Frequently Asked Questions
About Hearing Loss

What causes minimal hearing loss?

Ear infection or otitis media is the most frequent cause of minimal hearing loss in children. It is an inflammation in the middle ear that usually causes fluctuating hearing loss averaging 21-40dB. However, many children are born with minimal hearing loss caused by problems in the inner ear. Because these hearing losses are mild they may go undiagnosed in the early years but they can cause significant problems educationally if they are not addressed.

This diagnosis is often missed and many children with hearing loss due to otitis media will pass a school screening test. Children with learning disabilities frequently have histories of chronic middle ear infection (4-5 episodes over a 6-12 month period), causing reduced hearing over a significant part of the school year.

What causes hearing loss?

About 50 percent of deafness is hereditary . Genetic hearing loss is not necessarily passed from parent to child, but may appear in other family members. More than 90 percent of the parents of deaf children are hearing people. Most hereditary hearing loss is recessive so both parents need to be carriers. Each parent carries a single copy of a deafness-causing mutation . The carrier rate in the general population for a recessive deafness-causing GJB2 mutation is about one in 33.

Other factors that can cause hearing loss include accidents and injuries, constant high noise levels that eventually cause severe damage to the nerves of the ear, illness or infection, and drugs which adversely effect the organ of hearing. Rubella or other viral infections contracted by the pregnant mother may cause deafness in an unborn child. A problem during the birth process such as a cutoff in the supply of oxygen may affect hearing. Hearing loss may also be part of the aging process in older people and is more likely to be mild. In many cases there may be no clear reason for hearing loss and the cause may never be determined.

Is hearing loss permanent? Can it be corrected?

In order to understand the different types of hearing loss it is important to know something about how normal hearing occurs. Sound waves traveling through air are funneled into the external ear canal which makes the eardrum with its attached ear bones (maleus=hammer, incus=anvil, stapes=stirrup) vibrate within the air-filled middle ear. This is the ears' conduction system. The piston-like movement of the three bones and eardrum stimulates a fluid wave in the liquid-filled inner ear. The movement of the inner ear fluid bends microscopic nerve endings called hair cells that are the ears' sensory structures. There are 30,000 hair cells and when they are bent by the movement of the fluid they work like a switch turning on an electrical current that travels through the nerve of hearing to the central auditory centers in the brain.

Conductive hearing loss: caused by a problem affecting the conduction system. Examples are excessive wax blocking the external ear canal, fluid in the middle ear preventing the eardrum from vibrating, or a disruption or fixation of the bones in the middle ear. Many conductive hearing losses can be treated and eliminated with medication or surgery. If a problem in the middle ear cannot be corrected, hearing aids and other assistive devices may be helpful.

Sensorineural hearing loss: caused by a problem in the inner ear hair cells (sensory loss) or auditory nerve (neural loss). Some or all of the hair cells in the cochlea may be damaged or absent. It is also possible that the auditory nerve from the cochlea to the brain may be damaged, incompletely formed, or there may be problems with transmission of sound across the auditory nerve. Infrequently, the auditory nerve may have a tumor growing in it which is generally benign (acoustic neuroma).This type of loss is not reversible. Most people with sensorineural hearing loss benefit from hearing aids. If the hearing loss is severe or profound, a cochlear implant may be recommended. A cochlear implant can be thought of as a very strong hearing aid which is surgically implanted. Sensorineural hearing loss can be stable, can fluctuate or be progressive and can even worsen as children get older. It is important to monitor children's hearing to determine the stability of their hearing loss. Young children should be tested at least twice yearly. Older children should be tested annually. Your child should always be retested if you suspect a change in his/her hearing ability.

Mixed hearing loss : a combination of conductive and sensorineural losses

Will my child ever talk?

Almost all children who are deaf can learn to speak. With the use of powerful hearing aids and/or cochlear implant and speech therapy, a deaf child can learn to hear which is the first step to learning to talk.

Testing for Hearing Loss

When should my child be tested for hearing loss?

