Hearing Loss in Children

For years, routine hearing tests took place only when children entered school. However, hearing loss can cause serious problems much earlier. The most significant is the delayed development of language and speech.

Early intervention and detection of hearing loss is important to prevent problems with speech and language development. We offer a team approach when a child is diagnosed with hearing loss. Our ENT specialists work closely with audiologists and speech pathologists to evaluate and manage hearing, speech, language and balance problems in your child.

There are many types of hearing tests that checks your child’s hearing. Some tests are age specific.

For Newborns

We recommend hearing tests before newborns leave the hospital. There are two primary types of hearing screening methods for newborns (used either alone or together).

• Evoked otoacoustic emissions (EOAE) is a test that uses a tiny, flexible plug. We will insert the plug into the baby’s ear. The plug sends sounds to the ear. A microphone in the plug records the otoacoustic emissions (responses) of the ear in reaction to the sounds. There are no emissions in a baby with hearing loss. This test is painless and is usually completed within a few minutes, while the baby sleeps.
• Auditory brainstem response (ABR) is a test that uses electrodes (wires) attached with adhesive to the baby’s scalp. While the baby sleeps, the tiny microphone emits clicking sounds in the baby’s ears. The test measures the brain’s activity in response to the sounds. As in EOAE, this test is painless and takes only a few minutes.

If the screening tests identify that your child has a hearing loss, further testing is necessary. We recommend all babies with hearing loss be identified by 3 months of age. Therefore, treatment can begin before the baby is 6 months old (an important time for speech and language development).

For Infants

Evaluation of hearing in the infant may include the use of the above mentioned EOAE and ABR tests. Also, the following may be necessary:

• Behavioral audiometry is a screening test used in infants to observe their behavior in response to certain sounds. Additional testing may be necessary.

For Toddlers

Evaluation of hearing may include the above mentioned tests, along with the following:

• Play audiometry is a test that uses an electrical machine to transmit sounds at different volumes and pitches into your child’s ears. Your child usually wears some type of earphones. This test is slightly modified for the toddler age group and made into a game. We will ask the toddler interact with a toy (i.e., touch a toy, move a toy) every time they hear the sound. Play audiometry relies on the child’s cooperation.
• Visual reinforcement audiometry (VRA) is a test where the child looks toward a sound source. When the child gives a correct response, the child is “rewarded” through a visual reinforcement such as a toy that moves or a flashing light. The test is most often used for children between 6 months to 2 years of age.

Older Children

Evaluation of hearing for the child older than 3 to 4 years may include the above mentioned tests, along with the following:

• Pure tone audiometry is a test that uses an electrical machine that produces sounds at different volumes and pitches in your child’s ears. The child usually wears some type of earphones. In this age group, the child is simply asked to respond in some way when they hear the tone in the earphone.
• Tympanometry (also called impedance audiometry) is a test that most physician offices can perform. The test helps determine how the middle ear is functioning. It does not tell if the child is able to hear, but helps to detect any changes in pressure in the middle ear. This is a difficult test to perform in younger children because the child needs to sit very still and not be crying, talking, or moving.

Treatment Options

Technology to help hearing-impaired children is evolving rapidly. Children generally benefit from some sort of amplification, ranging from digital hearing aids to cochlear implants. Your doctor may recommend training in sign language and lip-reading.

• Learn more about the CHOC Cochlear Implant Program.