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Support for your child's development before they start school

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What is the purpose of this service?

To help children between the ages of birth to three with disabilities or delays, to learn and grow.

Who can receive these services?

Families with an eligible infant or toddler from birth to three years old.

What services are offered?

Infants and toddlers are evaluated to see if there is a delay in:

movement,

learning,

dealing with others,

behavior, and/or

self-help skills.

If services are needed, an Individualized Family Service Plan (IFSP) will be written to set goals and identify needs.

Families, with the support of Early Intervention Providers, help their infants and toddlers reach their goals.

How to apply?

Use the DHS Office Locator to find an Early Intervention Child and Family Connections office in your local area.

Call 1-800-843-6154 (Voice/TTY).

Additional Information

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To help children between the ages of birth to three with disabilities or delays, to learn and grow. Families with an eligible infant or toddler from birth to three years old. Infants and toddlers are evaluated to see if there is a delay in: movement, learning, dealing with others, behavior, and/or self-help skills.

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Information on diagnosis

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Hearing loss in children can lead to speech and language delays. Learn more about the causes, symptoms and treatments available to children.

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What you can expect during the testing process

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In the first few years of life, hearing is a critical part of kids' social, emotional, and cognitive development. Even a mild or partial hearing loss can affect a child's ability to develop speech and language properly.

The good news is that hearing problems can be overcome if they're caught early - ideally by the time a baby is 3 months old. So it's important to get your child's hearing screened early and checked regularly.

Causes of Hearing Loss

Hearing loss is a common birth defect, affecting about 1 to 3 out of every 1,000 babies. Although many things can lead to hearing loss, about half the time, no cause is found.

Hearing loss can occur if a child:

was born prematurely

stayed in the neonatal intensive care unit (NICU)

had newborn jaundice with bilirubin level high enough to require a blood transfusion

was given medications that can lead to hearing loss

has family members with childhood hearing loss

had certain complications at birth

had many ear infections

had infections such as meningitis orcytomegalovirus

was exposed to very loud sounds or noises, even briefly

When Should Hearing Be Evaluated?

Newborn hearing screening identifies most children born with a hearing loss. But in some cases, the hearing loss is caused by things like infections, trauma, and damaging noise levels, and the problem doesn't emerge until later in childhood. Researchers believe that the number of people who have hearing loss doubles between birth and the teen years. So it's important to have kids' hearing checked regularly as they grow.

Your newborn should have a hearing screening before being discharged from the hospital. Every state and territory in the United States has now established an Early Hearing Detection and Intervention (EHDI) program; the program identifies every child with permanent hearing loss before 3 months of age, and provides intervention services before 6 months of age. If your baby doesn't have this screening, or was born at home or a birthing center, it's important to have a hearing screening within the first 3 weeks of life.

If your baby does not pass the hearing screening, it doesn't necessarily mean there's a hearing loss. Because debris or fluid in the ear can interfere with the test, it's often redone to confirm a diagnosis.

If your newborn doesn't pass the initial hearing screening, it's important to get a retest within 3 months so treatment can begin right away. Treatment for hearing loss can be the most effective if it's started before a child is 6 months old.

Kids who seem to have normal hearing should continue to have their hearing evaluated at regular doctors' appointments. Hearing tests are usually done at ages 4, 5, 6, 8, and 10, and any other time if there's a concern.

But if your child seems to have trouble hearing, if speech development seems abnormal, or if your child's speech is difficult to understand, talk with your doctor.

Symptoms of a Hearing Loss

Even if your newborn passes the hearing screening, continue to watch for signs that hearing is normal. Some hearing milestones your child should reach in the first year of life:

Most newborn infants startle or "jump" to sudden loud noises.

By 3 months, a baby usually recognizes a parent's voice.

By 6 months, a baby can usually turn his or her eyes or head toward a sound.

By 12 months, a baby can usually imitate some sounds and produce a few words, such as "Mama" or "bye-bye."

As your baby grows into a toddler, signs of a hearing loss may include:

limited, poor, or no speech

frequently inattentive

difficulty learning

seems to need higher TV volume

fails to respond to conversation-level speech or answers inappropriately to speech

fails to respond to his or her name or easily frustrated when there's a lot of background noise

Types of Hearing Loss

Conductive hearing loss is caused by blockage in the transmission of sound to the inner ear. Ear infections are the most common cause of this type of hearing loss in infants and young children. This loss is usually mild, temporary, and treatable with medicine or surgery.

Sensorineural hearing loss can happen when the sensitive inner ear (cochlea) has damage or a structural problem, though in rare cases it can be caused by problems with the auditory cortex, the part of the brain responsible for hearing. Cochlear hearing loss, the most common type, may involve a specific part of the cochlea such as the inner hair cells, outer hair cells, or both. It usually exists at birth, and can be inherited or come from other medical problems, though sometimes the cause is unknown. This type of hearing loss is usually permanent.

The degree of sensorineural hearing loss can be:

mild (a person cannot hear certain sounds)

moderate (a person cannot hear many sounds)

severe (a person cannot hear most sounds)

profound (a person cannot hear any sounds)

Sometimes the loss is progressive (gets worse over time) and sometimes unilateral (one ear only).

Because the hearing loss can get worse over time, audiologic testing should be repeated later on. Although medicines and surgeries cannot cure this type of hearing loss, hearing aids can help children hear better.

Mixed hearing loss happens when a person has both conductive and sensorineural hearing loss.

Central hearing loss occurs when the cochlea is working properly, but other parts of the brain are not. This rarer type of hearing loss is more difficult to treat.

Auditory processing disorder (APD) is a condition in which the ears and brain cannot fully coordinate. People with APD usually hear well when it is quiet, but cannot hear well when it is noisy. In most cases, speech-language therapy can help kids with APD.

How Hearing Is Tested

Several methods can be used to test hearing, depending on a child's age, development, and health status.

During behavioral tests, an audiologist carefully watches a child respond to sounds like calibrated speech (speech that is played with a particular volume and intensity) and pure tones. A pure tone is a sound with a very specific pitch (frequency), like a note on a keyboard.

An audiologist may know an infant or toddler is reponding by his or her eye movements or head turns. A preschooler may move a game piece in response to a sound, and a gradeschooler may raise a hand. Children can respond to speech with activities like identifying a picture of a word or repeating words softly.

Other Tests to Evaluate Hearing

If a child is too young to get behavioral hearing testing, or has other medical or developmental problems to prevent this type of test, doctors can check for hearing problems by looking at how well the ear, nerves, and brain are working.

Auditory brainstem response (ABR) test

For this test, tiny earphones are placed in the ear canals and small electrodes (sensors which look like small stickers) are placed behind the ears and on the forehead. Usually, clicking sounds are sent through the earphones, and the electrodes measure the hearing nerve's response to the sounds.

Young infants under 6 months can sleep for the entire test, but older infants may need sedation for this test. Older cooperative kids can do this testing in a silent environment while they're visually occupied.

Normal hearing has a certain appearance when test results are measured on a chart. Because of this, a normal ABR suggests that a baby's inner ear and lower part of the auditory system (brainstem) are working normally for typical speech. An abnormal ABR may be a sign of hearing loss, but it may also be due to some medical problems or measurement problems.

