HEARING LOSS IN CHILDREN

Contributed by Mandy Mroz, AuD, director, Healthy Hearing

This content was last reviewed on: May 4th, 2017
Children with hearing loss can have delayed language and speech development.
Understand the importance of early intervention for children with hearing loss.

Hearing ability is important for children to develop speech and language skills as
they grow. In the past, hearing loss in children often went undetected until the child
was around two years old, when it became obvious that he or she wasn't talking yet.

Even newborns can be tested and treated for hearing loss.

Research has demonstrated that detection and intervention for hearing loss prior to
six months of age results in significantly better outcomes than intervention after six
months of age. As a result, newborn hearing screening has become universal in
hospitals across the United States and children with hearing loss are being identified
and treated at much younger ages.

How common is hearing loss in children?

While data varies, roughly 1.4 babies per 1,000 newborns have a hearing loss.
Research from a 2005 National Health Survey conducted by the Centers for Disease
Control and Prevention (CDC) indicated five out of every 1,000 children are
impacted by hearing loss, with cases being diagnosed between ages three and 17.
Unfortunately, hearing loss is becoming more commonplace in youth due to the
noise in our environment. In 2013, the CDC estimated at least 12.5 percent of
children and adolescents ages six to 19 have suffered permanent damage to their
hearing due to excessive noise exposure.

Causes of childhood hearing loss

There are several possible causes for hearing loss in children, whether it's
congenital or acquired. Hearing losses in children can also be conductive,
sensorineural or mixed. It's important that parents, caretakers, physicians, teachers
and others know the signs of and address hearing loss in children because early
hearing loss - especially that which is undiagnosed - can cause significant
development and emotional problems for children that have long-lasting effects.

Congenital hearing loss

Congenital hearing loss means it was present in an infant at birth. There are various
causes of congenital hearing loss, though they are not always easily identified.
There are both non-genetic and genetic factors that might cause hearing loss.

Non-genetic factors that might cause congenital hearing loss include:

Birth complications, including the presence of herpes, rubella cytomegalovirus,
toxoplasmosis or another serious infection, lack of oxygen or the requirement of
a blood transfusion for some reason.
Premature birth. Babies that have a birth weight of less than 3 pounds or that
require certain life-sustaining drugs for respiration due to prematurity are at risk
for hearing loss.
A nervous system or brain disorder.
The use of ototoxic medication by the mother during pregnancy. Ototoxic
medications are not usually illicit substances - medications like various
antibiotics and NSAIDS can potentially cause damage to the auditory nerve or
other hearing structures of the fetus.
The mother had an infection during pregnancy, including things like
toxoplasmosis, cytomegolavirus, herpes simplex or German measles.
 Maternal diabetes.
Drug or alcohol abuse by the mother or smoking during pregnancy.

The above causes of congenital hearing loss are all non-genetic factors. However,
non-genetic factors account for only around 25 percent of congenital hearing loss.
Experts agree that genetic factors - meaning the hearing loss is hereditary - cause
more than 50 percent of all hearing loss in children, whether the loss is present at
birth or manifests later in life.

Genetic factors cause more than 50 percent of all hearing loss in children,
whether present at birth or developed later in life.
Genetic factors that might cause congenital hearing loss include:
Autosomal recessive hearing loss - This is the most common type of genetic
congenital hearing loss - autosomal recessive accounts for around 70 percent of
all genetic hearing loss cases. What this means is that neither parent has a hearing
loss, but each parent carries a recessive gene that gets passed to the child. Parents
are usually surprised when their child is born with this type of hearing loss
because people typically aren't even aware they have the recessive gene.
Autosomal dominant hearing loss - This type of hearing loss accounts for around
15 percent of genetic hearing losses, according to the American Speech-
Language-Hearing Association (ASHA). In autosomal dominant hearing loss,
one parent carrying a dominant gene for hearing loss passes it to the offspring.
This parent may or may not have hearing loss, but he or she might have other
symptoms or signs of a genetic syndrome.
Genetic syndromes - These include Usher syndrome, Treacher Collins
syndrome, Waardenburg syndrome, Down syndrome, Crouzon syndrome and
Alport syndrome.

You might have noticed that the percentages don't add up to 100 for genetic and
non-genetic causes of congenital hearing loss. This is because some of the time,
doctors are not sure why an infant is born with a hearing loss.
Acquired hearing loss
Children can also be affected by acquired hearing loss, meaning it occurs after birth.
There are various causes of acquired hearing loss, including:
A perforated eardrum
Otosclerosis or Meniere's diseases, which are progressive
Infections like meningitis, measles, mumps or whooping cough
Taking ototoxic medications
A serious head injury
Exposure to loud noise, causing noise-induced hearing loss
Untreated or frequent otitis media (ear infections)
Exposure to secondhand smoke

Transient hearing loss

Transient or fluctuating hearing loss in children is also detrimental to speech and
language development. Transient hearing loss can be caused by otitis media, more
commonly known as middle ear infection. At least 75 percent of children have had
one episode of otitis media by the time they are three years old. This type of
infection is very common in children because of the Eustachian tube position during
childhood. The Eustachian tube, which allows for air pressure equalization between
the middle ear and the nasopharynx, is smaller and more horizontal during
development. Thus, it is very susceptible to blockage by fluids or large adenoids.
Transient hearing loss due to an ear infection can occur when fluid inhibits the
vibrations of the tiny middle ear bones, making efficient sound transmission
difficult. Thankfully, this type of hearing loss is usually temporary and resolves
itself. However, frequent, untreated middle ear infections can cause cumulative
damage to the bones, eardrum or auditory nerve, creating a permanent,
sensorineural hearing loss.

