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Hearing is one of the five senses. It is an intricate process of picking up sound and connecting meaning to it. The human ear is
fully developed at birth and responds to sounds that are very faint as well as sounds that are very loud. Even in the uterus,
infants respond to sound. It is well recognized that hearing is critical to speech and language development, communication, and
learning. Children with listening difficulties due to hearing loss or auditory processing problems continue to be undiagnosed and
have insufficient services available. The earlier hearing loss occurs in a child's life, the more serious the effects on the child's
development. Similarly, the earlier the problem is identified and intervention begun, the less serious the ultimate impact.
There are four major ways in which hearing loss affects children
1. It causes delay in the development of receptive and expressive communication skills (speech and language).
2. The language impairment causes learning problems that result in reduced academic achievement.
3. Communication difficulties often lead to social isolation and poor self-worth.
4. It may have an impact on career choices.
Detecting Hearing Loss
According to the National Institutes of Health (NIH), nearly 12,000 babies are born each year in the United States with a hearing
impairment. It is estimated that serious hearing loss occurs in about one to three of every 1,000 healthy newborns, and in two
to four of every 100 babies in newborn intensive care units. Without screening or testing, hearing loss may not be noticed until
the baby is more than 1 year old. If hearing loss is not detected until later years, there will not be stimulation of the brain's
hearing centers. This can affect the growth and development of hearing, and can delay speech and language. Social and
emotional development and success in school may also be affected.
Most hearing loss is congenital (present at birth), but some babies develop hearing loss after they are born. Hearing loss is more
likely in premature babies and babies with respiratory problems who have required long-term use of breathing machines, those
with previous infections, and those taking certain medications.
Because of these risks, many health organizations including the National Institutes of Health (NIH) and The American Academy
of Pediatrics (AAP) now recommend universal infant hearing screening. This means all newborn babies should be screened for
hearing loss. Most states have laws that require universal newborn hearing screening.
Beyond the newborn period, the parents may be the first to detect hearing loss in their child. Unfortunately, many children with
severe hearing loss from birth are not diagnosed until 2 1/2 or 3 years of age. Other children may not be diagnosed until 4 years
Different Types of Hearing Loss
Hearing loss can be categorized by many different types. Two types of hearing loss are sensorineural and conductive. Both
types of hearing loss can be present at birth or acquired after birth.
Sensorineural hearing loss (or nerve-related deafness) involves damage to the inner ear caused by aging, pre-natal and birth-
related problems, viral and bacterial infections, heredity, trauma, exposure to loud noise, fluid backup, or a benign tumor in the
inner ear. Almost all sensorineural hearing loss can be effectively treated with hearing aids
Sensorineural – a loss of function within the inner ear or with the connection to the brain. Causes of this type of hearing loss
Congenital factors – conditions present at birth, such as: Infection by the mother with toxoplasmosis, rubella, herpes, or
Genetic factors- syndromes the child has at birth
Low birth weight
Hereditary – in the family
Conductive hearing loss involves the outer and middle ear that may be caused by blockage of wax, punctured eardrum, birth
defects, ear infection, or heredity, and often can be effectively treated medically or surgically. Conductive hearing loss is a
problem in the outer or middle ear where sound waves are not sent to the inner ear properly. Conductive hearing loss is the
most common type of hearing loss in children and is usually acquired. Factors that may cause this type of hearing loss are:
Congenital factors (conditions present at birth), such as:
• Conditions of the pinna (the outside of the ear)
• Conditions of the tympanic membrane (eardrum)
• Conditions of the external ear canal
• Conditions of the ossicles (the three tiny bones that deliver the sound waves to the middle ear)
Mixed hearing loss refers to a combination of conductive and sensorineural loss and means that a problem occurs in both the
outer or middle and the inner ear.
Central hearing loss results from damage or impairment to the nerves cells of the central nervous system, either in the pathways
to the brain or in the brain itself.