Auditory steady state response (ASSR) test

This test is similar to the ABR, though an infant usually needs to be sleeping or sedated for the ASSR test.

Sound passes into the ear canals, and a computer picks up the brain's response to the sound and automatically decides whether hearing loss is mild, moderate, severe, or profound. This ASSR test has to be done with (and not instead of) ABR to check for hearing.

Central auditory evoked potential (CAEP) test

This test is similar to the ABR, and uses the same tiny earphones and small electrodes. This CAEP test allows the audiologist to see if the pathways from the brainstem to the auditory cortex are working properly. The audiologist may recommend a CAEP test for some specific types of hearing loss. This test can be done at any age and does not require participation from the child.

Otoacoustic emissions (OAE) test

A sleeping infant or an older child who may be able to sit quietly can do this quick test. A tiny probe is placed in the ear canal, then many pulsing sounds are sent and the probe records an "echo" response from the outer hair cells in the inner ear. These recordings are averaged by a computer.

A normal recording suggests that the outer hair cells are working well. But in some cases, a hearing loss may still happen if other hearing pathways are not working normally.

Hospitals use ABR or OAE to screen newborns. If a baby fails a screening, the test is usually repeated. If the screening is failed again, the baby is sent to an audiologist for a full hearing evaluation.

Tympanometry

Tympanometry is not a hearing test but a procedure that can show how well the eardrum moves when a soft sound and air pressure are introduced in the ear canal. It's helpful in identifying middle ear problems, such as fluid collecting behind the eardrum.

A tympanogram puts the tympanometry results into a graph. A "flat" line on a tympanogram may indicate that the eardrum can't move, while a "peaked" pattern usually suggests that the ear drum is moving normally. Doctors who do this exam should also do a visual ear examination and see the ear drum.

Middle ear muscle reflex (MEMR)

The MEMR (also called acoustic reflex test) tests how well the ear responds to loud sounds by evoking a reflex. In a healthy ear, this reflex helps protect the ear against loud sounds.

For the MEMR, a soft rubber tip is placed in the ear canal. A series of loud sounds are sent through the tips into the ears and a machine records whether the sound has triggered a reflex. Sometimes the test is done while the child is sleeping.

Who Performs Hearing Tests?

A pediatric audiologist specializes in testing and helping kids with hearing loss and works closely with doctors, teachers, and speech/language pathologists.

Audiologists have a lot of specialized training. They have master's or doctorate degrees in audiology, have performed internships, and are certified by the American Speech-Language-Hearing Association (CCC-A) or are Fellows of the American Academy of Audiology (F-AAA).

Hearing Aids and Other Interventions

While medical treatments and surgery can help people with certain types of hearing loss, hearing aids are the main treatment for sensorineural hearing loss. The most common type of hearing loss involves outer hair cells that do not work properly. Hearing aids can make sounds louder and overcome this problem.

A hearing aid has three basic parts: the microphone, amplifier, and receiver. Settings can be customized to make certain sounds louder.

Some hearing aid styles are worn on the body while others fit behind the ear or in the ear. If regular hearing aids can't be used - as in certain types of conductive hearing loss - specialized hearing aids that attach to the skill bone can send sound waves directly to the cochlea.

No single style or manufacturer is best - your doctor will help you choose a hearing aid based on your child's needs. Most kids with bilateral hearing loss (in both ears) wear two hearing aids.

Because they are so technology-heavy, hearing aids are expensive. Unfortunately, health insurance companies do not usually cover hearing aids, although several states now require that insurance cover at least part of their cost. Talk to your child's doctor to look for financial assistance options for hearing aids.

A specialized amplification device called an FM system (sometimes called "auditory trainers") may help kids in school. These systems have a microphone that a teacher can speak into and a receiver help by the child, which can send the sound to the ears or directly to a hearing aid. They can work well in the classroom to improve hearing in group or noisy environments and also can be fitted for personal or home use. Other assistive listening or alerting devices may help older kids.

In addition to hearing aids or FM systems, hearing rehabilitation may include auditory or listening therapy and speech (lip) reading. Technology is improving all the time, so ask your doctor about newer tools available to help aid a child's communication.

A cochlear implant is a surgical treatment for hearing loss; this device doesn't cure hearing loss, but is a device that gets placed into the inner ear to send sound directly to the hearing nerve. It can help children with profound hearing loss who do not benefit from hearing aids.

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In the first few years of life, hearing is a critical part of kids' social, emotional, and cognitive development. Even a mild or partial hearing loss can affect a child's ability to develop speech and language properly. The good news is that hearing problems can be overcome if they're caught early - ideally by the time a baby is 3 months old.

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How to cope with a hearing loss diagnosis 

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How to cope with a hearing loss diagnosis 

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Dealing with the diagnosis

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Hearing loss poses an extra challenge for growing children. But it doesn't have to hold them back from learning and communicating. With the right treatment and services, your child can learn all the skills and reach the same milestones as other kids her age.

Here's what you can do to help.

1. Start Right Away

Early treatment is key for children with hearing loss.

"Babies' brains develop quickly, and it's important to stimulate those sound pathways in the brain as soon as possible," says Dale Amanda Tylor, MD, an ear, nose, and throat doctor at Washington Township Medical Foundation in Fremont, CA. "Children who are exposed to sounds earlier are more likely to develop along the same path as others their age."

Most children get hearing aids or other devices like cochlear implants. They're electronic devices that go inside the inner ear to help the brain process sounds.

It's never too early to start these treatments. Most states test babies for hearing loss shortly after birth. That means they can get fitted for hearing aids at just a few weeks old. Ask your child's doctor to help you pick a certified pediatric audiologist who can help you choose the best treatment.

"Even kids with profound hearing loss can catch up with their peers by age 5 or 6 if they have cochlear implants by age 1 or 2," Tylor says.

2. Use Early Intervention Services

About 95% of parents of children with hearing loss don't have the condition themselves. So they have a lot to learn about living with and treating it. An early intervention program helps you coordinate all the services your child will need. Babies with hearing loss should get in one as soon as possible.

You can find a program through your local public school or hospital. You'll work with hearing specialists, like audiologists and speech-language pathologists, to come up with an "individualized family service plan" (IFSP). Early intervention also provides support for families and can teach you ways to help your child stay on track with language and speech.

Continued

3. Find Support for Yourself

It's easier to help your child if you have help, too.

"Coping with hearing loss is a lot to handle at first, so families need extra emotional support," says K. Todd Houston, PhD, an associate professor of speech-language pathology at the University of Akron.

Some parents find counseling helpful. Others turn to support groups. Both let you connect with other families who are living with hearing loss. There are many online communities, or you can ask your doctor about groups in your area. The Alexander Graham Bell Association has a listing of chapters on its website and offers meet-ups and conferences for families.

"Many parents really enjoy the shared experience and validation of a support group," Houston says.

4. Explore Sounds With Your Child

Hearing sounds and speech from an early age will help your child learn language. Find simple ways to add them to the day:

Play games with your baby that teach imitation, like peekaboo, pat-a-cake, and the itsy bitsy spider. These teach your little one about taking turns when they talk with others.

Talk about the things you're doing. For example, "We're driving to grandma's house," or "Daddy is washing the dishes."

Read to your child. Describe the pictures as you go. As your kid gets older, ask him to point to the pictures as you name them. Or ask him to name the pictures.

