Listen Up! Dealing with Childhood Hearing Disorders

Childhood hearing disorders

The effect of hearing loss in children affects the development of speech and language. A child, who can’t hear, can’t develop normal speech and will have trouble acquiring cognitive abilities (knowing, thinking, and judging) that are needed for learning.

One of the greatest challenges with childhood hearing loss is early diagnosis. In our country, many children with this problem are not spotted until it becomes apparent that their speech and normal development has been affected, which on average is around 2 years old. Hearing loss at birth is either genetic or secondary to maternal infections in pregnancy and these generally involve the inner ear. Hearing loss involving the outer and middle ear is commoner in older children and is usually secondary to the presence of fluid in the middle ear (termed Otitis Media).

Infections to the brain and surrounding tissues like meningitis or encephalitis or even virulent forms of common childhood diseases like measles and chicken pox can cause deafness. Certain groups of antibiotics used to combat infections can have severe effects on the inner ear, destroying the delicate cells which help to process and conduct sound and can result in ‘ototoxicity’.

Symptoms of hearing loss

Many people think hearing is either normal or “deaf”. There is a range of hearing loss, which can be from a mild to profound loss. A child with even mild to moderate hearing loss may miss almost half of what is being said at home and in school. Children who can’t hear may not be able to explain their symptoms to adults. Below is a list of some symptoms a child with hearing loss may exhibit.

• speech delay
• poor performance in school
• child who seems to misunderstand instructions frequently
• recurrent ear infections or pain
• family history of hearing loss
• syndromes that are associated with hearing loss (eg – Down’s syndrome)
• diagnosis of learning disability
• low birth weight and/or prematurity
• severe jaundice after birth

If your child suffers from any of the above symptoms, it may be beneficial to have a hearing screening done for him/her.

Testing for hearing loss

There is no child who is too young to be tested. It is important to note that hearing testing can be modified to suit any age from birth itself. The choice of hearing test will depend on each child’s development and mental maturity. It ranges from OAE (Oto-accoustic emission), BERA (Brainstem Evoked Response Audiometry), Play audiometry or Pure Tone audiometry.

What can be done once hearing loss is detected?

The most important thing to do once hearing loss is diagnosed is to determine why?

Can this situation be treated or modified?

If the hearing loss is irreversible and affecting the child’s speech and development, hearing should be augmented early with the use of hearing aids or implantable hearing devices. These are most beneficial when used early as possible to achieve normal development of speech. Treatable conditions like Otitis Media can be medically treated or may need minor surgery to restore hearing.

Seeking Advice

The most important thing you can do if you think you have a hearing problem is to seek advice from a health care provider. A child with hearing impairment should receive help right away, the earlier the better. A child in this situation will have a disadvantage in development and learning. The stress and burden of hearing loss on a child and their family can be huge especially when the child seems to struggle to understand/learn seemingly simple things. There are several types of professionals who can help you. You might want to start with your primary care physician, an otolaryngologist or an audiologist. Each has a different type of training and expertise to assist you and most often they work together.

An otolaryngologist, sometimes called an ENT, will try to find out why you’re having trouble hearing and offer treatment options. He or she would refer you to another hearing professional, an audiologist after ruling out any other medical related underlying cause for the hearing loss. Treatment will depend on the severity of hearing loss, so some treatments will work better for certain individuals than the others. There are a number of devices and aids that helps hearing better when you have hearing loss. The most common ones are hearing aid, cochlear implants or a bone anchored hearing aid.

Hearing loss devices and Aids

A hearing aid will not restore normal hearing but will increase the awareness of sounds. Choose a hearing aid only after having sufficient trial period. Wear the hearing aids regularly so as to help the individual to adjust to them faster. If there is hearing loss in both ears, it is best to use hearing aid in both ears as it provides a natural signal to the brain plus and also assist in localisation of sound. Find a hearing aid centre which is capable of providing servicing and minor repairs. It is also important to note how long the warranty is for the hearing aid device.

A cochlear implant is very different from a hearing aid. Hearing aids amplify sounds so they may be detected by damaged ears. Cochlear implants bypass damaged portions of the ear and directly stimulate the auditory nerve. Children and adults who are deaf or severely hard-of-hearing can be fitted for cochlear implants. This involves a surgical procedure which the child undergoes under general anaesthesia with risk factor, just as with any kind of surgery. An additional consideration is learning to interpret the sounds created by an implant. This process takes time and practice. Speech-language pathologists and audiologists are frequently involved in this learning process. Prior to implantation, all of these factors plus the cost needs to be considered.

A Bone Anchored Hearing Aid is a well-established hearing solution for conductive and mixed hearing losses and also for single-sided sensorineural hearing loss, commonly referred to as single-sided deafness (SSD). Children with congenital atresia, various cranio-facial syndromes such Treacher Collins and Goldenhar, cholesteatomas and middle ear dysfunctions benefit greatly from this procedure. This also involves a surgical procedure wherby the implant allows sounds to by pass the middle ear space where the air-bone gap occurs, and stimulate the cochlea directly instead. You can achieve better sound quality because of direct bone conduction. The sensory nerve function must be normal in this group of children.

Assisting people with hearing loss

There are many ways that we can accomodate people with hearing loss while they are having their hearing challenge addressed.

• Make sure you have face-to-face contact with the person you are talking to.
• Speak clearly but not too slowly, and don’t exaggerate your lip movements – this can make it harder to lipread.
• Modify your house acoustically by having plants, cushions, rugs and curtains that absorb unwanted noise and makes speech easier to listen to.
• Keep the TV turned off at social gatherings at home.
• Find a suitable place to talk, with good lighting, preferably daylight and away from noise and distractions.
• Even if someone is wearing hearing aids it doesn’t mean they can hear you perfectly. Ask if they can hear clearly or if there is a need to lipread.
• Don’t shout when they have difficulty following the conversation. It can be uncomfortable for hearing aid users and it looks aggressive. This would make them be reclusive.
• If you’re talking to a group that includes deaf and hearing people, don’t just focus on the hearing people. Include them into your conversation. If the hearing isn’t the same in both ears, make sure they are seated in the best position to maximise the ‘good side’.
• Engage them in one-to-one conversation as opposed to group conversations wherever possible (especially when speaking about important matters) – it is much easier to listen to one voice rather than sieving conversation from many voices.
• In the end, select a hearing aid that best suits the needs and lifestyle. Do not choose a hearing aid based on cost alone.