PEDIATRIC HEARING HEALTHCARE
Children have special healthcare needs, and hearing healthcare for children is a specialty in and of itself. The House Clinic works with the House Children’s Hearing Center of UCLA to provide children with specialized care including audiologic, speech and language, psychologic and educational services.
The external and middle ear conduct and transform sound; the inner ear receives it. When there is some difficulty in the external or middle ear, a conductive hearing impairment occurs. When the trouble lies in the inner ear, a sensorineural or nerve hearing impairment is the result. Difficulty in both the middle and inner ear results in a mixed impairment.
For more detail about hearing impairment, please visit our section on Hearing Loss.
SIGNS OF HEARING LOSS IN CHILDREN
Signs of hearing problems in infancy generally include failure to blink or startle at loud noises, failure to turn the head toward familiar sounds, greater responsiveness to loud noises than to voices, a failure to babble, coo, or squeal, the consistent ability to sleep through loud noises, and monotonal babbling.
For toddlers signs that may indicate hearing loss include failure to speak clearly by age two, showing no interest in being read to or in playing word games, habitual yelling or shrieking when communicating or playing, greater responsiveness to facial expressions than to speech, shyness or withdrawal (often misinterpreted as inattentiveness, dreaminess, and/or stubbornness), and frequent confusion and puzzlement.
In older children, signs of hearing loss are similar to those for adults: inappropriate responses to questions or other sound stimuli, a failure to respond to verbal requests, and a seeming inattentiveness.
CAUSES OF HEARING IMPAIRMENT IN CHILDREN
German measles contracted by a mother during the first three months of pregnancy may interfere with inner ear development in the fetus. Occasionally other virus disease are at fault. The viruses of measles and mumps may cause a sensorineural impairment after birth but this happens infrequently.
Problems at Birth
Jaundice occurring at or shortly after birth is capable of damaging the inner ear. This is most often due to RH incompatibility between the mother‘s and the child‘s blood. Fortunately, this is uncommon.
Approximately 50% of childhood hearing loss has a hereditary basis. Hereditary hearing impairment may be present at birth, or may develop later in life. Even though there may be no hearing impairment in the parents, careful questioning may reveal some more distant relative with a similar problem.
Meningitis occasionally results in sensorineural hearing loss, which may be mild to profound.
Ear infections rarely lead to sensorineural hearing loss.
DIAGNOSIS OF HEARING IMPAIRMENT
A complete otologic examination by a competent ear specialist is necessary to determine what type of hearing impairment is present, its possible causes, and its treatment. At times it may be necessary to obtain x-rays, balance tests or laboratory tests to make this decision.
Audiologic evaluations are adapted to the age of the child. A child is never too young for a hearing evaluation.
HOW DOES HEARING LOSS AFFECT YOUR CHILD?
Degree and type of hearing loss are critical in a child‘s speech development. But speech development can be influenced by age at diagnosis, treatment, adequacy of amplification, and help from parents and teachers.
Mild Hearing Loss
A child with mild hearing loss usually has normal speech, but will have trouble in the school setting because it will be difficult to hear speech from more than twelve feet away or when there is background noise. This is because much of the meaning in English is contained in the voiceless consonants which are high-pitched and soft. They are s, sh, t, p, k, ch, and th. A child with a mild loss in both ears will need some amplification in each ear to hear clearly at school, in groups, or at a distance.
Some children with a mild loss are not suspected of poor hearing until they reach first grade. They are often thought to be “slow”, because they cannot understand when the teacher speaks from a distance and, therefore, respond erratically. When these children receive hearing aids, they usually find that school is easier.
Children with a moderate hearing loss can clearly hear speech only when the speaker is very close – less than two feet away. They need hearing aids to hear the softest sounds and to acquire understandable speech. If they receive hearing aids before four years of age, they usually progress rapidly in learning to talk. They can attend regular schools, but may need special help.
Children with a severe hearing loss do not perceive speech, no matter how close they are to the speaker. They will not learn to talk intelligibly without hearing aids and special help.
Severely impaired children who receive hearing aids early have a far better chance of acquiring speech than children who remain unaided longer. This is not to say that a child with a severe loss who gets hearing aids at age three will never learn to speak, but it does mean the task will be harder. Many children who do not receive aids until after age six may never develop clear speech or the ability to easily understand spoken words.
All children with severe hearing losses require special help because they receive only a portion of the clues usually available in speech sounds. With hearing aids, they can detect vowel sounds, pitch, some consonants, and stress clues from speech. With their eyes, they can learn to detect about 25% of the consonant sounds. With lipreading and listening together, they may receive about half of the clues that normal-hearing people use to understand speech.
Children with a profound hearing loss receive even less auditory information. The younger children are when fitted with hearing aids, the greater the likelihood they will eventually speak. Having suitable hearing aids at all times is a significant factor in determining whether the child will learn to speak. Children with a profound loss often depend greatly on their vision to perceive speech.
TREATMENT OF HEARING IMPAIRMENT IN CHILDREN
Fortunately, the child with a conductive hearing impairment will always be able to hear, either through ear surgery or by the use of properly fitted hearing aids.
There is no known medical or surgical treatment that will restore hearing in sensorineural hearing impairment. Treatment consists of rehabilitation through the use of hearing aids and special training.
Hearing Impairment in One Ear
A hearing impairment that is confined to one ear deprives a person of the ability to distinguish the direction of sound. He will also have difficulty hearing from the involved side in a noisy background. These are usually minor problems to a young child, however, the child should be carefully monitored. Sometimes speech and language delays may develop. Once the child is of school age, special considerations may be needed, i.e. preferential seating.
When this impairment is conductive, surgery may restore the hearing, giving a better auditory balance when the loss becomes a problem, usually in the teens. When the impairment is sensorineural, it is often possible to restore some of this balance through the use of a hearing aid.
Hearing Aid Evaluation
Evaluation of the hearing in a young child may require several visits with the audiologist. It is important to arrive at an accurate measurement of both the type and degree of impairment in order to select the proper aid. An aid that is too powerful for a young child may irritate his ears and cause him to reject it. On the other hand, if the aid is not strong enough, the child may receive little or no benefit from it an object to wearing it.
Auditory (Listening) Training
Hearing aids are not like glasses. A child who develops visual trouble frequently sees perfectly with glasses. When wearing hearing aids there is always some distortion of sound, particularly when the impairment is sensorineural (in the nerve).
Because sound is not perfectly clear with hearing aids, young children need to have special listening training to understand speech well. Auditory training programs proceed in gradual steps from very simple tasks, like being aware of sound when it begins, to the identification of different gross patterns of sound (i.e. long vs. short, fast vs. slow), to understanding (discriminating) some words either in isolation or in phrases. Training in speech-reading (lipreading) is often included in auditory training, especially for children with severe and profound hearing impairments.
Lipreading with listening can help a child to guess at words which are insufficiently clear through listening alone. Lipreading cannot, however, take the place of hearing, because only about 25% of the speech sounds are visible on the lips.
Most school systems have programs for helping parents teach their child to listen. If your child is of preschool age, this program would be in the home and is called a parent-infant training program. School age children may be in special classes for the hearing impaired or in regular classrooms with additional speech and tutorial help.