Q&A

Answers by Prof. Dr. J. L. Northern

There are various causes of hearing loss in children and they can occur at different times. Parents can find answers about hearing loss in babies and children as well as advice on early detection and possible treatments here.

JERRY L. NORTHERN, PHD, PROFESSOR EMERITUS AT THE UNIVERSITY OF COLORADO SCHOOL OF MEDICINE


Jerry L. Northern, PhD, is Professor Emeritus at the University of Colorado School of Medicine where he served as of Director of Audiology for 26 years. Dr. Northern is from Denver, Colorado USA where he was raised by his deaf grandparents communicating through American Sign Language. A prolific writer and editor of several professional journals, he has authored a dozen textbooks in the areas of hearing and hearing disorders. Internationally known for his expertise in pediatric audiology, Professor Northern has served as a consultant in nearly 30 countries.  His professional career includes extensive experience in clinical practice, teaching and lecturing, research, medical-legal issues and the hearing aid industry. Dr. Northern is a founding member and past president of the American Academy of Audiology.
 

Why is hearing so important for children?

A child’s ability to hear and speak is vital for educational, emotional and social development and forms the basis for success and achievements in his or her adult life. By the time a child is born, they have already had several months of experience of hearing in the womb. Their ability to hear and speak continues to develop after birth as they listen to and imitate voices and other acoustic stimuli in their environment. If the brain does not receive adequate acoustic stimuli because of an undetected hearing loss, the development of age appropriate speech and language can be delayed making it difficult to close the developmental gap. Therefore, it is very important to detected and manage hearing loss in young babies as early as possible.

How does a newborn screening work?

Neonatal hearing screening is carried out shortly after birth. Parents should tell their doctor that they want a hearing test to be carried out. The hearing screening does not take long, is completely painless and quickly establishes whether there is a need for further hearing evaluation or not. The hearing test should be carried out after the baby is one-two days old, because immediately after birth amniotic fluid may still be present in the ears, which can give false test results.

How reliable is a newborn screening? Will my pediatrician take a follow-up test later?

Newborn hearing screenings are very reliable and accurate for identifying hearing loss. However a failed screen does not immediately suggest hearing loss.. If the baby fails the initial hearing screening test, then the screening is repeated. If the hearing screening is failed again, then baby is referred for a more in depth hearing evaluation. The Pediatrician should also be doing routine hearing screenings as a routine part of the child's well baby visits.

What may the negative effects of late hearing loss detection or lack thereof be?

Late detection of hearing loss can lead to delayed speech and language problems and potentially result in long-term challenges that may have profound impact on a child’s development. Research has confirmed that the earlier the identification and intervention, the better the prognosis for the child’s educational success.

Which are the causes of hearing loss in babies?

There are various causes of hearing loss in babies that can effect hearing in one or both ears and they can occur at different developmental times:

Pre-natal causes:

  • Approximately half of all pre-natal cases have a family history or component
  • Maternal infection during pregnancy
  • Various birth syndromes are associated with hearing loss
  • Substances consumed by the mother during the pregnancy (e.g. drugs and or alcohol)

Further causes:

  • Birth complications (e.g. low birth weight, cleft lip or palate, defects of the ear, nose or throat))
  • Untreated ear infections
  • Meningitis
  • Head injuries
  • Noise exposure (e.g. loud toys, fireworks, power tools, noisy recreational activities)

How can I protect my child’s hearing from excessive noise?

Avoid spending extended time with your child in very noisy places and make sure that your child wears adequate hearing protection. There are both custom-made and special pediatric earplugs and earmuffs on the market. Buy the best you can afford and remember to have the hearing protection available when needed. Also inform yourself and look for decibel (dB) ratings when buying toys and other sound producing systems and products for your child and your home. 

What do you think of presenting white noise while the baby sleeps? Will that affect his or her hearing?

There is no evidence that white noise is harmful as long as it's kept at a reasonable volume.

I am pregnant and want to visit a rock concert: Can loud sounds and music cause hearing loss in unborn children?

There is sufficient sound isolation created by the amniotic fluid to protect your baby. If there are concerns, please discuss them with your doctor.

How can I recognize hearing loss in my child?

Parents should note how their baby responds to loud sounds in their environment (e.g. a startle or blinking to sudden loud noise such as clapping) – Anytime there is concern or question about the child’s hearing parents should contact their pediatrician. 

Can hearing loss run in the family?

Yes, about half of all cases of hearing loss are genetic. This doesn’t necessarily mean that one or both of the parents suffer from hearing loss – rather they may “just” carry the recessive gene.