Hearing loss screening for children

As mentioned above, hospitals routinely perform hearing screening on infants in
the first 24-48 hours after birth. If an infant fails the initial screening, he or she is
usually scheduled for a second screening a few weeks later. However, sometimes
infants who pass the hearing screening at birth may exhibit signs of hearing loss as
they age. If you think your child is having difficulty hearing you, visit your
pediatrician right away.

Pediatric audiologists administer hearing tests designed specifically for children.

One way to determine if your childs hearing is developing appropriately is by

monitoring important speech and hearing milestones, such as those listed below
from ASHA.
From birth to four months, your infant should:
Startle at loud sounds
Wake up or stir at loud noises
Respond to your voice by smiling or cooing
Calm down at a familiar voice

From four months to nine months, your infant should:

Smile when spoken to
Notice toys that make sounds
Turn its head toward familiar sounds
 Make babbling noises
Understand hand motions like the bye-bye wave

From nine to 15 months, your infant should:

Make various babbling sounds
Repeat some simple sounds
Understand basic requests
Use its voice to get your attention
Respond to name

From 15 to 24 months, your infant should:

Use many simple words
Point to body parts when you ask
Name common objects
Listen with interests to songs, rhymes and stories
Point to familiar objects you name
Follow basic commands

Older children could also acquire hearing loss that is either permanent or temporary.
Here are some things to look for if you think your toddler or preschool-age child
might have hearing loss:
Has difficulty understanding what people are saying.
Speaks differently than other children her or his age.
Doesn't reply when you call his or her name.
Responds inappropriately to questions (misunderstands).
Turns up the TV volume incredibly high or sits very close to the TV to hear.
Has problems academically, especially if they weren't present before.
Has speech or language delays or problems articulating things.
Watches others in order to imitate their actions, at home or in school.
Complains of ear pain, earaches or noises.
Cannot understand over the phone or switches ears frequently while talking on
 the phone.
Says "what?" or "huh?" several times a day.
Watches a speaker's face very intently - many children's hearing loss escapes
detection because they are very successful lip readers.

Treatments for childhood hearing loss

Depending on the severity and cause of hearing loss in your child, hearing aids,
cochlear implants and a combination of speech therapy or assistive listening devices
might be recommended forms of treatment. If you notice that your infant or child
shows any of the above signs, take him or her to your family doctor, who can refer
you to a pediatric audiologist to have your child's hearing tested. If a child has wax
buildup, an ear infection or another problem causing temporary hearing loss, the
audiologist will take care of the problem or refer you to an otolaryngologist (ear,
nose and throat physician) to have the temporary hearing obstruction treated.

There has never been more hope for children with hearing loss, even those with
profound loss.
Audiologists can perform in-depth behavioral hearing examinations for even very
young children (as young as 6 months) who cannot participate in traditional testing
procedures. There are several objective tests that infants, toddlers and young
children can undergo as well. These tests are painless and non-invasive. After exam,
the audiologist will spend time talking with you about your child's hearing ability
and recommend an appropriate treatment plan or medical intervention.

Hearing aids
Hearing aids are just one kind of device that can help children with hearing loss
hear clearly again. There are many advanced models, including high-powered aids
for children with profound hearing loss, that offer high-quality hearing assistance.
Many solutions for children include special coverings and other accessories to
ensure that young children don't remove or misplace their hearing aids. There are
several models of devices to choose from, including behind-the-ear hearing aids or
those that are almost entirely in the ear canal and very discreet.

Cochlear implants
Cochlear implants are surgically implanted devices that directly stimulate the
auditory nerve in the inner ear with electrical stimulation. Cochlear implants also
have an external device, and many companies make kid-friendly devices that can
be held on with a soft headband. Cochlear implants work for infants and children
who cannot benefit from hearing aids.

Speech therapy
For children who have had hearing loss that has affected their speech, he or she
might need speech-language therapy after getting hearing aids or a cochlear implant
to help him or her catch up on speech delays.

Assistive listening devices

Many hearing aid manufacturing companies offer assistive listening devices such
as FM systems that are discreet and work well in a classroom situation in
conjunction with the child's hearing aid or cochlear implant. FM technology helps
overcome the poor acoustics of classroom settings or other venues with lots of
background noise. Essentially, the teacher wears or has a discreet microphone in
front of him or her that transmits his or her voice directly to the child's hearing aids
or cochlear implant.