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Clinical Reference Systems: Pediatric Advisor 10.0
Hearing Loss
What is hearing loss?
A hearing impairment refers to all degrees of hearing loss.
Types of hearing loss are classified by where in the ear the
problem occurs and the severity of loss.
What are the types of hearing loss?
- Conductive hearing loss
A conductive hearing loss results when something
interferes with sound waves traveling through the outer
and middle parts of the ear. Causes of conductive
hearing loss include:
- complete blockage in the outer ear by wax
- infection in the middle ear (otitis media)
- damage to the tiny bones in the middle ear.
- Sensorineural hearing loss
A sensorineural hearing loss results from a problem in
the innermost part of the ear or in the auditory nerve
(the term auditory refers to hearing). Causes of
sensorineural hearing loss include:
- diseases, such as meningitis and rubella
- tumors
- abnormal development of the inner part of the ear and
other genetic conditions
- physical injury to the inner ear.
Sensorineural hearing losses are permanent. Sometimes
the problem with the inner ear also causes problems with
balance. Children with both hearing and balance
problems may have mild delays in the development of
their motor skills.
- Mixed hearing loss
A child may have both a sensorineural hearing loss and a
conductive hearing loss. This type of hearing loss is
called a mixed loss.
What are the levels of severity?
Hearing losses are also classified by their severity: mild,
moderate, severe, and profound. The level of severity is
determined by the loudness of sound that a child can hear
without a hearing aid. The loudness of sound is measured by
decibels (dB).
Mild: Children with mild hearing losses can hear sounds
of 20 to 40 dB or louder. They may have trouble hearing
faint or distant speech. The most common cause of a
mild hearing loss is fluid collection in the middle ear,
a conductive hearing loss.
Moderate: Children who have moderate losses of hearing
can hear sounds louder than 45 to 60 dB. They need
speech to be loud. It is hard for these children to
understand speech in group situations.
Severe: Children with severe losses can hear sounds of
65 to 85 dB or louder. They can hear only loud voices
one foot or less away, or loud sounds in the
environment.
Profound: Children with profound hearing losses may
hear loud sounds of 90 dB or more, but they may be more
aware of vibrations than sound. The term deaf usually
applies to children with profound hearing losses or to
children with no hearing at all.
Children with hearing loss that crosses two levels of
severity are given the label of both; for example, mild to
moderate hearing loss, or moderate to severe.
How and when should my child be tested?
Early testing is important in helping a hearing-impaired
child adapt to the hearing world. Every child who may have
a hearing loss needs thorough testing of his hearing and
middle ear function. A child is never too young to have a
hearing test.
An audiologist performs hearing tests. He or she is
specially trained to recognize and evaluate hearing. If
necessary, an audiologist can fit your child with a hearing
aid.
After a hearing loss is diagnosed, health care professionals
will try to find out the cause of the hearing loss. They
will also look for related problems or disabilities.
Additional tests may include blood tests, an EKG, and a CAT
scan (a special x-ray) of the middle and inner ear.
Results from these tests help determine the best treatment
and educational strategy for your child. Tests can be
taken in a special center for assessing disabled children,
or by a team of professionals your pediatrician selects.
The professionals may include an otolaryngologist (a doctor
who specializes in the ear, nose, and throat problems), an
ophthalmologist (an eye doctor), a developmental
pediatrician, a geneticist, a speech/language pathologist, a
psychologist, and a learning specialist.
Hearing-impaired children need regular hearing and ear
exams. Typically, audiologists see younger children more
often than older children because their ear canals are
growing and changing shape. Young children may often need
new ear molds for holding the hearing aid in place.
Call your child's doctor if there is any sudden change in
your child's response to sound, especially from a cold. The
change may signal a middle ear problem. A buildup of fluid
in the middle ear could worsen your child's hearing loss.
Most doctors put ventilating tubes (ear tubes) in children
who have a sensorineural hearing loss and fluid in the
middle ear. Any additional hearing loss may make a big
difference in what a child can hear. A child with ear tubes
can continue to use hearing aids.
What is the treatment?
A child's early years are very important for learning and
the development of language. Treating hearing impairment
early makes a big difference in how well a child functions
later in life. The audiologist tries to provide the best
use of a child's remaining hearing. She or he designs a
treatment plan for your child. This plan consists not only
of making sound louder with hearing aids, but also hearing
and language training, and parent support and training.
