Risk for Pediatric Hearing Loss
Most infants have their hearing screened at the hospital when they are born. If you did not receive a copy of your infant’s hearing screening, please contact the hospital where your child was born. Just because your child passed the infant hearing screen doesn’t mean you should stop paying attention to your child’s ability to communicate. In fact, 1 to 6 out of every 1,000 children in the United States are born deaf or hard-of-hearing. More lose their hearing later during childhood. So it is important to always be vigilant.
Parents, caregivers, or grandparents are often the first to notice signs that something is wrong. Even if your baby’s hearing was screened at birth, don’t ignore warning signs.
If you think your child may not be hearing well, immediately see your Doctor of Audiology. The person who takes care of the child is usually correct.
There is no family history of hearing loss, so my baby is not at risk, right?
Only half of children with hearing loss have any risk factor at all.
Risk factors include:
Birth to 28 days:
Abnormal facial or ear structures
Significant birth or prenatal events
Global developmental or speech-language delays
Family history of sensorineural hearing loss from birth
Mother had during pregnancy: toxoplasmosis, rubella, CMV (cytomegalovirus), herpes, syphilis
Hyperbilirubinemia at levels requiring exchange transfusion
Birthweight less than 1500 g
Low Apgar scores: 0-3 at 5 min; 0-6 at 10 min
Respiratory distress (eg, meconium aspiration)
Prolonged mechanical ventilation for more than 10 days
Ototoxic medication (eg gentamicin, vacomicin, streptomycin) administered for more than 5 days or used in combination with loop diuretics
Physical features or other stigmata associated with a syndrome known to include sensorineural or conductive hearing loss (Down Syndrome, Waardenburg Syndrome)
29 days to 24 months
Parental or caregiver concern about hearing, speech or language, and or developmental delay
Any of the newborn risk factors above
Recurrent or persistent Otitis Media (ear infections) for at least 3 months
Head trauma with a fracture of the temporal bone
Childhood infectious diseases associated with sensorineural hearing loss (eg, meningitis, mumps, measles)
Neurodegenerative disorders (eg Hunter syndrome) or demyelinating diseases (eg Friedreich ataxia, Charcot-Marie-Tooth syndrome)
How do I know my child is hearing normally?
Your child is likely hearing normally if your child is able to:
Around two months of age
Startle to loud sound
Quiet to familiar voices
Make vowel sounds like “ohh”
Around four months of age
Look for sound sources
Make squeals and chuckles
Around six months of age
Turn head toward loud sounds
Begin to imitate speech sound
Babble sounds like “ba-ba”
Around nine months of age
Imitate speech sounds of others
Understand “no-no” or “bye-bye”
Turn head toward soft sounds
Around 12 months of age
Correctly use “ma-ma” or “da-da”
Give a toy when asked
Respond to singing or music
12 to 15 months of age
Respond to his or her name and “no”
Follow simple requests
Use an expressive vocabulary of 3-5 words
Imitate some sounds
18 to 24 months of age
Know body parts
Use an expressive vocabulary 2-word phrases (minimum of 20-50 words)
50% of speech is intelligible to strangers
By 36 months of age
Use an expressive vocabulary of 4 to 5 word sentences (approximately 500 words)
Speech is 80% intelligible to strangers
Understand some verbs
What should I expect at my child’s hearing evaluation?
The type of testing used for your child depends on both your child’s age and ability to respond on that day. Your child may need more than one test session to get the optimum test results.
All testing will include a complete history from you regarding your child’s prenatal healthcare and pregnancy, birth and post natal medical conditions, medications, accidents, development and any concerns that you have.
The test age listed is based on developmental age of your child.
Otoscopic Examination: all ages
A flashlight with what appears to be a cone with a magnifying lens called an otoscope will be used to look into your child’s ear to assess the tympanic membrane (ear drum) and ear canal.
Tympanometry: all ages
A small ear plug with a tiny microphone, speaker and air pump will be placed in the opening of your ear canal. This device will change the air pressure in your child’s ear canal which makes the ear drum move back and forth. A tone will be played from the device during the test. The device records the result as a graph. Your child needs to be relatively inactive for this test and not crying. We use distraction techniques when necessary to help with testing.
Otoacoustic Emissions: all ages
A small sponge containing a sensitive microphone is placed into the ear canal for delivery of a sound and detection of the ear’s response to that sound. Your child can be asleep or awake and each ear is tested individually. Your child must be relatively inactive during the test. It tells us about the function of hearing from the outer ear to the cochlea.
