A Newborn Hearing Screening is conducted within the first few days of life, before a baby even leaves the hospital. If the screening indicates that follow-up testing is needed, you’ll need to make an appointment to see a pediatric audiologist recommended by your doctor as soon as possible. Pediatric audiologists are best equipped to test babies, determine whether there is a hearing loss, and guide in the next steps going forward to choose the best options to suit your baby’s needs.
What types of testing does a Pediatric Audiologist do?
-Newborns and very young infants
The audiologist will conduct an ABR that is more comprehensive than the newborn screening done at the hospital. ABR stands for Auditory Brainstem Response, and measures the reaction of a child’s brain to sound stimulation. The ABR will give a picture of your child’s ability to hear.
-Older babies (about 9 months and up)
As your baby becomes more mature and can actively participate in the process, an audiologist will do follow-up testing to further define the baby’s hearing ability. This is called sound-field testing and is done in a special soundproof room with speakers. The technique used is called Conditioned Play Audiometry (CPA), which uses behavioral conditioning to teach children to respond to sounds. The child may simply look in the direction the sound is coming from and be rewarded by seeing an image of a playful cartoonish monkey, for example. Tones (like musical notes) at different volume levels will play through the speakers and result in a graph of your child’s hearing called an audiogram.
What if there is a hearing loss?
If your child has hearing loss, your audiologist and pediatrician will help decide what to do next. They may refer you to an ENT to address any medical issues that can be resolved. Therapists can provide early intervention services so you can learn more about hearing loss and how to facilitate listening, speaking, and communication development. These professionals can also help you choose the best technology and provide assistance in accessing insurance coverage.
If hearing aids are the best route, a pediatric audiologist will assist you with the fitting of hearing aids and complete the programming of these devices. They make impressions for earmolds to fit the hearing device onto the baby’s ears. Earmolds will have to be made often since tiny ears grow quickly.
The audiologist will regularly monitor hearing levels to be on the alert for changes in hearing that may result from factors like middle ear infections or progressive hearing loss. In addition, regular monitoring of the hearing aids insures that they are providing the best access to sound possible.
If surgically implanted technology called cochlear implants are the best route for your child, a pediatric audiologist will help you through the before and after surgery process that has many steps.
What happens when my child with a hearing loss goes to daycare or nursery school?
The audiologist seeks to ensure that your child has the best access to sound possible to develop listening, speaking, and communication skills. There is assistive technology available in addition to hearing aids that can make hearing easier for the child in daycare, nursery school, etc. The audiologist can evaluate these settings and make recommendations for this assistive technology.
They can also be a great source of information not only for parents, but also for daycare and school staff. All adults who have regular interactions with a child that has hearing loss should be comfortable managing the child’s listening devices and understand that these devices should be used during all the child’s waking hours for maximum benefit.
How is the audiologist certified to do this work?
New audiologists must earn a doctoral degree and hold a state license. Hundreds of hours of supervised clinical experience, passing of a national exam, post-graduate clinical experience, and continued education to maintain a current license are all requirements to practice as an audiologist. They study hearing loss, central auditory processing, and balance disorders. Most training programs allow audiologists to specialize in pediatric, geriatric, or educational audiology. They are the ideal specialists to guide you through the journey of hearing loss along with your child’s physicians.
What many people don’t know is that there are several different types of hearing loss. Each type has its own best practices for treatment, but even within these categories each case is highly individualized. Once a diagnosis is reached, patients work with their doctor to find the best treatment plan for that specific case.
If you or your child is new to the world of hearing loss, the information can be overwhelming. Doctors and audiologists are best suited to guide you through the process, but arming yourself with some basic knowledge can help make the whole experience easier.
Common Types of Hearing Loss
Sensorineural Hearing Loss (Inner Ear): This is the most common type of hearing loss and is likely permanent. It occurs when there is damage to the tiny hair cells of the inner ear. Family history of hearing loss, genetic disorders, and anatomical abnormalities are some of the possible causes. Families can work closely with their team of professionals to help determine what the cause of the loss might be, although sometimes the etiology remains unknown.