Sing songs together.

5. Speak Up for Your Child

You know what's best for her. If something in your plan isn't working, let your care team know. They should work with you to meet the goals you've set. If not, look for specialists who will.

"Being involved with your child's care is one of the best things you can do to help your child succeed," Houston says. "So don't be afraid to fight for what your child needs and to ask lots of questions along the way."

WebMD Feature Reviewed by Shelley A. Borgia, CCCA on June 01, 2016

Sources

SOURCES:

Alexander Graham Bell Association: "From Diagnosis to Action."

American Speech-Language Hearing Association: "Development: Birth to One Year," "Development: One to Two Years."

CDC: "Treatment and Intervention Services."

K. Todd Houston, PhD, CCC-SLP, LSLS Cert. AVT, associate professor of speech-language pathology, School of Speech-Language Pathology and Audiology, University of Akron, OH.

Dale Amanda Tylor, MD, MPH, pediatric and general otolaryngologist at Washington Township Medical Foundation, Fremont, CA.

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Hearing loss poses an extra challenge for growing children. But it doesn't have to hold them back from learning and communicating. With the right treatment and services, your child can learn all the skills and reach the same milestones as other kids her age. Here's what you can do to help.

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What does it mean to have a conductive or sensorineural loss? What do different degrees of hearing loss mean?

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UCSF Benioff Children's Hospital Oakland

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Types of Hearing Loss

Conductive Hearing Loss: Conductive hearing loss occurs when sound is not conducted efficiently through the outer ear canal to the eardrum and the tiny bones (ossicles) of the middle ear. Conductive hearing loss usually involves a reduction in sound level or the ability to hear faint sounds. This type of hearing loss can often (but not always) be corrected medically or surgically. Possible causes of conductive hearing loss may include: fluid in the middle ear from colds/congestion; ear infection (otitis media, otitis externa, Swimmer's Ear); allergies; poor eustachian tube function; perforated eardrum; impacted earwax (cerumen); presence of a foreign body; absence or malformation of the outer ear, ear canal, or middle ear bones (ossicles); benign tumor.

Sensorineural Hearing Loss (SNHL): Sensorineural hearing loss occurs when there is damage to the inner ear (cochlea), or the nerve pathways from the inner ear to the brain. Most of the time, SNHL cannot be medically or surgically corrected. This is the most common type of permanent hearing loss. SNHL reduces the ability to hear sound. Even when speech is loud enough to hear, it may still be unclear or sound muffled. Possible causes of SNHL include: illnesses, genetic syndromes, drugs that are toxic to the ears; hereditary/genetic hearing loss; aging; head trauma; absence or malformation of the inner ear structures or auditory nerve; exposure to loud noise.

Mixed Hearing Loss: Mixed hearing loss refers to when a conductive hearing loss and sensorineural hearing loss occur simultaneously. For example, there may be damage to the outer or middle ear as well as the inner ear (cochlea) or auditory nerve.

Auditory Neuropathy Spectrum Disorder (ANSD): Auditory Neuropathy Spectrum Disorder is an auditory disorder in which the neurons in the hearing nerve and brain stem do not "fire" together in an appropriate manner. As a result, a person with with ANSD may have difficulty distinguishing one sound from another and/or trouble understanding speech clearly. In some cases, ANSD causes only mild hearing difficulties and/or is only a problem in noisy situations. However, in many cases, there are significant hearing difficulties and amplification of some type is required. The causes of ANSD are unknown, however children who are born prematurely, require extended oxygen support, or have a family history of the condition are at a higher risk. Symptoms can develop at any age, however most children with ANSD are born with it and are diagnosed within the first few months of life.

Auditory Processing difficulties can impact language development, speech, learning, reading, and success in school. The effects vary based on the amount of auditory processing difficulty and whether problems other than auditory processing are present. Auditory processing problems can exist when no hearing loss is present, or exist along with hearing loss (conductive, sensorineural, or mixed). When hearing loss is present, it may not be possible to determine which difficulties are caused by auditory processing disorder and which are caused by the hearing loss or other factors. A comprehensive auditory processing evaluation is required to determine if a child has an auditory processing disorder.

Degrees of Hearing Loss

The outcome of a hearing evaluation is graphed on a chart called an audiogram, which records the softest sounds your child heard in each ear and/or in a soundfield during the behavioral hearing test (hearing thresholds). Loudness is measured in decibels hearing level (dBHL) and is represented on the vertical axis of the audiogram, from 0 dBHL (very soft) to 110 dBHL (very loud). Frequency (or pitch) is measured in Hertz (Hz.) and is represented on the horizontal axis of the audiogram, from 250Hz (very low, e.g. fog horn) to 8000 Hz (very high, e.g. whistle). Hearing test results are not typically given in percentage, but instead in degrees. The degree of hearing loss is based on the recorded audiometric thresholds, and ranges in severity from mild to profound.

Mild Hearing Loss: Thresholds between 25-40 dBHL. Difficulty will often occur for soft speech and listening in background noise; in quiet, a mild hearing loss may be manageable for adults, however children can still experience impacted language development.

Moderate Hearing Loss: Thresholds between 41-55 dBHL. Difficulty hearing conversations, especially while in background noise. Speech must be loud to be understood. The TV, radio, etc., often needs to be turned to higher volume levels to be heard clearly. For children, speech, language, vocabulary and comprehension are likely to be affected.

Moderately-severe Hearing Loss: Thresholds between 56-70 dBHL. Speech must be loud to be understood. Volume and clarity of speech is significantly reduced and the most difficulty will occur in groups. For children, speech, language, vocabulary and comprehension are likely to be affected.

Severe Hearing Loss: Thresholds between 71-90 dB. Normal conversation is not audible, and loud speech is difficult to hear or understand. May be able to identify environmental sounds, and may be able to discriminate vowels, but not consonants. Speech, language, vocabulary and comprehension are significantly impacted. Visual imput such as sign language is beneficial, even if amplification is used.

Profound Hearing Loss: Thresholds 91 dB and higher. Only very loud sounds may be heard, and even amplified speech may be soft and may not be understood. Speech, language, vocabulary and comprehension are significantly impacted. Visual input such as sign language is often relied upon, even if amplification is used.

The Speech Banana Audiogram

The audiogram below is is a tool that can be used to understand what we are hearing or not hearing (based on different pitches within the environment). The sounds that we use to produce speech in conversation have frequencies and decibels. The most typical frequency and decibel for each speech sound is graphed on the audiogram below to provide information about what sounds can be heard at specific degrees of hearing loss. A child that can hear the sounds of speech will have a much easier time imitating, understanding and learning spoken language when compared to that of a child who can not hear all of the sounds of speech.

The "Speech Banana" is a term used to describe the area where the phonemes, or sounds of human speech, appear on an audiogram. When the phonemes are plotted out on the audiogram they take the shape of a banana, therefore audiologists and other speech professionals refer to that area as the speech banana. While many other sounds fall outside of the speech banana, audiologists are most concerned with the frequencies within the speech banana because a hearing loss in those frequencies can affect a child's ability to learn language.

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UCSF Benioff Children's Hospital Oakland

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Ranked one of America's leading hospitals, UCSF Benioff Children's Hospital is dedicated to treatment and care of infants and children. Our world-class doctors provide nurturing care and extraordinary outcomes in every specialty including cancer, heart disease, brain disorders, primary care issues, and many more.