Children should be tested for hearing loss as early as possible. Ideally all newborns should be screened for hearing loss before they leave the hospital. The Center for Disease Control's Early Hearing Detection and Intervention (EHDI) program funds newborn hearing screening programs in many states. The EDHI web site covers topics such as screening guidelines, state programs, and resources for parents and professionals. You can visit their site at www.cdc.gov/ncbdd/ehdi/ehdi.htm .

Many things can affect hearing as a child gets older. Even if an infant passes new born hearing screening, children should be tested again if any concern develops about hearing or speech and language development.

There are numerous testing measures available to determine the hearing status of children of all ages. Detecting deafness early enables children with hearing loss to receive services that promote language, cognitive development, and social interaction early, during the years that are crucial to academic and social development. Hearing should be screened at birth and 2-3 times a year during the first few years of life and yearly throughout schools years. This can be done in the pediatrician's office or at school. If there is a question about hearing, a child should have a diagnostic evaluation by an audiologist.

How are infants tested for hearing loss?

A baby's hearing can be tested hours after birth through two techniques: automated auditory brainstem response screening (ABR) and/or otoacoustic emissions screening (OAE). The ABR monitors brain activity that occurs in response to sound. OAE's are a quick, non-invasive probe measure that determines if the cochlear, or inner ear, is working normally. Both techniques are painless, easy to administer, relatively inexpensive, and accurate. They can be done while an infant is sleeping. Early diagnosis is of major importance because the earlier the hearing loss is diagnosed the sooner intervention can begin, leading to better communication skills in the child. It is important to remember that these are screening tests. If a concern develops about hearing it is important to have a diagnostic evaluation with an audiologist.

Why is it important to have my baby's hearing screened early?

The most important time for a child to be exposed to and learn language is in the first three years of life. Children hear even before they are born and begin learning speech and language in the first 6 months of life. Hearing is critical for developing speech and language. Even before a child begins to talk they are hearing speech around them and starting to learn to understand what the people around them are saying. Research suggests that children who have hearing impairment and receive early intervention before 6 months of age have better language skills than those who don't. The earlier you know about deafness or hearing loss, the sooner you can begin treatment approaches that will help your child learn to communicate.

Where can my child's hearing be tested?

Many hospitals automatically screen all newborns for hearing loss. Many hospitals have speech and hearing clinics with audiologists who can test your child's hearing. Your pediatrician or family physician can also provide a referral to an Ear, Nose, and Throat or Otology practice that has a licensed audiologist on staff or to an audiologist in a hospital or to an Audiology practice where your child can be tested. Audiologists can perform hearing tests, refer patients for medical treatment to an otolaryngologist (a physician specializing in ear, nose and throat problems) and provide hearing rehabilitation services. Audiologists work in hospitals, clinics, private doctor's offices, public and private schools, universities, speech and hearing centers, and nursing homes. They are also listed in the yellow pages. It is best to find a pediatric audiologist who has extensive experience working with children. The American Speech Language and Hearing Association (1-800-638-8255 or ASHA) ( www.asha.org ) or the American Academy of Audiology (1-703-610-9022) ( www.audiology.org ) can assist you in finding a qualified clinician in your area.

What is an audiologist?

An audiologist is a professional with a Masters or Doctoral degree who diagnoses, treats, and manages individuals with hearing loss or balance problems. Audiologists have special training in the prevention, identification, assessment and non-medical treatment of hearing disorders. Audiologists receive professional certification and licensure and are the most qualified professionals to perform hearing tests, refer patients for medical treatment and provide hearing rehabilitation services including hearing aids.

Audiologists determine appropriate treatment through a complete medical history and a variety of specialized hearing and balance tests. Based on the diagnosis, the audiologist presents treatment options to patients with hearing impairment or balance problems. Audiologists dispense and fit hearing aids as part of a comprehensive treatment program. They refer patients to physicians when the hearing or balance problem requires medical or surgical evaluation or treatment.

What is a speech-language pathologist and how do they help child with hearing loss?