Conductive Hearing Loss (Middle and Outer Ear): Conductive hearing loss occurs when the outer or middle ear is not functioning properly. Many young children suffer from conductive hearing loss during their toddler years because at this young age, the eustachian tube that lies in the middle ear is more flat than angled as seen in an older child. This makes it difficult for fluid to drain from the middle ear when little ones are sick. Some known causes are fluid, frequent ear infections, and swimmer’s ear. Your pediatrician or ENT can often manage these conditions. However, some children have outer or middle ear differences such as microtia (a very small external ear), atresia (no external, middle ear, or opening to the middle ear), or abnormalities within the tiny bones in the middle ear system. These abnormalities can cause conductive hearing loss to be permanent.
Mixed Hearing Loss: Mixed hearing loss is a combination of both a sensorineural and conductive hearing loss. The middle ear and the inner ear both contribute to the diagnosis.
Less Common Types of Hearing Loss
Auditory Neuropathy: This occurs when sound travels through the inner ear normally, but the transmission of sound to the brain is impaired. Individuals with auditory neuropathy may have fair to poor ability in discriminating speech. This type of hearing loss needs to be monitored closely as the hearing will fluctuate (as the degree of hearing loss varies), and hearing aid programming needs to be adjusted accordingly.
Neural Hearing Loss: This rare type of hearing loss results from malformation or damage to the auditory nerve that connects the cochlea to the brain and is typically profound and permanent. Traditional hearing aids or cochlear implants do not provide benefit, because the auditory nerve cannot transmit information to the brain. An auditory brainstem implant may be recommended.
Treatment Options: Children diagnosed with hearing loss should be evaluated by an audiologist and specific recommendations such as hearing aids, bone conduction hearing aids, and cochlear implants will be recommended depending on the factors of their individual case. Children with conductive hearing loss may have options such as PE tubes if hearing loss is a result of chronic fluid that is medically managed by a physician. Your doctor and audiologist will help guide you through treatment after a successful plan is determined.
SING A SONG: Pick a song to sing with your toddler each time you clean up. Over time, as you start to sing, stop before the last word and use auditory closure to allow the child to finish singing the song.
SORT BY COLORS: Have your toddler clean up sorting by colors. Encourage them to find only one color first while you find another.
AUDITORY MEMORY: Ask your child to find two or three objects to put away first. Continue to have them listen for which objects they can bring you. (Ex. "Can you put the lion and the monkey in the box?")
TRY NOT TO POINT! Give your child directions but try to do so through listening first then if they need a visual you can show them by pointing or gesturing.
SEQUENCE THE EVENTS: Give your toddler the sequence of events so they can begin to learn the order and understand what comes next. Ex. "First, we are going to clean up our play dough, then we have to wash our hands and after we can have a little snack."
It’s critical for babies and toddlers to wear their hearing devices as often as possible, yet we face one obstacle - keeping them on! Little ones are constantly exploring and on-the-go, and since there’s no stopping that, here are some ways to help keep their hearing aids/ implants on.
1. Bonnets/Pilot Caps
A pilot cap or bonnet prevents a baby from being able to take their hearing aids out. Companies specialize in making them for hearing aids and cochlear implants so that they are designed to not cause feedback. Some websites include www.hearinghenry.com and www.silkawear.com.
2. Wig Tape
Wig tape can be used on a cochlear implant or hearing aid and is safe for skin. Wig tape may only last for a few hours and must be changed everyday.
A lanyard is attached to the child’s shirt with a small loop around the hearing aid or implant. Although this does not help keep the hearing aids or implant on the ear, it does prevent the aid from being lost for an active infant or toddler.
4. Huggie Aids
A “Huggie Aid” is a rubber ring that is attached to the aid and wraps around the ear to keep it secure.