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Special considerations for children with hearing loss in one ear

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Unilateral hearing loss, or UHL, is hearing loss in only one ear. Children with UHL can have trouble hearing and knowing where sounds come from. An audiologist can help.

On this page:

About UHL

Your child may have had a hearing screening after they were born. It may have shown a hearing loss in only one ear. Or, the hearing loss may happen when your child is older. This type of hearing loss will not keep them from learning to talk. However, they may have some speech and language delays because of the UHL. We do not yet know why some children have problems and others do not. You should talk to your doctor if you are worried about your child.

Learn more about how speech and language develops.

UHL can sometimes get worse, but it usually does not. Hearing that gets worse over time is a progressive hearing loss.

Signs of UHL

It may be hard to see signs of UHL in babies and young children. A child with UHL may have:

Trouble finding where sounds come from, called localization. It helps direct us to who is talking at any moment. Your child may miss some of a message if they do not know who is talking. It is also important for safety. If your child is near a street, they may have trouble knowing where a horn is coming from. This could put them in danger.

Problems understanding speech in noisy places. It is easier to focus on sounds when you hear from both ears.

Problems hearing you from another room or from outside. Sounds seem louder when we hear with both ears. When two normal-hearing ears hear together, sound seems louder. With UHL, your child may hear speech but not understand what is said.

When your child has trouble hearing, they may:

Get upset at not being able to hear.

Be very tired by the end of the day. This happens when they have to focus on speech all day.

Seem like they are not paying attention.

Answer questions wrong.

"Act out" or have tantrums when frustrated.

Turn the TV or radio on too loud.

Testing for UHL

Any child with hearing loss should be seen by an ear, nose, and throat doctor, or ENT. The ENT will look in your child's ears and check for fluid in the middle ear. The ENT may order special tests to find out why your child has UHL.

An audiologist can test your child's hearing. This will include tests of his middle ear. The audiologist may do special hearing tests, if needed.

Your child may see a speech-language pathologist, or SLP. The SLP will test their speech and language. The local early intervention, or EI, program can see children under 3 years old. Your child may get services from the EI program. They can suggest activities you can do at home to help your child.

Treatment for UHL

Your child may be able to use a hearing aid. It depends on their age and the amount of hearing loss. Your audiologist will help you decide what is best for your child.

Your child may need speech and language treatment. An SLP can help your child learn to speak clearly. The SLP can teach your child to listen to sounds and find where they come from. Both the audiologist and SLP can suggest ways to help your child hear at home and at school.

Tips for Helping Children With UHL

There are things you can do to help your child hear and learn. They include:

Making sure that your child's "good" ear is facing sounds. Think about this when you are feeding your child and when you are in the car. Your child should face the person speaking.

Look at your child when speaking to them.

Talk about what you are doing. Say things like, "I am making a sandwich," or "It's time to wash the dishes." This teaches your child words and sentences.

Repeat words. Use new words to help your child say more.

Play listening games with your child. See who can hear the phone ring or who hears the dog bark.

Get your child's attention before talking to them. This may help them focus on what you say.

Help your child find where sounds come from.

Make sure your child puts the phone to their good ear.

Speak louder than usual, and face your child. Try not to talk to them from another room.

Teach your child to take care of their hearing. Have them wear earplugs when they are around loud noises. Make sure they do not turn the volume up too loud when using headphones.

A fun website for you and your child to visit is Dangerous Decibels. Your child might enjoy going to the "Virtual Exhibit" part of the site.

Tips for School

Look closely at the setup when choosing a day care center or preschool. Try to avoid situations where many classes are within one large area. This will be noisy.

Make sure that your child is seated near the teacher with their better ear facing the teacher. Being closer lets your child hear and see the teacher better.

Ask that the teacher give your child pictures and handouts to go along with verbal lessons.

Make sure that your child is not seated with their normal-hearing ear facing a noisy hallway or air conditioner.

Make sure the teacher knows how your child's hearing aid or frequency modulation (FM) system works. Have extra batteries for these systems in the classroom.

Talk to your child's teacher to monitor your child's progress. If you or the teacher have concerns, ask for further testing.

Let your child's teacher know that your child may have trouble localizing sound. For example, they may not hear when someone calls their name on the playground.

Seek help if you notice your child is becoming frustrated or having trouble making friends.

Share with your child's teacher what you have learned about UHL. Give the teacher written information about UHL.

Ask to talk with an educational audiologist or other professional who works with children who have hearing loss. This person can work with your child and the teacher on strategies to help your child in school and with friends. This person can also make sure that the classroom has the best acoustics. These are changes to the room that lower noise levels.

Tips for Home

Make your home "listening friendly." There are things you can do to reduce noise. Use carpeting and cloth curtains. Replace buzzing fluorescent lights. Run noisy appliances, like the dishwasher or washing machine, when your child is not home or is sleeping.

Try not to let your child's normal-hearing ear face noise sources, like the dishwasher, air conditioner, or radio.

Do not have the TV or radio on while eating dinner or at other times when you are talking with your child.

Be aware of where your child sits at the dinner table. Try to have the child facing those who will be talking to them.

Be aware of where your child is seated in the car. For example, a child with hearing loss in their right ear should sit behind the passenger seat. This lets their normal-hearing ear face the other people in the car.

Do not give your child instructions from another room. They will likely hear your voice but may not understand what you are saying.

Teach others the things that you have learned about helping your child.

Make sure that your child's hearing aid is working. A hearing aid that does not work is much worse than no hearing aid at all.

You can help your child with UHL learn to help themself. What you do now will make a difference!
The information on this webpage has been adapted from the doctoral project of Sarah McKay, AuD, CCC-A.
To find an audiologist near you, visit ProFind.

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Unilateral hearing loss, or UHL, is hearing loss in only one ear. Children with UHL can have trouble hearing and knowing where sounds come from. An audiologist can help.

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Three million children under the age of 18 have some kind of pediatric hearing loss. One in 1,000 children have significant permanent hearing loss.

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Information on what hearing aids are and different styles

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What are hearing aids?

More than three million children in the United States have hearing loss. Hearing aids can help improve hearing and speech, especially in children with sensorineural hearing loss (hearing loss in the inner ear due to damaged hair cells or a damaged hearing nerve). Sensorineural hearing loss can be caused by noise, injury, infection, certain medications, birth defects, tumors, and problems with blood circulation.

Hearing aids are electronic or battery-operated devices that can amplify and change sound. A microphone receives the sound and converts it into sound waves. The sound waves are then converted into electrical signals. Children as young as 2 months can be fitted with hearing aids.

What are the different types of hearing aids?

The type of hearing aid recommended for your child will depend on several factors, including his/her physical limitations, medical condition, and personal preference. There are many different types of hearing aids on the market, with companies continuously inventing newer, improved hearing aids. However, there are four basic types of hearing aids available today. Consult your child's physician for additional information on each of the following types:

In-the-ear (ITE) hearing aids

These hearing aids come in plastic cases that fit in the outer ear. Generally used for mild to severe hearing loss, ITE hearing aids can accommodate other technical hearing devices, such as the telecoil, a mechanism used to improve sound during telephone calls. However, their small size can make it difficult to make adjustments. In addition, ITE hearing aids can be damaged by ear wax and drainage.

