Hearing Loss

There are several ways in which a hearing loss can be detected. All newborns have a newborn hearing screening and may be referred for a more in-depth hearing test. A child may also be referred by their pediatrician or school nurse when a routine hearing screening indicates more testing is needed. An audiologist conducts a diagnostic hearing test as a first step. This test is more in-depth than a hearing screening.

Depending on the child’s age, there are several options to perform the diagnostic hearing test:

• A child can raise their hand when they hear the beep noise.
• Conditioned play audiometry is when a child plays a hearing game, and they put a toy in a bucket if they hear a sound.
• Visual reinforcement audiometry where a child is taught to turn toward a stimulus played through speakers or headphones.
• Auditory Brainstem Response (ABR) test. An ABR is needed if a child cannot reliably inform the tester of their hearing levels in each ear. It is a typical testing measurement for infants or children who cannot test with headphones. ABR’s are done while the child is sleeping and involve the placement of electrodes on their head.

There are many options for hearing loss:

1. Traditional Hearing Aids
   This is the most common treatment option for children with hearing loss. There is a small device behind the ear and a custom-made earpiece that sits in the patient’s ear to help them hear.
2. Bone Conduction Systems
   For patients with single-sided deafness or a permanent conductive hearing loss, these devices are initially fit on a soft headband and eventually can be surgically implanted.
3. Cochlear Implants
   Cochlear implants are a surgically implanted device that is placed in the inner ear by an ENT doctor. There is an external piece (called a sound processor) that helps deliver the sound to the implant. These are typically implanted in children with at least a severe hearing loss.

Some hearing losses are genetic. Sensorineural hearing loss is a type of hearing loss caused by damage to the inner ear or auditory nerve. The diagnosis of a sensorineural hearing loss warrants a referral to a genetics specialist, at the family pediatrician’s discretion to rule out genetic syndromes or recessive genetic hearing loss as a reason. It can be caused by a variety of factors, such as abnormalities in the inner ear, a number of viruses and even some medications that are known to cause hearing loss (known as ototoxic medications).

Another type of hearing loss is conductive hearing loss, which can be caused by ear infections, abnormalities in the three small bones in the middle ear, outer ear abnormalities or certain conditions or genetics anomalies. Patients with conductive losses do not receive cochlear implants and there are different options for them.

Finally, there is a type of hearing loss called a mixed hearing loss, which is a combination of the type of hearing losses described above.

Some signs to look out for in children that may indicate hearing loss are:

• Speech delay
• Inability to localize sound (identify where sound is coming from in a room or environment)
• Not responding to environmental sounds
• Asking for frequent repetition
• Lack of attention or daydreaming in environments with significant background noise
• Often misunderstanding instructions
• Listening to the television at very high volumes