- Hearing aids
Hearing aids do not restore hearing. They are
loudspeakers that help get the best sound possible to
your child's ear. The aid makes sounds louder, not
clearer. It may distort some sounds.
A very important aspect of treatment is teaching your
child how to hear better; for example, by ignoring
noises in the environment and paying attention to
voices. Make sure that you talk to the audiologist
about what sounds your child can hear with and without a
hearing aid, the effects of noise on your child's
hearing, and how to keep the hearing aids in the best
working order.
Children of all ages can use hearing aids. The aids
even help young infants.
- Cochlear implants
The cochlea is the part of the ear that turns the
vibrations we call sound into electrical signals. The
brain then interprets the electrical signals into
meaningful sounds such as speech. Some children with
profound hearing loss may benefit from an electronic
device called a cochlear implant (CI).
A CI consists of three parts: a microphone, a
microcomputer, and a cochlear electrode. The
microphone, worn behind the ear, sends the sound to a
microcomputer. The microcomputer is connected to the
microphone by a wire and is worn in a pouch attached to
the belt. It turns the sound into an electrical code
which is sent by radio wave to the cochlear electrode.
The wire electrode is surgically implanted through the
skull behind the ear into the cochlea. The cochlear
implant does not give the child normal hearing.
However, the child may be able to interpret the signals
produced by the implant after he or she gets used to the
signals and what they mean.
Children with cochlear implants still need the therapies
listed below.
- Therapies
Language training programs for hearing-impaired children
are offered as early as infancy. Parent-infant programs
help parents provide an environment rich in language for
their child.
Hearing-impaired children use a variety of ways to
communicate. You will need to decide which way works
best with your child.
Auditory oral approach: The auditory oral approach
trains children to make the most of their speech and
hearing abilities. It works best with children who have
a lot of hearing left.
Total communication: The total communication approach
uses speech, hearing, vision, speech-reading, finger
spelling, reading, writing, and signing (American Sign
Language).
The best approach for a child depends on such factors
as:
- the severity of the hearing loss
- when the hearing loss occurred
- the type of hearing loss
- when the hearing loss was diagnosed
- what the child has learned already about speech and
language
- parent-child interaction
- educational needs.
Think about and discuss the following questions to help
determine the best method of communication for your
child:
- How much hearing does your child have left?
- How does your family communicate with your child?
- Are you willing to attend sign language classes?
- What resources are available to you and your child?
How can I help my child learn to communicate?
- Talk directly to your child. Always face your child and
bend down to his or her level before you begin to speak.
Use short, simple phrases and sentences. Don't use baby
talk. Speak clearly and not too fast.
- Use a lot of facial and body expressions.
- Talk about things that are important to your child.
Provide materials, toys, and games that are interesting
to your child to stimulate conversation.
- Repeat words and phrases often. As part of your child's
daily routines--for example, getting dressed--emphasize
words like shirt, socks, shoes. Add words to your
child's one- and two-word phrases. For example, when
your child says "blue train," say back to the child,
"The blue train is going fast."
- Encourage your child to join in your conversation.
Praise your child's efforts at making sounds. Respond
to the meaning your child is trying to communicate.
Encourage taking turns in conversation.
- Avoid having conversations in places where there is a
lot of noise, including sound from television, radio,
electrical appliances, and competing conversations.
SUPPORT ORGANIZATIONS FOR PARENTS
Alexander Graham Bell American Society for Deaf
Association for the Children
Deaf, Inc. 814 Third Ave.
347 Volta Place, NW Silver Spring, MD 20910
Washington, DC 20007
Boys Town National Institute
American Speech-Language- for Communication Disorders
Hearing Association in Children
10801 Rockville Pike 555 North 30th St.
Rockville, MD 20852 Omaha, NE 68131
www.asha.org
International Association for
Children's Hearing Education Parents of the Deaf (IAPD)
and Research (CHEAR) 814 Thayer Ave.
871 McLean Ave. Silver Spring, MD 20910
Yonkers, NY 10704
SKI Hearing Impaired Outreach
National Information Center Utah State University
on Deafness Logan, UT
Gallaudet University
800 Florida Ave. NE
Washington, DC 20002-3695
Suggested Reading
See:
Hearing Loss: Book List
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