Hearing Loss in Children

________________________________________________________________________

KEY POINTS

• Hearing loss is a gradual or sudden decrease in your child’s ability to hear sounds.
• Treatment may include hearing aids, surgery, and language and hearing education.
• Children with hearing loss need regular hearing and ear exams. Follow the full course of treatment prescribed by your healthcare provider.

________________________________________________________________________

What is hearing loss?

Hearing loss is a gradual or sudden decrease in your child’s ability to hear sounds. It’s important to get hearing problems checked and treated because they can cause problems with communication and relationships with other people. Hearing loss can also cause safety issues.

Hearing losses may be mild, moderate, severe, or profound. The level of severity is determined by the loudness of sound that a child can hear. For example:

• Mild: A child with a mild hearing loss may have trouble hearing faint or distant speech. The most common cause of a mild hearing loss is fluid buildup in the middle ear.
• Moderate: A child who has a moderate hearing loss needs speech to be loud. It is hard for your child to understand speech in groups.
• Severe: A child with a severe loss can hear only loud voices 1 foot or less away or loud sounds that are nearby.
• Profound: A child with a profound hearing loss, also called deafness, may be more aware of vibrations than sound.

What is the cause?

Hearing loss happens when there is a problem with one or more parts of the ear or hearing pathways. There are different types of hearing loss. For example:

• Conductive hearing loss: This type of hearing loss happens when sound waves are blocked as they pass through the outer or middle ear. The most common cause of this kind of hearing loss is earwax. Other causes include ear infections, a tear or hole in your child's eardrum, or damage to the small bones in the middle ear that conduct sound waves. This kind of hearing loss may not be permanent, depending on the cause.
• Nerve-related hearing loss: This type of hearing loss is caused by a problem in the innermost part of the ear or in the auditory nerve. This type of hearing loss is usually permanent. Possible causes include:
  • Abnormal development of the inner part of the ear
  • Injury to the ear from an infection such as meningitis or rubella
  • Tumors
  • Physical injury to the head or inner ear
• Hearing loss caused by medicines. Some medicines can damage the ear and lead to a loss of hearing. Some medicines cause permanent damage, such as some antibiotics and drugs used to treat cancer. Others can cause temporary hearing loss, such as aspirin or drugs used to treat malaria.

What are the symptoms?

Your child may have a hearing problem if:

• Loud noises do not startle your child by 3 or 4 months of age or if your child does not turn towards the source of a sound.
• Your child notices you only when your child sees you.
• Your child does not make sounds other than gurgles and other vibrating noises that your child can feel.
• By 15 months of age, speech is hard to understand or delayed. For example, your child does not speak single words such as "dada" or "mama.”
• Your child does not always respond when called.
• Your child hears some sounds but not others.
• Your child hears poorly and has trouble holding his or her head steady. Your child is slow to sit up alone or walk.
• Your child has a cleft lip or palate, kidney disease, short stature, or other birth defects.

How is it diagnosed?

Most states test a newborn's hearing before the baby leaves the hospital. Later, any child who may have a hearing loss needs full testing. Your child may be referred to a hearing specialist or an ear, nose, and throat specialist for hearing tests. Your child may have X-rays or other scans to check for possible causes of hearing loss.

How is it treated?

A child's early years are very important for learning and the development of language. Treating hearing problems early makes a big difference in how well your child does later in life. Treatment depends on the cause. Possible treatments include:

• Hearing aids

  Hearing aids make sounds louder. They do not make sounds clearer and may distort some sounds. Children of all ages can use hearing aids. The aids may even help babies. To use the hearing aid, your child will need to learn to pay attention to voices and ignore background noises.

• Hearing and language training

  Language training programs for hearing-impaired children are offered as early as infancy. Parent-infant programs help you learn how to help your child.

  A child with hearing loss can use many ways to communicate. You and your healthcare provider will decide what ways work best for your child. For a severe hearing loss, your child may need to learn speech-reading, finger spelling, and sign language.

• Education

  Contact your local school district before your child starts school. Some schools have special programs for children with hearing loss. A team of professionals will help evaluate your child and put together an Individual Education Plan (IEP). Parents have a right to help put together this plan. You may also ask your healthcare provider to review the plan.

• Surgery
  • Ear tubes. A buildup of fluid in the middle ear could worsen your child's hearing loss. Your child may need to have tubes put in the ears to help drain fluid. If your child also has hearing loss from something other than a fluid buildup in the ear, your child can use a hearing aid with ear tubes. The tubes usually fall out on their own after several years but can also be removed in a later surgery.
  • Cochlear implants

    Your child may benefit from an electronic device called a cochlear implant that is surgically put inside the ear. The implant turns the vibrations we call sound into electrical signals that are sent to the brain. This is different from normal hearing and it takes time to learn. Your child will need to learn to understand the signals as sounds.

• Follow-up

  Children with hearing loss need regular hearing, and ear exams. Younger children need to be tested more often than older children because their ear canals are growing and changing shape and they might not be able to tell you that their hearing is getting worse. Because your child's other main way to learn and communicate is through sight, regular eye exams are also important to ensure that your child keeps seeing well.

How can I take care of my child?

Follow the full course of treatment prescribed by your healthcare provider. In addition:

• Talk directly to your child. Always face your child and bend down to your child’s level before you start to speak. Use short, simple phrases and sentences. Don't use baby talk. Speak clearly and slowly and use lots of facial and body expressions
• Talk with your child at mealtime, bath time, and dressing. Repeat words and phrases often, such as naming shirt, socks, and shoes as your child gets dressed.
• Encourage your child to ask for items, make choices, and answer questions. Use toys and games to help your child use language.
• Avoid talking with your child in places where there is a lot of noise. This includes sounds from TV, radio, electrical appliances, and other people talking.
• Be patient with your child. Your child may not be able to put needs and feelings into words. Watch your child’s body language for signs that your child is upset or that something is wrong. Respond to the meaning your child is trying to communicate. Praise your child's efforts.

Ask your provider:

• How and when you will get your child’s test results
• If there are activities your child should avoid and when your child can return to normal activities
• How to take care of your child at home
• What symptoms or problems you should watch for and what to do if your child has them

Make sure you know when your child should come back for a checkup. Keep all appointments for provider visits or tests.