Hearing Loss

Types of Hearing Loss in Children:

When a child has trouble hearing, the loss is identified by its type and degree.  Types of hearing loss are classified relative to the damaged part of the ear, or where the loss occurred.  The degree of hearing loss is determined by its severity.

Types of hearing loss:

Conductive hearing loss occurs when there is an interference with the transfer of sound through the outer or middle part of the ear.  Possible causes of conductive hearing loss include:  ear wax, ear infection, and collapsed ear canal, damage to the bones of the middle ear, ear infection and many more.  Conductive hearing losses are typically medically or surgically treatable.  If medicine or surgery are unsuccessfully, conductive hearing loss can be treated with amplification including different types of hearing aids.  Because conductive hearing loss is rarely permanent, attention is focused upon its temporary affects on speech and language development or classroom performance.

Sensorineural hearing loss is caused by a problem in the inner ear or nerve or hearing.  Possible causes include abnormal inner ear development, injury from medicine or disease, tumor, physical injury to the inner ear and many more.  Sensorineural hearing losses are permanent and are treatment with amplification including hearing aids, cochlear implant or other forms depending upon the severity of the loss.  Again, once the loss is diagnosed, attention becomes focused on language development and educational needs.

Mixed hearing loss is typically considered combinations of conductive and sensorineural hearing loss.  Other types of mixed loss may be considered sensory or neural.  Neural or central losses are rare and management may include many combinations of medical, Audiologic and therapeutic care.

Degrees of hearing loss:
Losses are identified as mild, moderate, severe and profound.  The degree of the hearing loss identifies the level at which the child can hear.

Mild:  Children with mild hearing losses have hearing in the 20-40dB range.  The most common cause of mild hearing loss is children are middle ear fluid or infection resulting in mild conductive hearing losses.  Children with mild hearing losses will have difficulty hearing soft or distant speech but will typically have normal speech and language development or only slightly delayed development.  Mild hearing losses may or may not require intervention depending upon its nature is it chronic or not, severity of the mild loss and lifestyle demands.  For example, an adult with more limited social activities may not require assistance, but a child in a classroom needs it.  In the best case, a child’s hearing should be better than 15dB to function easily in a classroom.

Moderate:  Children with moderate hearing losses have hearing in the 40-60 dB range.  These children will have difficulty hearing soft speech in one on one conversations and difficulty in the presence of background noise.  Moderate hearing losses require intervention. Intervention typically includes, educational services, hearing aids and classroom modifications.

Severe: Children with severe hearing losses can hear sounds in the 60-80 decibel range. They can only hear sounds less than one foot away from their head or very loud environmental sounds.  Intervention services are a necessity for language development.  Intervention may include sign language, educational services, hearing aids, cochlear implant and classroom modifications.

Profound:  Children with profound hearing losses may hear sounds above 80 decibels.  They will not hear conversational speech but may be aware of sound vibration.  Children with profound hearing losses are considered deaf and intervention is a necessity.  Intervention may include sign language, educational services, hearing aids and cochlear implant. 

For children, early identification is the primary goal for management of hearing loss.  Most states have a high risk registry and/or screening procedure that occurs prior to the infant leaving the hearing loss.  The high risk registry identifies children who may be at risk for hearing loss or progressive hearing loss.  If your child is at risk, an infant evaluation is recommended.  Screening procedures in the hospital can determine the presence or absence of normal auditory sensitivity.  If your infant receives a referral, an infant diagnostic evaluation is recommended.  If your child is referred for either reason, schedule the evaluation as soon as possible.  Children begin learning language while in the womb.  Every minute without sound can affect their speech and language development, education and future. 

What is the treatment?
Early hearing is critical to speech and language development.  Treatment may include any of the following audiological methods with the goal of hearing, language training, parent support, education and planning for the future.

Early intervention includes any service designed to help a child reach their development and educational goals.  Most states have a program to provide early intervention services to children with hearing loss.  Services may include, audiology, deaf education, speech and or sign language, hearing aids, cochlear implant, or medical management if possible.

Hearing aids provide the best sound possible to your child’s ear with a focus on the sounds of speech.  They do not restore hearing or auditory function.  Hearing aids are often used temporarily or permanently depending upon your child’s needs.  If your infant has chronic middle ear pathology that is causing him or her speech and language delay, hearing aids may be recommended until the problem can be resolved.  Hearing aids can be fit to children of any age, and as with all other intervention, the sooner the better.

Cochlear implants are used for infants and children with severe to profound and profound hearing losses.  They are recommended when hearing aids are not able to provide enough sound for speech and language development or when a child or infant shows failure to progress.  Cochlear implants are implanted into the inner ear.  It is an electronic device.  For more information on cochlear implants, see that section.

Ear tubes are placed in the ear drums of children when fluid accumulates in the middle ear resulting in a hearing loss.  The tube allows the fluid to drain out, allowing for improved hearing.  The tubes are typically left in place until they migrate outward.  Tubes are often used with hearing aids as needed.

Therapies include language training for hearing impaired children.  There are multiple ways for children with hearing loss to learn to communicate.  Some children use only their hearing aids or implants while other children combine their technology with signed forms of language.  Still other children, may forego technology and rely solely upon sign language for communication.