Speech-language pathologists work with a team that can include parents, audiologists, psychologists, social workers, classroom teachers, special education teachers, guidance counselors, and physicians to provide comprehensive language and speech assessments for children. These services help children with communication skills, cognitive abilities and social interaction. Services provided by speech-language pathologists include memory retraining, cognitive skills, language development, and efforts to improve abstract thinking. These services can help children overcome their disabilities, gain self-esteem, and lead productive and meaningful lives.

Hearing Loss and Learning

How does hearing loss affect learning?

Good hearing is essential to the social and intellectual development of infants and young children. Hearing loss can affect learning, speech, attention and emotional development. It also affects reading, writing and academic performance. These deficits can occur as early as kindergarten and first grade. Most children with hearing loss begin to show significant learning difficulties by the third grade due to the increasing complexity of language, social interaction, and verbal communications. Some of these problems can even affect children with minimal hearing loss. Children with minimal hearing loss experience problems hearing faint or distant speech and can miss classroom instruction and subtle conversational cues that could cause a child to react inappropriately. They have difficulty following fast-paced verbal exchanges and hearing the fine word-sound distinctions such as plurality, tense, possessives, etc. In addition, a child with a minimal hearing loss may appear immature and tire more easily than normal-hearing children because of the extra effort needed to hear.

What are signs that a communication disorder is affecting school performance?

Often hearing problems are mistaken for attention and behavior problems and are not properly identified as hearing loss. Problems in language development can lead to difficulty in learning to listen, speak, read or write. Children with communication disorders who do not receive treatment may perform at a poor academic level, struggle with reading, have difficulty understanding and expressing language, misunderstand social cues, avoid attending school, show poor judgment, and have difficulty taking tests.

What is Auditory Processing Disorder and how does it affect my child's learning?

Auditory Processing Disorder (APD) refers to the process of how the brain takes in auditory information. Even though children with APD can hear well, they may have difficulty using those sounds in speech and language because their brain does not pick up the electrical signals coming from their ears. Children with APD may have trouble listening, following verbal directions, developing language, remembering auditory information, remaining attentive, and understanding speech. All of these difficulties may worsen in noisy acoustic environments, such as classrooms.

It is important to understand that APD cannot be diagnosed from a checklist of symptoms. No matter how many symptoms of APD a child may have, only careful and accurate diagnostic tests can determine the underlying cause. To diagnose APD, an audiologist administers a series of tests in a sound-treated room. Most of the tests for APD require that a child be at least 5 years of age so that test interpretation is possible. There are many types of auditory processing deficits so once a diagnosis is made individualized management and treatment activities can be recommended that address each child's specific areas of difficulty.

Hearing Aids

Does a hearing aid "fix" hearing?

Hearing aids cannot restore perfect or normal hearing b ecause a sensorineural hearing loss involves damage to some part of the inner ear (usually the cochlear). Some degree of sound distortion usually occurs. A hearing aid can amplify the loudness of the sound, but even with the most current hearing aids speech may not be completely clear. Because young children have very plastic brains, children with hearing loss can learn to listen and speak through auditory training and speech and language therapy.

Do all children with hearing loss need to wear hearing aids?

Children with permanent hearing loss should be properly amplified. However, some children with severe to profound hearing loss in both ears may find that they do not get enough benefit from hearing aids. These children may be candidates for a cochlear implant. Other children may have conductive hearing loss that can be corrected or improved by surgical or medical intervention. If the hearing loss cannot be medically corrected, they may benefit from hearing aids. These children need to be carefully evaluated by medical professionals.

Why is it so important for babies to have hearing aids?

Babies begin developing the skills necessary for language as soon as they are born. Research suggests that there is a critical learning period during which babies learn language, from birth to about three years of age. Research also shows that when infants are aided early on they have the greatest chance of developing language skills comparable to their same-aged peers. Exposure to sound actually stimulates the development of the auditory neural synapses within the brain. If a child is unaided, it is important to begin using a visual form of language early to be certain that the child has a method of communication.

What types of hearing aids are there?

There are essentially two kinds of hearing aid technology: analog and digital.

Analog hearing aids use an analog signal to amplify sound. It is considered basic technology and offers limited adjustment capability. It is the least expensive and the least flexible. They may be very good for patients with more mild hearing loss and for patients who do not rely on listening to understand speech. As technology improves, fewer analog hearing aids are being developed.