Behind-the-ear (BTE) hearing aids

Behind-the-ear hearing aids, as the name implies, are worn behind the ear. This type of hearing aid, which is in a case, connects to a plastic earmold inside the outer ear. These hearing aids are generally used for mild to severe hearing loss. However, poorly fitted BTE hearing aids can cause feedback, an annoying whistling sound, in the ear.

Canal aids

Canal aids fit directly in the ear canal and come in two styles: in-the-canal (ITC) aid and completely-in-canal (CIC) aid. Customized to fit the size and shape of the individual's ear canal, canal aids are generally used for mild to moderate hearing loss. However, because of their small size, removal and adjustment may be more difficult. In addition, canal aids can be damaged by ear wax and drainage.

Body aids

Generally reserved for profound hearing loss, or if the other types of hearing aids will not accommodate, body aids are attached to a belt or pocket and connected to the ear with a wire.

Who may be a candidate for hearing aids?

Nearly all children who have a hearing loss that may be improved with hearing aids can benefit from these devices. The type of hearing aid recommended may depend on several factors, including, but not limited to, the following:

the shape of the outer ear (deformed ears may not accommodate behind-the-ear hearing aids)

depth of depression near the ear canal (too shallow ears may not accommodate in-the-ear hearing aids)

the type and severity of hearing loss

the manual dexterity of the child to remove and insert hearing aids

the amount of wax build-up in the ear (excessive amounts of wax or moisture may prevent use of in-the-ear hearing aids)

ears that require drainage may not be able to use certain hearing aid models

Wearing a hearing aid

Once the hearing aids have been fitted for the ears, your child should begin to gradually wear the hearing aid. Because hearing aids do not restore normal hearing, it may take time to get used to the different sounds transmitted by the device. The American Academy of Otolaryngology recommends the following when beginning to wear hearing aids:

Be patient and give your child time to get used to the hearing aid and the sound it produces.

Start in quiet surroundings and gradually build up to noisier environments.

Experiment where and when the hearing aid works best for your child.

Keep a record of any questions and concerns you have, and bring those to your child's follow-up examination.

Taking care of hearing aids

Hearing aids need to be kept dry. Methods for cleaning hearing aids vary depending on the style and shape. Other tips for taking care of hearing aids include the following:

Keep the hearing aids away from heat.

Batteries should be replaced on a regular basis.

Avoid the use of hairspray and other hair products when the hearing aid is in place.

Considerations when purchasing a hearing aid

A medical examination is required before purchasing a hearing aid. Hearing aids can be purchased from an otolaryngologist (a physician who specializes in disorders of the ear, nose, throat, and related structures of the head and neck), an audiologist (a specialist who can evaluate and manage hearing and balance problems), or an independent company. Styles and prices vary greatly. The National Institute on Deafness and other Communication Disorders recommends asking the following questions when buying hearing aids:

Can the hearing loss be improved with medical or surgical interventions?

Which design will work best for my child's type of hearing loss?

May my child test the hearing aids for a certain period of time?

How much do hearing aids cost?

Do the hearing aids have a warranty and does it cover maintenance and repairs?

Can my child's audiologist or otolaryngologist make adjustments and repairs?

Can any other assistive technological devices be used with the hearing aids?

Hearing aids typically need to be replaced after about five years. New, programmable and digital hearing aids, which can be adjusted as the level of hearing changes, may reduce the need for replacement.

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Just one unit of blood can help as many as five children! Donate Blood More than three million children in the United States have hearing loss. Hearing aids can help improve hearing and speech, especially in children with sensorineural hearing loss (hearing loss in the inner ear due to damaged hair cells or a damaged hearing nerve).

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Keep their hearing aid on their head

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Sometimes called a "bionic ear," the cochlear implant offers the hope of gaining or restoring the ability to sense sound for some people with significant hearing loss.

What Is a Cochlear Implant?

A cochlear implant is a surgically implanted device that helps overcome problems in the cochlea (KO-klee-uh). The cochlea are snail-shaped, curled tubes near nerves in the ears. They transform sound vibrations reaching the ear into signals that can be sent to the auditory nerve (or hearing nerve). The auditory nerve then sends these signals to the brain, where they're translated into recognizable sounds.

If important parts of the cochlea aren't working as they should and the auditory nerve isn't stimulated, there's no way for the sounds to get to the brain. As a result, hearing doesn't happen. This is called sensorineural hearing loss.

By completely bypassing the damaged part of the cochlea, the cochlear implant uses its own electrical signals to stimulate the auditory nerve, allowing the person to hear.

About Normal Hearing

The ear is made up of three parts, and in normal hearing, sound passes through all three on the way to the brain:

1. The outer ear: This is the outer, visible part of the ear and the ear canal. When a person hears a sound, the outer ear captures the sound vibration and sends it through the ear canal to the middle ear.

2. The middle ear: This consists of the eardrum and three tiny bones (the malleus, incus, and stapes). The sound vibration from the outer ear causes motion in these bones.

3. The inner ear: This is where the cochlea are. The motion of the bones in the middle ear makes the fluid in the cochlea move, which stimulates the hair cells (the thousands of tiny hearing receptors inside the cochlea). The hair cells bend back and forth and send chemical signals to the auditory nerve, which carries these signals to the brain, where they're interpreted.

Hair cells can be damaged or destroyed through aging, heredity, disease, infection, or repeated or severe exposure to loud noise. If the hair cells don't work, the auditory nerve can't be stimulated and can't send information to the brain. So, the person won't be able to hear.

Hearing loss can be mild, moderate, or severe, depending on the number of hair cells that are defective, damaged, or destroyed. People with mild or moderate hearing loss may find that hearing aids help (hearing aids make sounds louder). Those with profound or severe hearing loss might even have trouble understanding loud sounds. A hearing aid won't help in these cases, so a doctor might recommend a cochlear implant.

What a Cochlear Implant Does

The cochlear implant artificially stimulates the inner ear area with electrical signals, which sends those signals to the auditory nerve, letting a person hear.

Although sound quality from a cochlear implant is different from that in normal hearing, the cochlear implant lets someone sense sound that he or she couldn't hear otherwise. And regular improvements to the way the implants work are helping to make the sound even more natural. Most infants, even if they never heard before, will be able to make sense of these sounds and develop speech and language.

A cochlear implant consists of an implant package, which is secured inside the skull, and a sound and speech processor, which is worn externally (outside the body). Several components of the cochlear implant work together to receive sound, transfer it to the auditory nerve, and send it to the brain.

The cochlear implant package is made up of:

a receiver-stimulator that contains all of the electronic circuits that control the flow of electrical pulses into the ear

an antenna that receives the signals from the external sound and speech processor

a magnet that holds the external sound and speech processor in place

one wire containing electrodes that are inserted into the cochlea (the number of electrodes can vary depending on the cochlear implant model type used). The electrodes act much like normal functioning hair cells and provide electrical charges to stimulate the auditory nerve.

The sound and speech processor is a minicomputer that processes sound into digital information, and then sends that information to the implant package in the form of electrical signals. This is worn externally and looks a lot like a normal hearing aid. Depending on the type of sound and speech processor used, it can either be worn as a headset behind the ear or in a belt, harness, or pocket.