Acquired hearing loss includes:
• Loud noise exposure
• Damage from certain medications that can be harmful to the ears
• Excessive ear wax
• Foreign bodies in the ear canal, such as beads or popcorn kernels
• Tumors of the middle ear
• Problems with the Eustachian tube (a passage from the tympanum of the ear to the pharynx). The thin, semitransparent,
oval-shaped membrane that separates the middle ear from the external ear.
• Ear infections such as ottis media is inflammation of the middle ear, or middle ear infection.
• Chronic ear infections with fluid in the middle ear
• Damage of the eardrum
Facts on Hearing Loss in Children
Every day in the United States, approximately 1 in 1,000 newborns (or 33 babies every day) is born profoundly deaf with
another 2-3 out of 1,000 babies born with partial hearing loss, making hearing loss the number one birth defect in America.
Of the 12,000 babies in the United States born annually with some form of hearing loss, only half exhibit a risk factor –
meaning that if only high-risk infants are screened, half of the infants with some form of hearing loss will not be tested and
identified. In actual recognition risk-based newborn hearing screening programs identify only 10-20% of infants with hearing
loss. When hearing loss is detected beyond the first few months of life, the most critical time for stimulating the auditory
pathways to hearing centers of the brain may be lost, significantly delaying speech and language development.
Only 69% of babies are now screened for hearing loss before 1 month of age (up from only 22% in 1998). Of the babies
screened, only 56% who needed diagnostic evaluations actually received them by 3 months of age. Moreover, only 53% of
those diagnosed with hearing loss were enrolled in early intervention programs by 6 months of age. As a result, these children
tend to later re-surface in our schools’ special education (IDEA, Part B) programs.
When children are not identified and do not receive early intervention, special education for a child with hearing loss costs
schools an additional $420,000, and has a lifetime cost of approximately $1 million per individual.
Hearing Loss Treatment
Recent research indicates that children identified with a hearing loss who begin services early may be able to develop language
(spoken and/or signed) on level with their hearing peers. If a hearing loss is detected in your child, early family-centered
intervention is recommended to promote language (speech and/or signed depending on family choices) and cognitive
development. An audiologist, as part of an interdisciplinary team of professionals, will evaluate your child and suggest the most
appropriate audiology intervention program.
Specific treatment or hearing loss will be determined by your child’s physician based on:
• Your child’s age, overall health, and medical history
• Extent of the condition
• Your child’s tolerance for specific medications, procedures, or therapies
• Your opinion or preference
Management of Hearing Loss
Management of hearing loss may include one or more of the following:
Use of hearing aids – electronic or battery operated devices that can amplify and change sound. A microphone receives the
sound and converts it into sound waves. The sound waves are then converted into electrical signals. The hearing aid fitting
process typically consists of six stages: assessment, treatment planning, selection, verification, orientation, and validation. The
widespread use of computers has made the process of fitting hearing aids more accurate and efficient.
Over 60% of individuals with hearing loss are fit with two hearing aids (binaural). The benefits of wearing two hearing aids are
enhanced ability to (a) hear better in the presence of background noise, (b) determine where sound is coming from, and (c)
hear soft sounds at lower levels.
Cochlear implants – a surgically placed appliance that helps to transmit electrical stimulation to the inner ear. Only certain
children are candidates for this type of device. Nearly half of all cochlear implant recipients are children. Cochlear implants can
help an estimated 200,000 children in the United States who do not benefit from hearing aids.
Hearing Loss Early Intervention Services
Early intervention and detection of hearing loss is necessary to prevent additional problems with speech and language
development. A healthcare team approach is usually applied when a child is diagnosis with some degree of hearing loss. Team
members include the following:
Audiologist – a professional who specializes in evaluation and management of hearing and balance problems in people of all
ages. Audiologists are also involved with the fitting and management of hearing aids and other assistive devices.
Otolaryngologists- a physician with precise training in medical and surgical treatment for disorders of the ear nose and throat.
Speech Pathologist – a professional who helps evaluate and manage speech, language and hearing problems.