be near noisy areas of the school.
In the classroom, children with hearing aids should sit close to the teacher for best hearing and visual cues. An FM system, which communicates between the hearing aids and a body-worn microphone on the teacher, provides improved signal to noise ratio for best understanding of the teacher. Optional accessories for hearing aids allow hearing-impaired children to use their hearing aids as their Bluetooth headset for cell, iPod, iPad, computer, etc. A miniature remote microphone is available for placing in front of or plugging directly into a TV for clear transmission.
Parents and teachers are essential for tracking their hearing-impaired student’s progress via questionnaires and continued discussion with the support team. The audiologist is needed for providing the best amplification solution for the child’s listening environments and hearing needs. This includes real ear verification measurements to help determine the best settings of the aids for that child.
What does it mean if my child was diagnosed as having an auditory processing disorder?
Children with auditory processing disorders may have normal hearing on the hearing assessment, but they have difficulty making sense of speech at times, especially in difficult situations such as in background noise or if multiple commands are given. Children with APD can learn to listen and understand better with appropriate auditory therapy with an audiologist or speech-language pathologist. They may benefit from hearing aids set very low or with an FM system to improve the signal to noise ratio in class.
Will hearing loss limit my child’s activities or future potential?
Children with hearing loss are capable young people who, with early and continuing guidance and assistance from their families, schools, and medical community, can achieve and succeed at whatever they choose!
The vestibular system controls balance and alignment, and plays a crucial role in a child’s development. Disease or trauma can affect the development of normal movement and motor control. If your child is experiencing symptoms of dizziness or vertigo, then the signals the brain is receiving from the vestibular system have been disrupted. An evaluation by a doctor or ENT specialist is necessary to ensure the condition isn’t serious and won’t interfere with growth and development.
Why is my Child Experiencing Dizziness?
Semicircular canals in the inner ear detect movement and send that information to the brain, enabling spatial orientation and allowing us to walk, run, and move normally. A disruption in these signals can leave us feeling dizzy or lightheaded.
People who experience lightheadedness feel as if they are going to faint. This may be accompanied by nausea or vomiting. The feeling often dissipates when you lie down. Occasional episodes of lightheadedness are common, and are rarely indicative of a serious problem. They happen when a sudden drop in blood pressure and blood flow to the head occurs, as when you get up too quickly from sitting or lying down.
Vertigo is another form of dizziness characterized by the sensation that your surroundings are moving, despite the lack of any actual movement. You feel unsteady, as though your body is spinning or tilting, which makes standing or walking difficult. You may experience nausea and vomiting.
What are the Treatments for Dizziness?
Your child’s doctor will first determine whether he or she is suffering from lightheadedness or vertigo, and then figure which underlying condition is causing these episodes. There are many possible factors, ranging from colds and allergies to anxiety, medications, inner ear disorders, and migraine headaches.
Treatment varies depending on the condition responsible. Often a cold or flu will run its course and symptoms will dissipate after a few days. A change in medication can reduce or eliminate side effects. Other treatment options include physical and occupational therapy, vestibular rehabilitation, lifestyle changes, medications, and surgery.