Auditory Brainstem Evoked Response: Birth to 9 months
A small sponge earphone is placed in the ear canal of each ear and electrodes are taped to the head and nape of your child. The electrodes pick up electrical activity from the auditory system at different levels of the hearing nerve up through different levels of the auditory brainstem. Each ear is tested separately. It does not tell us if the child understands sound because it does not assess hearing above the level of the brainstem. Your infant or child must remain quiet (preferably sleeping) during the test.
Auditory Steady State Response: Birth to 9 months
A small sponge earphone is placed in the ear canal of each ear and electrodes are taped to the head and nape of your child. The electrodes pick up electrical activity from the auditory system at different levels of the hearing nerve up through different levels of the auditory system. Each ear is tested separately. Your infant or child must remain very quiet (preferably sleeping) during the test.
Note: All audiometry is completed in a sound-treated audiologic test booth.
Visual Response Audiometry and Conditioned Oriented Responses: 9 months to 2.5 years
Your child is taught to associate a speech or frequency-specific sound with a reinforcement stimulus (a lighted toy). Whenever possible your child will be fit with small sponge tip earphones inserted into the opening of the ear canal or headphones, so that each ear can be tested separately. When this is not possible, stimuli will be presented through the speakers into the sound-treated room.
Play Audiometry: 2.5 years to 4 years
Your child is conditioned to put a toy in a box or to add to a tower when a stimulus tone is heard. Your child will hear the different frequency tones through small sponge tip earphones inserted into the opening of the ear canal or headphones, so that each ear can be tested separately. The number of frequencies, each ear, speech testing, and if bone conduction testing is also done will be based on how long the attention span of your child is with the tasks given. More than one test session may need to be scheduled.
Conventional Audiometry: 4 years to adolescence
Your child is instructed to raise his or her hand or answer yes when they hear the test tone. They will be tested using frequency specific test stimuli for each ear and with speech. These will be delivered to the ear via sponge tip earphones inserted into the opening of the ear canal or headphones as well as a bone oscillator held in place on the bone behind the ear with a head band. The amount of test information gathered depends upon the understanding and cooperation of your child.
What happens if a hearing loss is found?
Any evidence of a hearing loss may require a repeat hearing evaluation on a second date. If testing shows hearing thresholds greater than 20 dBHL at the test frequencies, further evaluation and treatment will be ordered.
Approximately 95% of all cases of hearing loss in children happen to parents who do not have hearing loss themselves or in their families. Being told your child has hearing loss is a shocking and foreign experience. You are typically not prepared to hear this diagnosis, ask questions or understand what you hear at your visit.
Therefore, it is required that a follow-up consultation is scheduled with your Doctor of Audiology to review your child’s test results, answer questions you may have, discuss the next tests that may be necessary as well as options for treatment.
For every pediatric patient we see with hearing loss we:
Answer your questions on hearing, hearing aids, and cochlear implant technology
Refer your child for appropriate medical assessment as needed
Refer your child for appropriate genetic evaluation as needed
Put you in touch with helpful associations, organizations, and local school personnel for hearing help as needed
Provide close monitoring and follow-up visits
Help you find support groups in your area
No single treatment or intervention is appropriate for every child or family.
What services should I expect to be available for my child?
Birth to 36 months
Babies that are diagnosed with hearing loss should begin to get intervention services as soon as possible. This should occur no later than 6 months of age.
There are many services available through the Individuals with Disabilities Educations Improvement Act 2004 (IDEA 2004). Services for children ages birth – 36 months are called Early Intervention or Part C services. Even if you child was not diagnosed with a hearing loss, he or she may be eligible for early intervention treatment services. The IDEA 2004 states children under the age of 36 months who are at risk of having developmental delays may be eligible for services. These services are provided through the early intervention program. Though this system, you can ask for an evaluation.
36 months to 22 years
Special education is designed to meet the needs of children 36 months – 22 years of age with disabilities or experiencing developmental delays. Services for these children are provided through the public school system. These services are available through the Individuals with Disabilities Education Improvement Act 2004 (IDEA 2004), Part B.
What is EHDI?
Every state has an Early Hearing Detection and Intervention (EHDI) program.
EHDI works to identify infants and children with hearing loss. EHDI also promotes timely follow-up testing and services or interventions for any family whose child has a hearing loss.
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