Digital hearing aids make use of digital technology to control the auditory signal. They are usually able to provide a cleaner signal and can eliminate background noise. They are also the most expensive.

What styles of hearing aids are there?

Behind the ear (BTE) hearing aids: These are the most commonly dispensed hearing aids. They are available for people with mild to severe hearing losses. BTE hearing aids fit over the ear and use an ear mold to send sound into the ear. They are usually easy to manipulate and can easily be connected to an FM system so they are ideal for children in school.

In-the-ear (ITE) hearing aids: These are very popular with adults who have mild to moderately-severe hearing loss because they are smaller than BTE hearing aids. They fill in the ear and usually have one or two small switches which are used to turn the hearing aid on and off or to change programs. These hearing aids are not good for children because they need to be remade every time the child grows (which can be more than once a year). In addition they are not compatible with FM systems.

Completely-in-the-Canal (CIC) hearing aids: These are very small hearing aids that fit into the ear canal and are less visible than ITE hearing aids. Because they are so small they may not be able to have all the options that a BTE hearing aid has.

Cochlear Implants

What is a cochlear implant and how does it work?

A cochlear implant is very small, complex electronic device that can provide sound to a person who has a severe or profound hearing loss. One part is surgically placed inside the inner ear while the other external part is worn behind the ear. The cochlear implant delivers electrical stimulation to the inner ear (the cochlea) and bypasses the damaged hair cells, directly stimulating the hearing nerve. These electric currents activate the nerve, which then sends a signal to the brain. The brain learns to recognize this signal and the person experiences this as "hearing".

Unlike a hearing aid which amplifies sound, the cochlear implant bypasses the damaged, non-working hair cell parts of the inner ear. In normal hearing, the inner ear converts sound waves into electrical impulses that are sent to the brain, and a hearing person recognizes them as sound. The cochlear implant works in a similar way. It electronically finds useful sounds and then sends them to the brain. However, the result is not the same as normal hearing. Although an implant does not create normal hearing, it provides the person with a digitalized computerized version of sounds. It gives a person with a severe or profound hearing loss access to sound, and can help them to understand speech. With the help of intensive speech, language and listening therapy, many children with cochlear implants develop excellent speech and language skills and can even communicate over the phone.

What is the ideal age for a deaf child to receive a cochlear implant?

There is no single ideal age for implantation in children. It depends on each family, each child, and the individual factors affecting each child. The best age for implantation is still being debated, but research has clearly indicated that children who receive cochlear implants early have the best results. In 2002 the FDA lowered the age for inclusion in pediatric clinical trials to 12 months. Many centers will implant children as early as 6 months if there is certainty as to the audiologic indications.

In general, because it is felt that there is a window of opportunity for learning the skills necessary for spoken language, the earlier the implant the better. Speech and language development occurs, for the most part, by age six. Progress does not occur as quickly or as easily after that age. The decision about whether to implant an older child is made individually. Factors to consider include use of hearing aids and auditory skills. If an older child has not worn hearing aids, benefit received from a cochlear implant may be limited.

Children implanted after the age of three years may require more frequent and more intensive speech and language therapy to progress at rates comparable to children implanted before age three. Implantation should always be weighed carefully against the child's educational and therapy environments, level of family involvement, and use of residual hearing with amplification, among other factors.

Who is a candidate for a cochlear implant?

Children and adults who have severe or profound sensorineural hearing loss and derive minimal benefit from hearing aids may be candidates for a cochlear implant.

The benefit that an adult receives from an implant depends on several factors: their degree of hearing loss, their ability to understand speech before receiving the implant, experience using a hearing aid, and the length of time they have been severely deaf. Generally the more experience a person has with hearing and the shorter the duration of their deafness, the more benefit they can expect to receive.

Young children are excellent candidates for cochlear implants because their nervous systems are able to learn easily which allows them to make use of the sound the implant provides. Children implanted early, who do not have other significant development disabilities and who receive intensive post-implantation speech, language and listening therapy, may acquire age appropriate speech, language, developmental and social skills. They are usually schooled in mainstream educational settings.

