hearing loss in young children       Early Identification of Hearing Loss       Why is Early Identification Important?   If the auditory channel is impaired or blocked, speech and language may not develop properly. Since the first three years of life are critical for normal speech and language development, every effort should be made to identify hearing impairment during these early listening years.       Identification of hearing loss in infants and children requires careful observation, thorough medical examination with an extensive case history, and audiological testing. Listed below are high risk factors, possible signs of hearing loss, and typical age related behaviors. This information should help a parent, physician, and teacher determine whether a child needs further medical and audiological evaluation.       When and How to Evaluate   If speech and language development begins normally and then stops, refer immediately for a hearing evaluation. A child of any age can have an audiological evaluation. The evaluation technique used depends upon the developmental age of the infant or child. Methods include Auditory Brainstem Response (ABR) testing at any age (including premature infants), and Visual Response Audiometry (VRA), which is designed to elicit consistent and reliable responses from only a few months of age. Play Audiometry is used at around 2 1/2 years of age until the child is able to respond consistently to the conventional evaluation techniques used with adults. Our pediatric audiology team can help decide which method is best for a child. In order to obtain complete and accurate test results, children may need to be seen on more than one occasion.       Early identification and assessment are the first steps in the successful management of the hearing impaired child.       High Risk Factors         Birth - 28 days:   Malformations of the ear, nose or throat   Rubella during pregnancy   Rh incompatibility   Family history of hearing loss   Apgar score from 0 - 3   Severe neonatal infections   Meningitis   Low birth weight (under 3.3 lbs.)   Hyperbilirubinemia   Ototoxic medications   Severe respiratory distress and/or prolonged mechanical ventilation (10 days or more)       29 days - 2 years   Meningitis   Presence of neonatal risk factors   Head trauma   Stigmata   Ototoxic medications   Neurodegenerative disorders   Childhood infectious diseases associated with hearing loss (e.g. mumps, measles)           Possible Signs of Hearing Loss at Any Age       People have to raise their voice consistently to get the child’s attention.   At any age after talking has begun, the child frequently says “huh” or “what” when somebody is speaking.   The child responds inconsistently to sound, sometimes hearing it and other times not.   The child has a history of ear infections - often getting earaches or runny ears.   At any age the child watches the speaker’s face carefully. The child turns his head so that one ear is facing the direction of the sound source.   The child complains of hurting ears. The child prefers low pitch or high pitch sounds.   The child talks in a soft or loud voice.   The child turns the radio or television set up (adolescents and teenagers excepted when listening to rock music).   The child does not always come or look when called. The child confuses sounds that are alike.   The child's speech is poorer than you would expect of a child of his or her age.   A child does not use verbal language.   A child frequently asks for things to be repeated.   A child often answers a question with an unrelated answer.   The child seems in attentive at home or at school.   The child likes to watch your face when you talk.           Possible Signs of Hearing Loss at Home or at School       Child has a history of hearing loss.   The child has a history of ear infections.   The child does not pay attention to instructions half or more of the time.   The child does not listen carefully - often needs instructions repeated.   The child has difficulty attending to auditory stimuli for more than a few seconds.   The child has a short attention span.   The child's attention drifts, daydreams.   The child is easily distracted/bothered by background sounds.   The child has problems with spelling/phonics.   The child has difficulty telling one sound from another.   The child forgets what is said in a few minutes.   The child does not remember routine things from day to day.   The child has problems with what was heard last week, month, year.   The child has problems recalling a sequence of instructions.   The child has problems following auditory directions.   The child frequently misunderstands what was said.   The child does not understand many words for age/grade level.   The child learns poorly through auditory channels.   The child has language problems (sentence structure, vocabulary, word formation).   The child has articulation (pronunciation) problems.   The child can not always relate what is seen to what is heard.   The child lacks motivation to learn.   The child takes longer to respond to verbal stimuli.   The child has below average performance in one or more academic areas.   The child does not always come or look when called.   The child confuses words that sound alike.   The child may show overactive, aimless behavior.   The child may be aggressive or destructive.   The child may be easily distracted, lack of ability to screen out stimuli and pay attention to others.   