Authors: Jillyen E. Kibby, MA, CCC-A and David Perlstein, MD, FAAP
Accurate hearing testing cannot be done until a child reaches the age of 5 or 6.
Current technology now permits the accurate assessments of hearing in children starting within a few hours of birth. In fact, 10 states have mandates that testing hearing be done in the newborn prior to discharge from the hospital.
Why test a child's hearing?
A child with undetected hearing loss may not be able to develop normal speech and language or acquire the cognitive abilities (knowing, thinking, and judging) needed for learning. Children whose hearing loss is not identified until, for example, 2 or 3 years of age may suffer from permanent impairment of speech, language, and learning.
The early identification of hearing loss permits the initiation of treatment and rehabilitation of the hearing-impaired child at a very young age. The child can then learn more normal speech skills when hearing loss is identified early and intervention begins.
Hearing loss can range from a mild impairment to profound loss. Many people think that hearing is only graded as normal or deaf. They may also think that the child is hearing normally if he or she is responding to sounds and voices. However, there are many subtle gradations between normal hearing and deafness and a child's hearing loss may not be apparent.
For example, it is common for a child with moderate hearing loss to develop speech and language and yet miss over half of what is being said. A child in this situation will have a distinct disadvantage in development and learning and will often reach a point where advancement stops unless the hearing loss is detected and treatment begins.
The stress on a child with hearing loss and their family can be enormous because the child does not understand why it is a constant struggle to learn seemingly simple material (and the family is baffled as to why their bright child is not doing well).
The degree of hearing loss often determines the impact it will have on the child throughout life. However, with early identification and treatment, the impact can be lessened.
What are the causes, risk factors, and signs of hearing loss in children?
There are a number of risk factors for hearing loss in children, so there are a number of special reasons why a child's hearing may need to be screened or tested. Common indications for a hearing evaluation include
- Speech delay
- Frequent or recurrent ear infections
- A family history of hearing loss (hearing loss can be inherited)
- Syndromes known to be associated with hearing loss (for example, Down's Syndrome, the Alport Syndrome, and Crouzon Syndrome)
- Infectious diseases that cause hearing loss (for example, meningitis, measles, and cytomegalovirus infection)
- Medical treatments that may have hearing loss as a side effect, including some antibiotics and some chemotherapy agents
- Poor school performance, and
- Diagnosis of a learning disability or other disorder, such as autism or pervasive developmental disorder (PDD)
In addition, the circumstances surrounding the pregnancy and birth may be associated with subsequent hearing loss. If there is a history that includes any of the following, a child should have a hearing assessment.
- Low birth weight (less than 2 pounds) and/or prematurity
- Assisted ventilation (to help with breathing for more than 10 days after birth)
- Low Apgar Scores (numbers assigned at birth that reflect the newborn's health status)
- Severe jaundice after birth
- Maternal illness during pregnancy (for example, German measles - Rubella)
Some parents start to suspect that their child cannot hear normally because the child does not respond to his or her name consistently or asks for words, phrases, or sentences to be repeated. Another sign can be that the child does not seem to be paying attention to sounds or to what is being said.
On the average, only half of all children diagnosed with a hearing loss actually have a known risk factor for hearing loss. This means that the cause is never known in about half of children with hearing loss. For this reason, many states in the U.S. have instituted a universal screen so that all babies have their hearing screened before they go home from the newborn nursery.
Who Tests Hearing in Children?
A specialist who tests a person's hearing is called an Audiologist. An Audiologist has an advanced degree (minimum of Master's Degree) in diagnostic hearing testing techniques and auditory rehabilitation for children and adults. However, because testing hearing in children requires specific equipment, setup, and training, not all Audiologists test children. When a child is referred for a hearing evaluation, it should be confirmed at the time of scheduling that the testing Audiologist has the appropriate experience and setup to test hearing in children.
What happens when a hearing loss is detected? What is the treatment for hearing loss in children?
When hearing loss is identified, a thorough search for its cause must be undertaken. In many situations, the hearing loss can be attributed to an ear infection or to fluid trapped in the middle ear space. In this situation, the physician can often prescribe antibiotics to treat the infection. If the infection is persistent, or the hearing loss is still present after treatment of the infection, then the child should be referred to a medical doctor who specializes in diseases of the ear and auditory system (an otolaryngologist or ENT). The ENT doctor will often administer further testing, and in some situations, he or she may recommend additional therapy such as surgery (ear tubes). If the hearing loss is persistent or is related to a nerve or inner ear problem, the ENT doctor will often recommend an evaluation by an Audiologist for hearing aids and rehabilitative therapy (which includes speech therapy and social integration of the hearing-impaired child).