LOCAL FRONTIERS: Hearing Loss in Children

Peter Marincovich, PhD, CCC-A

The social stress that children with hearing loss go through at school, at home and with their peers can powerfully hinder their confidence and social development. While most people living with hearing loss are adults who have developed worsening symptoms over time, over 15% of children in the United States have moderate to severe hearing loss in one or both ears. Additionally, early-onset deafness can be passed on genetically, and about 33 babies are born with profound deafness each day in the U.S.[1]

Before the 1990s, it was not uncommon for children’s hearing problems to go unnoticed until the second or third years of their lives.[2] Around this age, children exhibit observable signs of a hearing deficit, such as slow speech development and failure to respond to loud noises. Concerned parents, having no indicator of their children’s hearing deficits until this point, would only then take their children to see a specialist for diagnostic hearing tests. As we now know, it is extremely important to identify hearing problems as early as possible in the critical period for language development, which runs from birth through early adolescence.

The main effects of child hearing loss include delay in the development of speech and language skills, reduced academic achievement, social isolation, poor self-esteem, and fewer vocational options later in life.[3] Intervention before six months of age, research shows, leads to significantly better speech and reading comprehension than in children who receive attention after this critical period.[2] Failure to first identify child hearing problems until two to three years of age can result in irreversible impairments in speech, language and cognitive abilities, leaving the child with a significant disadvantage among his or her peers.

Without early intervention, the detrimental effects of hearing loss accumulate over time. To properly identify hearing loss in newborns, physicians and audiologists have implemented screening protocols within hospitals and birthing centers. When a newborn fails the screening test(s), the report goes to the child’s primary care physician, who then refers the child to an audiologist for complete testing to determine the degree of hearing loss.

Treating hearing loss is an ongoing process that requires regular visits with an audiologist and other professionals. Regardless of the patient’s age or degree of hearing loss, audiologists emphasize all aspects of care. Amplification is prescribed and adapted to the child as the child adapts to the amplification. Audiologists provide detailed reports for primary care physicians, speech pathologists, and other professionals who may be involved in a child’s care, and they help ensure that each decision made during the child’s treatment is based on a compilation of expert information.

Ideally, by the age of three, Individualized Education Programs are developed to organize care for children with hearing problems. The IEPs are designed to maximize each child’s success despite his or her hearing and learning disadvantage. The audiologist’s overall goal is to help hearing-impaired children stay connected with the world, and to minimize the social problems and sense of detachment that arise from loss of hearing.

Educating family members, especially parents, about the potential causes and signs of hearing loss can go a long way to prevent hearing loss in children. It is difficult for people of all ages suffering from hearing loss to even realize that they have a hearing deficit; for infants and toddlers who don’t yet have the language skills to grasp the concept of hearing loss, observant family members play an essential role in early identification.

One common cause of hearing loss in children is ear infection. According to estimates, three out of four children will have at least one ear infection before they reach three years of age.[4] In rare instances, ear infections that do not receive treatment can result in irreversible loss of hearing. Since ear infection often occurs before children can verbally express their ear pain, audiologists and other providers can help by reviewing with parents the various signs that might indicate an ear infection. These signs include tugging or pulling at the ear, fussiness, difficulty sleeping, fever, lack of balance, and failure to respond to sound.

A frequent complaint from parents raising children with hearing loss is that their kids often refuse to wear hearing aids. The benefits of wearing hearing aids far outweigh the embarrassment, but this point is never easy to get across to an upset child. In my experience, discussing in detail with children and their parents the importance of wearing hearing aids every day helps lessen the social anxiety that these children might feel. Parents are also appreciative when I prepare them for arguments that inevitably arise between themselves and their children over wearing hearing aids.

Tests for diagnosing hearing loss in children include Otoacoustic Emissions (OAE), Auditory Brainstem Response (ABR), Visual Reinforcement Audiometry (VRA), Behavioral Observation Assessment (BOA) and Conditioned Operant Response (COR). While newborns may have one or several of these tests performed at their initial health screening, the American Academy of Pediatrics recommends that all infants and children receive hearing tests periodically after their initial screening.[5]

Pediatricians should be aware of referral sources available in their regions for hearing-impaired children. Children suspected of having a hearing impairment can definitely benefit from seeing an audiologist in the diagnostic stage of their treatment. Audiologists are trained in interpreting test results, as well as determining the next step in treatment upon analyzing those results. Audiologists are also usually acquainted with several otolaryngologists and speech pathologists, serving as a qualified intermediary for referrals to experts in parallel fields.

Child aural rehabilitation (or, in many cases, “habilitation”), is an ongoing process that may continue throughout life. Immediate and long-term goals of aural rehabilitation include training the auditory system to perceive sound, gaining understanding of body language and visual cues, improving speech, developing language, learning to manage hearing aids and assistive listening devices (ALDs), and ultimately improving communication.

Modern hearing aids provide the most beneficial solution to child (and adult) hearing loss in the majority of cases. While some children with hearing loss are able to develop viable oral communication skills with conventional hearing aids, many require cochlear implants to significantly improve hearing. The treatment depends on the degree and type of hearing loss.

Early detection of hearing loss and early use of amplification with hearing aids, cochlear implants and/or ALDs has been shown to make a dramatic, positive difference in the language acquisition abilities of a child with hearing loss.[6] The auditory system requires exposure to sound in order to develop audible communications skills. Wearing hearing devices as often and as early as possible is of the utmost importance. An infant as young as four weeks old can be fitted with today’s amplification technologies, and the effectiveness of these devices improves the sooner a child with hearing loss achieves greater access to sound.

Working with children dealing with hearing loss is wonderfully rewarding. In all my years of experience helping people overcome their hearing problems, nothing is more gratifying than watching a child’s face light up when he or she first experiences clear sound again. By carefully coordinating care between physicians, parents, teachers and others close to children with hearing loss, we can mitigate the disadvantages of hearing problems early on, when treatment is most effective.

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Dr. Marincovich owns Audiology Associates, which has offices in Novato, Mill Valley, Santa Rosa and Mendocino.

Email: peter@audiologyassociates-sr.com

References

1. American Speech Language Hearing Association (ASHA), “Early hearing detection and intervention,” asha.org (2013).

2. ASHA, “Facts about pediatric hearing loss,” asha.org. (2013).

3. ASHA, “Effects of hearing loss on development,” asha.org (2013).

4. National Institute on Deafness and Other Communication Disorders, “Ear infections in children,” www.nidcd.nih.gov (2013).

5. American Academy of Pediatrics, “Recommendations for preventive pediatric health care,” Pediatrics, 105:645-646 (2000).

6. ASHA, “Child aural/audiologic rehabilitation,” asha.org, (2013).