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Hearing loss in children

Hearing loss in children is more prevalent than many realize.

According to the National Institutes of Health, about two to three out of every 1,000 children in the United States are born with a detectable level of hearing loss in one or both ears. In fact, more than 90 percent of deaf children are born to hearing parents.

Early Hearing Detection and Intervention

The good news is that in 2016, data collected by the Centers for Disease Control and Prevention (CDC) showed that over 98 percent of newborns in the United States were screened for hearing loss. This is despite the fact that only 43 states, plus the District of Columbia and Puerto Rico, have mandated newborn hearing screening programs.

“…98 percent of newborns in the United States were screened for hearing loss.”

Hearing loss, however, can also occur later in a child’s life or be detected later. In a study by the CDC, parents of 5 out of every 1,000 children felt their child had a hearing loss. This figure was based on children ages 3-17.

As a result of Early Hearing Detection and Intervention (EHDI) legislation enacted in 2000, all states have established EHDI programs. Early intervention – which refers to the period of birth until age three — is crucial when it comes to hearing loss. As the Alexander Graham Bell Association for the Deaf and Hard of Hearing (AG Bell) states on its website, “The human brain is programmed to learn language during the first six years of life, with the first three-and-a-half years being the most critical. Without intervention, it becomes increasingly difficult to acquire language as a child grows older.”

Signs of Hearing Loss in Newborns and Infants

Even if your newborn has passed the hearing screening, look for the following signs, courtesy of the CDC:

  • Does not startle at loud noises
  • After six months of age, does not turn to the source of a sound
  • By one year of age, does not say single words, such as “dada” or “mama”
  • Turns head when s/he sees you, but not if you only call out his/her name. This is sometimes mistaken for not paying attention or ignoring, but could be the result of a partial or complete hearing loss
  • Seems to hear some sounds but not others

Signs of Hearing Loss in Toddlers and Older Children

The CDC cautions that children have milestones when it comes to playing, learning, communicating, and acting. A delay in

any could be a sign of hearing loss or other developmental problem. Along with the CDC, the Cleveland Clinic lists signs of

hearing loss in toddlers and older children:

  • Delayed speech
  • Unclear speech
  • Doesn’t follow directions
  • Often says, “Huh?” or “What?”
  • Turns the TV or radio volume up too high
  • Problems in school
  • Attention or behavioral problems
  • Difficulty hearing in one or both ears on the phone

Types and Causes of Hearing Loss in Children

There are actually five different types of hearing loss. AG Bell explains:

Conductive: When there’s a condition of the outer or middle ear that prevents sound from reaching the inner ear and brain. Causes can include blockage of the outer ear or ear canal, an ear infection with fluid, or a malformation of the outer or middle ear. This can be temporary or treatable with medication or surgery, and if those fail, many benefit from hearing aids.

Sensorineural: Usually due to a problem with the cochlea, either through malformation or damage. Infections like meningitis or certain ototoxic medications can cause damage. This hearing loss can’t be treated with medication. But getting outfitted with a hearing device will likely help.

Mixed: A combination of conductive and sensorineural hearing loss.

Neural: This condition is rare, resulting from damage or malformation to the auditory nerve that connects the inner ear to the brain. The hearing loss is usually profound and permanent. Traditional options like hearing aids or cochlear implants usually don’t work. Sometimes auditory brainstem implants can help.

Auditory Neuropathy: When sound travels to the inner ear normally but further transmission of sound to the brain is impaired. Children with Auditory Neuropathy Spectrum Disorder (ANSD) can have a range of hearing loss as well as varying abilities to understand speech. This can be difficult to diagnose as hearing abilities may fluctuate.

More Information on Causes of Hearing Loss in Children

Unfortunately, for about one out of four babies born with hearing loss, the cause is unknown. More common is a genetic link. Of this demographic, one out of three babies have a “syndrome,” or other conditions in addition to the hearing loss.

For babies who develop hearing loss after birth, one out of four cases is due to maternal infections during pregnancy, complications after birth, and head trauma.

Newborn Hearing Tests

Before you leave the hospital or birthing center, your baby’s hearing should be screened. Two tests are used to screen hearing loss in babies. Your baby can even rest or sleep during the tests. The National Institute on Deafness and Other Communication Disorders (NIDCD) describes both tests:

Otoacoustic emissions (OAE): This tests whether some parts of the ear respond to sound. A soft earphone is inserted into your baby’s ear canal. It plays sounds and measures an “echo” response. This response occurs in ears with normal hearing. If there’s no echo, your baby might have hearing loss.

Auditory brain stem response (ABR): This tests how the auditory nerve and brain stem (which carry sound from the ear to the brain) respond to sound. Your baby wears small earphones and electrodes are placed on his or her head. The electrodes are like stickers and shouldn’t cause discomfort.

Infant Hearing Test

In addition to the above tests, behavioral audiometry may be used. This test observes an infant’s behavior in response to certain sounds.

Read more: Our journey after a failed newborn hearing screening

Toddler Hearing Tests

The aforementioned tests may be performed in conjunction with these, according to Stanford Children’s Health:

Play audiometry: An electrical machine transmits sounds at different volumes and pitches into your child’s ears. The child wears earphones. The test is camouflaged as a game. The toddler is asked to do something with a toy (touch it, move it) every time the sound is heard. The child’s cooperation is necessary for this test.

Visual reinforcement audiometry (VRA): The child is trained to look toward a sound source. When the toddler gives the correct response, s/he is “rewarded” through visual reinforcement like a toy that moves. This test is most often used for children between six months to two years of age.

Testing Older Children

If your child is older than three or four years of age, the previous tests may be used along with these (again from Stanford):

Pure tone audiometry: This is similar to play audiometry, but when the child hears a sound, s/he just has to respond in some way. Typically, this involves pressing a button.

Tympanometry (also called impedance audiometry or acoustic impedance tests): This can be performed in most healthcare provider’s offices. It helps determine how the middle ear is functioning. This isn’t a hearing test per se, but detects any changes in pressure in the middle ear. The child has to sit very still and not be crying, talking, or moving, so it’s more difficult to do with younger children. 

Child Hearing Loss Treatment

baby's hearing aids

When you suspect that your newborn has hearing loss, the first step is to have your child tested by a pediatric audiologist. Next, depending on the degree of hearing loss, get your child outfitted for hearing technology. The key is to have your child hearing sound as soon as possible.

Treatments for children with hearing loss include:

  • Hearing aids: Worn in and/or behind the ear
  • Cochlear implant: An electronic device that stimulates the auditory nerve through electrodes placed in the cochlea. The earlier one receives a CI, the greater the benefit.
  • Tubes: Help drain fluid from the middle ear

Additionally, it’s important to choose your communication outcome and start that path immediately. AG Bell lists the various communication options. Remember, it’s up to you, the parents, to decide what’s best for your child and your family. Speech and language therapy should be enlisted right away, and make sure follow-up with healthcare providers continues.

Read more: How having a deaf child has changed my life

To New Parents of a Child with Hearing Loss

A hearing loss diagnosis is not the end of the world. If anything, today’s advances in technology mean the world is wide open!

A NIH-funded study in 2000 found that children with hearing loss who began receiving treatment at an early age demonstrated language skills comparable to their hearing peers – regardless of the degree of hearing loss.

There are many resources for parents new to hearing loss. Search for groups in your community, connect with your audiologist or join the HearingLikeMe community for further support!

What questions do you have about hearing loss in children? Let us know in the comments and our community will be happy to help!

Author Details
The HearingLikeMe editorial team includes Jill Blocker von Bueren and Lisa Goldstein.