The sound and speech processor is made up of:

a sound and speech processor (which can either be a body-level model that can be clipped onto clothing like a portable radio, or an ear-level model that's hooked over the ear)

a microphone

a transmitter that sends the signals to the cochlear implant package. The transmitter also includes a magnet.

For the cochlear implant to work, the implant package and the sound and speech processor must be aligned - that's what the magnets are for. By lining up the magnets, both the implant package and sound and speech processor are secured and work together. If they aren't completely aligned, the device doesn't work and the person can't hear.

How a Cochlear Implant Works

Knowing how a cochlear implant works may help kids better understand their new bionic ear and the cool technology behind it that allows them to hear better.

Here's how the implant works:

The microphone picks up sound.

Sound is sent to the sound and speech processor.

The processor analyzes the sound and converts it into an electrical signal. (The signal contains information that determines how much electrical current will be sent to the electrodes.)

The transmitter sends the signal to the implant package, where it's decoded.

The implant package determines how much electric current should pass to the electrodes and sends the signal. The amount of electric current determines loudness, and the position of the electrodes determines the sound's pitch.

The nerve endings in the cochlea are stimulated and the message is sent to the brain along the auditory nerve.

The brain interprets the sound and the person hears.

Cochlear Implant Surgery

Surgery for a cochlear implant takes 2-4 hours and uses general anesthesia (which keeps a patient completely unconscious). The surgeon will place and secure the implant package under the skin and inside the skull, then thread the wires containing the electrodes into the spirals of the cochlea.

To secure the implant, the surgeon first drills a 3- to 4-millimeter bed in the temporal bone (the skull bone that contains part of the ear canal, the middle ear, and the inner ear). Then, the surgeon opens up the bone behind the ear to allow access to the middle ear. A small hole is drilled in the cochlea and the wires containing the electrodes are inserted. The implant package is then secured and the incision is closed with stitches.

After cochlear implant surgery, a child:

will probably be able to go home the next day

will have to wear a dressing over the implant area for 24 hours

might be off-balance or dizzy for a few days

may have mild to moderate pain (the doctor may recommend giving pain medicines)

won't have to have the stitches removed (they're absorbable and dissolve on their own)

can lie on the side of the cochlear implant in a few days

About 2 to 4 weeks after surgery, the sound and speech processor is matched with the implant package and is programmed and fine-tuned to meet the child's individual hearing needs.

Nowadays, children who are born deaf or with a profound hearing loss in both ears can even receive two cochlear implants, one for each ear, at the same time. This is a great advance as it requires only one surgery.

Learning to Use a Cochlear Implant

Because the hair cell damage, electrical signal patterns, and sensitivity of the auditory nerve are different for each person, a specialist must fine-tune the sound and speech processor for every patient.

By measuring the lowest and highest current for each electrode, the clinician finds the softest and loudest sounds that will be heard (each electrode produces a different sound with different pitch). The sound and speech processor matches sounds on different electrodes with different volumes and attempts to create an accurate version of the original sound. However, because a limited number of electrodes are taking over the function of the thousands of hair cells in a normal ear, sounds won't be totally "natural." However, infants who never heard before will be able to make great sense of these sounds and will quickly learn language.

After the first few programming sessions, the user begins to pick up sounds with the implant, but giving the implant full power is a gradual process that takes several months. In children who are born deaf, the stimulation from the implant will allow them to develop the brain pathways necessary to hear sounds and develop speech and language. This is an extended process with programming and intensive therapy that often lasts for several years.

During the programming process, the user attends speech and language therapy sessions to help identify and interpret the new sounds he or she is hearing. An important part of the therapy is parent education and training.

Therapy will help a child develop and understand spoken language through detecting, imitating, and associating meanings of sounds. These sessions last at least a year, along with parent education and training programs. In many cases, therapy has helped kids with cochlear implants develop speech and language on par with their peers.

Some families choose to have implants in both ears. This can help with speech detection when there is background noise.

Can an Implant Restore Hearing for Everyone?

Cochlear implants are very successful for some people, but not everyone is a candidate to receive one. Children 12 months of age or older with profound hearing loss in both ears are usually excellent candidates, but not every child is eligible.

Common reasons that a child might not be eligible for a cochlear implant include:

the child's hearing is "too good" (meaning the child can hear some sound and speech with hearing aids)

the hearing loss isn't due to a problem with the cochlea

the child has had profound deafness for a long time

the auditory nerve itself is damaged or absent

Each potential candidate must be evaluated by a cochlear implant team to see whether a cochlear implant is the best option.

Benefits of an implant can vary. The rehabilitation period can be long, and many factors (such as the condition of the auditory nerve or the presence of scar tissue in the cochlea) can affect the success of the implant.

The doctor or surgeon will help parents understand what an implant can reasonably achieve for their child.

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Sometimes called a "bionic ear," the cochlear implant offers the hope of gaining or restoring the ability to sense sound for some people with significant hearing loss. A cochlear implant is a surgically implanted device that helps overcome problems in the cochlea (KO-klee-uh). The cochlea are snail-shaped, curled tubes near nerves in the ears.

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What to expect during the surgical process

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Your Child's Recovery

A cochlear implant is a small electronic device that can help with hearing for a child with severe or total hearing loss. The implant does the job of damaged or missing nerves. A small device worn outside the ear turns on the implant. The doctor made a cut, called an incision, behind your child's ear. The doctor placed the implant in the inner ear.

Your child may have mild to moderate pain and have a headache for a few days. He or she may have some popping or clicking in the ear and feel dizzy. This usually goes away within 1 week. The area behind the ear will be swollen for about 3 to 5 weeks.

Some children say that things taste different or funny for a few days. They may also have a sore throat. This is common.

The doctor will not turn on, or activate, the implant until the incision has healed. This is in about 3 to 6 weeks. Most children can go back to school or daycare after 1 week, but they should not take part in sports or other strenuous activities for about 3 to 4 weeks. Talk to your doctor about how active your child can be.

This care sheet gives you a general idea about how long it will take for your child to recover. Each child recovers at a different pace. Follow the steps below to help your child get better as quickly as possible.

How can you care for your child at home?

Activity

Your child may want to spend the first few days in bed. When your child is ready and your doctor says it is okay, he or she can begin playing again. Encourage quiet indoor play for the first 3 to 5 days.

Your child will probably be able to go back to school or daycare after about 1 week. He or she should not go to PE or gym class or take part in sports for about 3 to 4 weeks or until your doctor says it is okay.

For about 3 to 4 weeks, do not let your child play hard. Take care that your child does not do anything that would turn him or her upside down, such as playing on monkey bars or doing somersaults. Also avoid bike riding, running, or other sports until your doctor says it is okay.

Diet

Your child can eat normally. If he or she complains of an upset stomach, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.

Medicines

Your doctor will tell you if and when your child can restart his or her medicines. The doctor will also give you instructions about your child taking any new medicines.

Make sure that your child takes pain medicines exactly as directed.

If the doctor gave your child a prescription medicine for pain, give it to your child as prescribed.

Talk to your doctor about over-the-counter medicine. Do not use ibuprofen (Advil, Motrin) without your doctor's okay, because it may increase the chance of bleeding. Read and follow all instructions on the label.