What happens after implementation?

Individuals who receive a cochlear implant require continual follow up. Children, in particular, require a long period of rehabilitation to teach them to listen to the new sounds and to optimally tune the device.

How long does it take to get maximum benefit from a cochlear implant?

Many factors determine progress. It depends on how long you have had a severe to profound hearing loss and your ability to use hearing with hearing aids. Improvement is slow in the beginning and improves rapidly over the first few months. For adults, generally there are good benefits by three months and it may take about a year to achieve full benefit.

How much do cochlear implants cost?

The total cost is between $40,000 and $60,000.  That includes the cost of the device itself and the surgery to implant it. In addition, cochlear implants need to be programmed on a regular basis after surgery. The fees for programming vary depending on individual needs.

Do insurance companies pay for cochlear implants?

Because cochlear implants are recognized as standard treatment for severe-to-profound nerve deafness, most insurance companies cover them. Medicare, Medicaid, the Veteran's Administration and other public health care plans cover cochlear implants. More than 90% of all private health plans cover cochlear implants. Cochlear implant centers usually take the responsibility of obtaining prior authorization from the appropriate insurance company before proceeding with surgery.

My Child's Education

What kinds of schools are available for a hearing impaired child?

There are various options available to educate children who are deaf. The law mandates that public schools are responsible for providing a free and appropriate public school education for all students regardless of disability. School districts are required to provide adequate services to educate hearing impaired students. Children may be mainstreamed in regular classes or provided special classes for students who are deaf or hard of hearing located in specific schools. A child may also attend a school for the deaf. These schools offer a variety of communication options for parents to choose for their child.

What is an IEP?

Federal law requires that an Individualized Educational Program (IEP) be developed for each child who is identified as having special needs. A hearing loss qualifies children for special education services if they have an educational deficit as a result of the hearing loss and require specially designed instruction to meet their educational needs. An evaluation by a multidisciplinary team will determine eligibility for special education services.

Once special education eligibility has been determined, a meeting will be convened to develop the IEP to help teachers determine exactly what your child needs and to set education goals for your child. The parent has the right to request reasonable services and placements for the child. If a parent disagrees with the services and/or assisted listening devices offered they have the right to appeal the decision.

Communication options

What communication options are available for my child?

Auditory-Verbal: Emphasizes the development and reliance upon auditory cues to receive and comprehend spoken language. Underlying this approach is the understanding of interdependency between listening and speaking. As a result, spoken language is expected as the response to being talked to.

Auditory-0ral: Like auditory-verbal therapy, this approach emphasizes the development and reliance on auditory cues to receive and comprehend spoken language. However, this approach acknowledges that in some instances emphasis on visual or vibrotactile cues may be utilized. Spoken language is the expected response.

Total Communication: This multi-sensory training approach emphasizes the combined use of spoken language with a manual communication system (signs). Sign alone or sign with vocalization are acceptable responses. Typically maintaining English word order is emphasized by service providers implementing this approach.

Manual Communication: (ASL, SEE) This approach emphasizes conveying meaning and eliciting responses based on a formal visual communication system. There are two sign systems typically used: ASL (American Sign Language) is the most common manual communication system. It is a formal language with its own syntax and grammar. SEE (Signed Exact English) is a system which uses signs but follows standard English syntax and marks English grammar forms with a set of endings. Adding auditory cues is compatible with SEE, as the word order is English word order and there is a match between what the child sees and hears. In contrast, the simultaneous presentation of speech and ASL results in a miss-match because ASL has a different word order from spoken English.

Cued Speech: This training approach provides supplemental visual gestures or "cues" to distinguish between speech sounds that look the same on the lips. It is designed to supplement spoken language until the child has the opportunity to establish more precise auditory skills for distinguishing between similar-sounding or visually similar-looking sounds.

Noise and Hearing Loss

Does noise cause hearing loss?