The child may be inconsistent in response to sounds.   The child may be withdrawn (out of touch with environment).   The child may show excessive fears or anxieties.   The child's speech is poorer than you would expect from a child of his/her age.       A child who has had one or more of these conditions is considered “at risk” for a hearing impairment and should have a comprehensive audiologic evaluation by a pediatric audiologist.           Milestones of Typical Development       Some babies have a significant hearing loss due to unknown factors. Use these developmental guidelines to watch for hearing and speech milestones.       0 - 4 months: Stops movement or quiets in response to speech, or unfamiliar noises. Startles to loud sounds. Moves eyes toward sound source. Rouses from light sleep to sudden loud noises. Imitates gurgling or cooing sounds and show response to noise making toys. At 3 months, the child should soothe or show responses to the mother’s voice.       4 - 7 months: Begins head turn toward sounds and voices out of sight (4 months) and turns head directly toward the sound source (7 months). Smiles in response to speech. Looks in response to own name. Babbling begins.       7 - 9 months: Turns to find a sound source out of sight. Gurgles or coos to sounds out of sight. Intonation patterns heard in speech. Comprehends “no.” Babbles in multiple syllables. Makes some kind or response to his/her own name. Responds to household sounds such as spoon rattling in a cup, running water, the noise of a washing machine or footsteps from behind. At 9 months, the child should engage in loud shrieking and sustained production of vowels.       9 - 12 months: Acquires first true word. Imitates sounds. Looks at a common object when named. Responds to music. Understands simple commands. Uses his/her own voice to get attention. At 12 months, the child should imitate sounds and simple words.       13 - 18 months: Uses sentence-like intonation. Perceives emotions of others. Uses 3 - 20 words. Uses all vowels and consonants in jargon.       19 - 24 months: Uses more words than jargon. Asks question by rising intonation at end of phrase. Comprehends about 300 words. Uses about 50 words. Produces animal sounds. Combines 2 words into phrases. Listens to simple stories. At 21-24 months, the child should localize directly to sounds, at all angles.           If you suspect a hearing loss, do ALL of the following:       1. Refer the child to his/her pediatrician or family doctor for a complete examination       2. Refer the child for an otologic examination by a doctor who specializes in problems of the ear.       3. Refer the child for an audiological evaluation by a certified audiologist at a speech and hearing center.       NO BABY IS EVER TOO YOUNG TO HAVE A HEARING TEST. The earlier we discover it, the earlier we can help. To make an appointment for your child to have a hearing screening or evaluation, please contact us at: (206) 323-5770 or (206) 388-1275 TTY.           Types of Hearing Loss in Young Children       Conductive hearing loss   Conductive hearing impairments occur when sound vibration cannot get from the surrounding air to the fluids in the inner ear as efficiently as they should. These impairments are caused by such things as:       Faulty development of the outer and middle ear.   Blockage of the ear canal (for example by ear wax).   Damage to the eardrum.   Damage to the ossicles (small bones of the middle ear).   Failure of the Eustachian tube to let air into the middle ear cavity.   Collection of fluids in the middle ear cavity.   Infection of the middle ear cavity.   Growth of a cyst in the middle ear cavity.   Growth of extra bone around the ossicles.       Conductive impairments never cause a total hearing loss but they do cause a loss of loudness. Although many sounds may become too quiet to be heard, those that are heard sound clear and undistorted.       Most conductive impairments can be treated by medication or by surgery. Those that cannot be cured can be alleviated by hearing aids, which helps restore the missing loudness.       Children who keep getting conductive hearing losses due to repeated ear infections may develop serious learning difficulties and perform badly in school. Repeated ear infections may also cause a more permanent hearing loss called a sensori-neural hearing loss.           Sensorineural Hearing Loss   Sensorineural hearing loss occurs when the nerves of the inner ear fail to respond to sound or the hearing nerve fails to carry information to the brain. This is caused by such things as:       Faulty development of the inner ear.   Inherited damage to the inner ear.   Damage to the inner ear and/or the hearing nerve from illness, drugs, or oxygen deprivation.   Damage to the ear from loud noises.   Acoustics neuromas.       Sensori-neural hearing impairments can have any degree of severity. In extreme cases the hearing loss is total. These hearing impairments cause a loss of loudness. They also cause a loss of clarity in those sounds that are loud enough to be heard.       Sensori-neural hearing impairments cannot be treated by medication or surgery, but most can be alleviated at least partially by hearing aids. Unfortunately, however, the hearing aids only restore the missing loudness. They cannot restore missing clarity.       Children with serious sensori-neural hearing impairments have difficulty learning speech and language and, therefore, require special educational treatment.