Where can I seek help if I suspect that my child has hearing loss?

If hearing loss is suspected, parents should immediately consult a pediatrician, pediatric audiologist (specializing in hearing disorders in children), pediatric hearing care professional (specially trained to work with children) or an ENT (Ears, Nose, Throat physician).

Which hearing solutions are available for children with hearing loss and how do I choose the right solution for my child?

Hearing loss can be managed in various ways depending on the type of impairment. In most cases, a pediatric audiologist will fit a hearing aid designed especially for children as a first step. Choosing the correct hearing aid will depend on the degree of hearing loss and the needs of the child. If the hearing aid does not offer sufficient help for those with a severe impairment, a cochlear implant (CI) may be the right choice. The cochlear implant is a surgical procedure reserved for severely deafened children who are at least 12 months of age or older.

How can I help my child with hearing loss to promote his or her development of speech?

Parents can use wireless microphone systems, as a supplement to hearing aids. The system includes a microphone worn by one or both parents and a receiver fitted onto the child’s hearing aid, enabling him or her to clearly understand speech even when further away or against a lot of background noise. However, parents must speak clearly and maintain eye contact. Advice and support from the child’s teachers are also particularly important aids to speech development, as are speech and music therapy, if needed.

How do I recognize hearing loss in a school aged child?

Students with an undetected hearing loss may be perceived as dreamers by their class mates, and may become classroom behavioral problems for their teachers. They frequently experience difficulty in hearing and understanding their teachers, which in turn is a barrier to educational progress. Possible consequences are a comparatively poorer performance, headaches, emotional stress and lower motivation. These problems are often wrongly associated with attention issues or discipline problems. Children may unnecessarily feel isolated and misunderstood because of it.

Which educational path is best suited for children with hearing loss? And how do I find the right school for my child with hearing loss?

There is no single “right” educational path for children with hearing loss, therefore parents should seek advice at state education and advisory centers, associations and self-help groups. The parents can also seek the opinion and assessment of a pediatric audiologist, a pediatrician or an ENT physician. When choosing a suitable school, parents should consider the different options and individual needs of their child as well as the degree of hearing loss, since both overloading and under-stimulation can lead to frustration. It’s also important to give the child a say in the decision.

Children with hearing loss may be supported in various types of educational environments. In the United States most children with hearing loss are educated in an inclusive or mainstream environment that promotes listening and spoken language.

Possible school types:

Mainstream schools: general education schools that predominantly teach children without special needs. The challenge: these schools are not specially adapted to the needs of children with hearing loss and may not have the necessary professionals (e.g., audiologists, speech-language pathologists, special needs teachers) readily available to help children with hearing problems.

Inclusive schools: mainstream schools that integrate pupils with hearing loss and other disabilities into the classroom setting. They usually employ teachers with additional qualifications and have specially equipped rooms.

Special needs schools for children with hearing loss: rooms and equipment are specially designed to meet the requirements and needs of children with hearing impairments and teachers are trained accordingly.

What technological aids can help children with hearing loss to participate in class?

There are child-friendly hearing aids that are particularly robust and tailored to the needs of children at different stages of their childhood. The effectiveness of hearing aids can be enhanced by Wireless Microphone systems. They consist of a microphone, which is worn by the teacher, and a receiver attached to the child’s hearing aid. This allows the child with hearing difficulties to understand their teacher well from a distance, even in classrooms with background noise. Another effective solution are Soundfield Systems. They amplify the teacher’s voice through a speaker to improve classroom acoustics and overcome background noise.

Are there any therapeutic measures that can help my child in successfully mastering school life?

Routine periodic monitoring of the child’s academic progress will help identify areas of educational weakness that can then be supplemented with additional teaching activities. Speech or music therapy can enhance the child’s verbal and communication skills and help promote reading and writing skills. 

What kind of future can I hope for my child who has hearing loss?

The future is bright!  The future for children with hearing loss has reached new heights with the explosion of available information and technologies and the myriad of choices for educational experiences.  Today’s education processes begin as soon as an infant is identified and diagnosed to have hearing loss.  And, with our current amplification technologies and intervention strategies, there is literally no limit to the goals the child with hearing loss might achieve.  Individuals with hearing loss can excel in every aspect of life including medicine, law, sports, teaching, entertainment, business, as well as the trades or arts specialties.  Parents and families are, perhaps, the most important element to the success of a child with hearing loss.  Research has confirmed that positive interactions within the family can have a substantial and lasting influence on their child’s long-term development and success.