Loud sounds destroy the tiny hair cells in the inner ear that are responsible for converting sound waves into electrical impulses that are sent to the brain. Once about 25% of these cells disappear, you begin to experience hearing loss. Hearing damage can occur in two ways. Brief exposures to extremely loud sounds can cause permanent damage. Consistent exposure to moderate-level sounds wears out these hair cells and weakens their ability to recover. Over time as these cells die permanent hearing loss occurs.

What are safe levels of noise?

Noise levels greater than 80 decibels can be hazardous and can damage your hearing. As a gauge, normal levels of conversation are 60 decibels. Examples of unsafe levels of exposure include prolonged exposure to any noise above 85 decibels such as noisy toys, lawnmowers, truck traffic or subways (90 decibels). More than 15 minutes of unprotected exposure to 100 decibels is considered unsafe such as iPods at maximum levels (100-115 decibels) and snowmobiles, chainsaws and pneumatic drills (100 decibels). Regular exposure to 110 decibels or more risks permanent hearing loss. This includes motorcycles (120 decibels), firearms and jet engines (140 decibels) and loud rock music (150 decibels).

How can I protect myself and my child from noise damage?

The optimum protection is to eliminate your exposure to unsafe levels of noise whenever possible. When noise cannot be eliminated, these strategies can help to limit the negative effect of noise.

1. Wear hearing protectors when exposed to any loud noise. This includes ear muffs, foam plugs, pre-molded ear plugs and canal caps. These can be purchased at drug stores, sporting goods stores or can be custom-made.
2. When using stereo headsets or listening to amplified music in a confined space like a car, turn down the volume and ask others to do the same. If sound from a head set can be heard by others 3 feet away, the volume is too loud.
3. Avoid children's toys that produce high noise levels.
4. Look for a noise rating when buying recreational equipment, children' toys, household appliances and power tools. If there is no noise rating, you can contact the manufacturer and request this information.
5. Do not sit near speakers at concerts, festivals and sporting events.
6. Avoid loud noisemakers such as firecrackers and guns.
7. It is essential that musicians wear ear protection.

Can iPods and other MP3 players cause hearing loss?

There is much concern among hearing specialists about the effects of iPods and other MP3 players because hearing loss is related to the volume and duration of sound. With these devices, music is sent directly into the ears, the volume is often high, and the devices hold thousands of songs that are listened to for long periods of time. Researchers studying cassette players and portable compact disc players have found an increased risk of hearing loss among people who listen to loud music through headphones for an extended period of time.

How can iPods be used safely?

To protect your hearing when using an iPod:

1. Set the volume while at home or in a quiet place
2. Set the volume so you can still hear sound around you and so that you can carry on a conversation
3. When you go into the street DO NOT MAKE IT LOUDER
4. OR buy noise canceling earphones that will block out street noise so you do not have to turn up the volume to hear the music comfortably. Two possible sources of noise-canceling ear phones are Bose and Etymotic.

How can I protect my child from hearing damage from iPods?

In March 2006 Apple released a software update for iPods that allows parents to use a combination lock to set the maximum decibel level for children. Apple posted information online at www.apple.com/sound on how to use this new feature and other strategies to limit long-term hearing damage.

Can noisy toys hurt my child's hearing?

Children's hearing is particular sensitive to noise. In addition, children tend to hold toys and games closer to their ears. In general it is best if toys do not exceed 80 to 85 decibels.

Most toy makers are meeting the non-required standards on toys developed by ASTM (a worldwide voluntary standards development organization). However, children may still play with them in an inappropriate way, holding them up to their ears for long periods of time.

If a toy seems too loud to you, don't buy it. Put masking tape over the speaker of a toy that seems especially loud to reduce the volume.

How can I locate Parent Groups?

These online forums help families create community in order to share concerns and successes, receive emotional support, learn information and ask questions related to various aspects of deaf life and parenting issues.

Alexander Graham Bell Association for the Deaf, Inc.

American Society for Deaf Children

BEGINNINGS for Parents of Children Who are Deaf or Hard of Hearing, Inc.

CI Hea r (Cochlear Implants)

Listen-Up

National Information Center for Children and Youth with Disabilities