If you think the pain medicine is making your child sick to his or her stomach:

Give the medicine after meals (unless your doctor has told you not to).

Ask your doctor for a different pain medicine.

If your doctor prescribed antibiotics, be sure your child takes them as directed. Your child should not stop taking them just because he or she feels better. Your child needs to take the full course of antibiotics.

Incision care

Your child may have a bandage over the incision. You can remove the bandage 2 or 3 days after surgery or when the doctor says it is okay.

After you remove the bandage, wash the area daily with warm, soapy water and pat it dry.

Keep the area clean and dry.

Other instructions

Do not let your child blow his or her nose. Tell your child not to try to stop a sneeze or a cough. Tell your child to open his or her mouth to sneeze or cough.

Follow-up care is a key part of your child's treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if your child is having problems. It's also a good idea to know your child's test results and keep a list of the medicines your child takes.

Where can you learn more?

Go to https://www.healthwise.net/patientEd

Enter Z384 in the search box to learn more about "Cochlear Implant Surgery for Children: What to Expect at Home".

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Cochlear Implant Surgery for Children: What to Expect at Home

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A cochlear implant is a small electronic device that can help with hearing for a child with severe or total hearing loss. The implant does the job of damaged or missing nerves. A small device worn outside the ear turns on the implant. The doctor made a cut, called an incision, behind your child's ear.

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Listening with a hearing aid on one side and a cochlear implant on the other

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Nowadays a whole range of possibilities for binaural hearing is available, from two hearing aids or two Baha® when the hearing loss is moderate, to bilateral cochlear implantation for severe to profound hearing losses. It is also possible to combine different devices and different stimuli such as a cochlear implant and a hearing aid or a Baha and a CI. This type of stimulation is called BIMODAL because it combines two different modes of stimulation: electrical stimulation coming from the cochlear implant and acoustic stimulation from the ear fitted with a traditional hearing aid or a Baha.

Benefits of binaural hearing

Binaural hearing is important because listening on both sides brings important advantages such as:

binaural redundancy and summation effects which give better speech discrimination both in quiet and more noticeably in noisy situations. Listening with two ears allows the recipient to access the advantages of the spatial separation between both ears, binaural squelch and head shadow effects (the reduced amplitude of a sound when it reaches an ear because it is obstructed by the head),

head shadow effect is fundamental in the localisation of sounds. The brain is able to calculate the phase differences in time and volume of the sound waves as they reach each ear. Localisation (the ability to tell the direction of a sound source) gives a more natural and comfortable listening experience. It is important for safety reasons such as avoiding oncoming traffic and also allows the listener to turn toward the sound source and use the additional visual cues,

research in recent years has demonstrated the benefits of a single cochlear implant when combined with a traditional hearing aid. We see, for example, better recognition of speech including phonemes, words and phrases in quiet and in background noise, especially when the noise comes from the front². This can be a very real benefit for people who work in jobs that require face-to-face communication, in the bimodal situation, the hearing aid provides acoustic information, particularly in the low frequencies, which gives an important complement to the cochlear implant. The information we extract from these frequencies allows better recognition and identification of voices and appreciation of the melody of music1,3,4,5,

very young children must acquire sensitivity to the phonemic units of language to develop most language-related skills. Combining electric-acoustic input provides benefits to language learning, probably due to the enhancement in spectral representations provided6,7.

Rehabilitation for binaural hearing

A very important part of rehabilitation is home-based auditory training and listening experience to maximise the benefits of bimodal stimulation. A recipient can be counselled to ask a friend or relative to support them through listening and conversational practice. First they can try listening to speech on the side of the implant and then switching to the side of the hearing aid. The recipient should be encouraged to focus on the voice without using lip reading. One step up is to add background noise, e.g. switch-on TV or a radio placed in front. Parents can do similar activities with children through play and everyday conversation situations.

Practice with listening over a distance can also be helpful, for example from one room to another. As well as listening to speech, it is useful experience to practice localising environmental sound sources such as the doorbell or phone ringing. Ask the recipient to take a mental 'sound-picture' i.e. sit in each room, close the eyes and take an impression of space, distances and new auditory sensations; this can be made into a game with children.

Encourage recipients to take a focussed approach to listening in everyday situations. They could perhaps take listening walks and keep a listening journal, become familiar with other environments (in the street, in the car, in the work environment), and make a focussed effort to notice sounds, trying to localise the source of the sound. Finally they could experiment with moving their head and considering if and how this affects the sound. Rather than 'testing' their child, parents can be encouraged to try this as shared activity with their child.

Children enjoy 'hide and seek' or 'treasure hunt' games, so this is a great opportunity to practise sound localisation in a fun way, for example, hide the mobile phone and set the alarm to ring while the child is looking. A useful resource is the app Öi - Hide and Seek https://itunes.apple.com created with the aim of finding the phone by listening. Toys with a similar focus on sound localisation include 'Max & Jojo's World Electronic Talking Hide and Seek Easter Egg Hunt' and 'Toysmith Hidden Tweets'.

Addressing particular challenges

A challenging situation is when different stimuli are received in each ear, for example, talking to a person on one side and trying to follow another conversation overheard from the other side; we call this dichotic listening ². This type of listening can be replicated in games such as chinese whispers or included in telephone training. With younger children, mum and dad (one on each side) can say different words (perhaps the names of objects or activities in a picture book) at the same time. It can be fun to have a 'sync speak' game, both talking at the same time e.g. "... ready, steady and go!...". Make this into a fun game by each person taking their turn to talk or listen.

Developing music appreciation benefits from focus but it should be enjoyable too. Starting with familiar songs and printing the lyrics may help, try to tap out the pace, hum the melody and if the recipient has a special map for the music, remind them to use it. Motivation to build in regular focussed listening to music may be encouraged if the recipient is interested in monitoring this with data logging.

Today we also have wireless technology and synchronisation possibilities between the hearing aid (ReSound) and the implant (Cochlear), allowing both the hearing aid and the sound processor to simultaneously stream with the True Wireless™ Devices: Cochlear Wireless Mini Microphone, Cochlear Wireless Phone Clip or Cochlear Wireless TV Streamer.

For optimal listening, it's vital to have the hearing technology in the best working condition. Remind recipients and parents that care and maintenance of both the hearing aid and the sound processor is crucial if the full benefit of bimodal fitting are to be realised.

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Bimodal Hearing: Cochlear Implants and Hearing Aids Together.

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Nowadays a whole range of possibilities for binaural hearing is available, from two hearing aids or two Baha® when the hearing loss is moderate, to bilateral cochlear implantation for severe to profound hearing losses. It is also possible to combine different devices and different stimuli such as a cochlear implant and a hearing aid or a Baha and a CI.

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Manufacturer options for cochlear implants

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Manufacturer options for cochlear implants

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The Journey for your Child | Advanced Bionics

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Whether your child was born deaf, experienced sudden hearing loss, or no longer properly benefits from hearing aids, an Advanced Bionics cochlear implant system may be an effective solution for treating your child's hearing loss. Our products and rehabilitation tools have enabled thousands of children around the world to talk, succeed in school, and socialize with peers.

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What is bone conduction and is it the right choice for your child

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BCHI and childhood deafness | Getting bone conducting hearing implants

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BCHIs or bone conducting hearing implants can be an option for some deaf children with: permanent conductive deafness, microtia, and deafness in one ear

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Manufacturer options for bone conduction

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Manufacturer options for bone conduction

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Bone conduction options for children

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Every child is different and so is a child's hearing loss. Perhaps your child is deaf in one ear or was born with Microtia or Atresia. Or perhaps they suffer from chronic ear infections or constantly draining ears and have hearing loss. Maybe they've tried hearing aids and are still struggling to hear. If your child has conducitive hearing loss, mixed hearing loss or single-sided deafness, a bone conduction implant may be able to help.
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Does your child qualify for a bone conduction implant?

Bone conduction implants can help children ages 5 and older with single-sided deafness, conductive hearing loss and mixed hearing loss.

Conditions like Microtia and Atresia, Down syndrome, Treacher Collins syndrome, Goldenhar syndrome and ear infections can make wearing hearing aids difficult.

A Hearing Implant Specialist will be able to advise if your child may benefit from a bone conduction implant. Find one today.

Will your child benefit from a bone conduction implant?

The good news is that research and decades of experience demonstrate that bone conduction implants may help your child: ¹⁻⁵

Hear better, even in noisy situations ²

Enjoy a clean, more natural sound because bypassing the damaged part of their ear may reduce the amount of amplification needed to help them hear better compared to hearing aids ²

Hear sounds as if they are coming from both sides

Become more aware of their surroundings, increasing his or her ability to hear important sounds ⁴

Engage in conversations more easily.

Introducing the Cochlear™ Baha® 5 System

Your child is unique and their hearing solution should be, too. With our Cochlear Baha Implant System, we can help your child hear better with more choices of wearing options, wireless connectivity solutions and personalized services. This means providing your child with an innovative bone conduction implant solution that includes a stable implant with proven reliability 6,7, Apple® and Android™ device compatibility and hearing performance for a lifetime.

Try out the Baha system

With a bone conduction system, your child has the unique advantage of hearing the difference first. A Hearing Implant Specialist can help him or her try (or demo) a sound processor so they can hear how it might sound before you make any decisions.

Want more information about bone conduction implants?

We can send you a free informational guide about bone conduction implants for your child today.
Request now

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learn how bone conduction works and how it can help children with hearing loss. discover why the cochlear™ baha ® system is helping children live full

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Every child is different and so is a child's hearing loss. Perhaps your child is deaf in one ear or was born with Microtia or Atresia. Or perhaps they suffer from chronic ear infections or constantly draining ears and have hearing loss. Maybe they've tried hearing aids and are still struggling to hear.

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Considerations for children with mild degrees of hearing loss

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Helping the child with mild hearing loss

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Why is it so crucial to identify hearing loss early

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Hearing Health Foundation was instrumental in advocating for the Universal Newborn Hearing Screening legislation, as today 97% of babies are screened before they leave the hospital. In 1993, that number was 5%. Approximately 3 out of every 1,000 children in the United States are born deaf or hard of hearing. More than 90 percent are born to parents with typical hearing. Fortunately, early identification allows children with hearing loss to receive help they need during the first two years of life, a critical period for the development of speech and language skills. The earlier a child's hearing loss is detected, the sooner the family can gather as much information as possible to make the best decision for their child's language and communication approach.

With early intervention, children with hearing loss are able to develop language skills to help them communicate freely and actively learn. There are many services available to support children. For example, the Individuals with Disabilities Education Act (IDEA) ensures all children with disabilities have access to services they need for a good education. In addition, Head Start and Early Head Start are federally funded programs to help young children of low-income families become better equipped to succeed in school.

However, if the child's hearing loss is left undetected or untreated, hearing loss can negatively impact a child's language development. Delayed intervention can also adversely impact a child's language development. One study had found that children who received earlier amplification or cochlear implantation had better language outcomes. Maternal education and communication modes used during early intervention can also improve language skills over time. A longitudinal study concluded that children with permanent hearing loss enrolled in an early intervention program before the 6 months of age developed on par with age-appropriate language skills than those who were enrolled after 6 months of age.

Similarly, another study had suggested that early enrollment in intervention programs were linked to higher language scores. It concluded that children enrolled before 11 months of age showed better vocabulary and verbal reasoning scores at 5 years of age compared with those enrolled later. Children that were enrolled later may experience delays that can interfere with academic development and comprehension in the classroom.

In the same study, the results suggest that family involvement was a contributing factor for the best outcomes of early intervention. Positive language outcomes were correlated with families that were highly motivated and active with their child's intervention, while limited family support was associated with poor language outcomes. Also, families who were actively involved with early intervention were more likely to communicate better with their children, which contributes toward their overall growth. However, it is also important to consider the contrary; a lack of family involvement poses the largest challenge to early intervention. Specifically, a systematic review on the follow-up rate in newborn hearing screenings found that, on average, 20% of babies who failed the initial screening did not return for follow-up testing. The high loss to follow-up is believed to be attributed to a lack of adequate knowledge of the risks of hearing loss. This is the largest threat to the success of the newborn hearing screening program, as it becomes the family's responsibility to follow-up on care beyond the initial hearing screening prior to discharge.

It is important to remember that hearing loss can occur at any time of life. Some forms of hearing loss do not appear until a child is a toddler or enters school, or even later. In addition, illness, ear infections, head injury, certain medications, and exposure to loud noise are all potential causes of hearing loss. In particular, recurring ear infections may negatively affect language development because of the resultant fluctuating hearing loss' lack of steady auditory input necessary for speech and language development.

Even if your child or a child of a loved one does not have hearing loss today, Hearing Health Foundation strongly encourages regular checkups and annual hearing tests performed by audiologists, ENTs, pediatricians, or other health providers to monitor potential changes in hearing. These professionals are also excellent resources for intervention services to help overcome barriers to communication.

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Hearing Health Foundation was instrumental in advocating for the Universal Newborn Hearing Screening legislation, as today 97% of babies are screened before they leave the hospital. In 1993, that number was 5%. Approximately 3 out of every 1,000 children in the United States are born deaf or hard of hearing.

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Why should you use custom earmolds for children

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I'll never forget the time when I first saw a child with bold, colorful hearing aids.

I was at my son's soccer game when a super-fast, skilled soccer player zoomed past us - with bright blue ear molds in his ears. He was one of the first children with hearing aids that we saw outside of an intentional setting.

We marveled at him, not only for his above-average soccer skills, but also how tough he looked in those stunning blue ear molds. When my son first got his hearing aids, I hadn't seen colorful ear molds in person so, we went with what seemed like a good choice - clear. But as my son and I watched this confident soccer player, we decided that we too would get bright blue ear molds.

Now, as a mother that has gone through the process of getting my son hearing aid ear molds many times, I have a few tips I've learned along the way.

What is a hearing aid ear mold?

Ear molds are the part of the hearing aid system that fit directly into the ear canal. Usually they are made of vinyl or silicone that is custom-made for the child's ear.

Each material has benefits and some disadvantages, according Beth Rosales, an audiologist at Easter Seals.

"A soft material is needed for comfort for kids," she says. "Kids ears get bumped and jostled a lot (babies being held or rolling on the ground, kids playing, etc.,) so soft material is necessary.

According to Dr. Rosales, both vinyl or silicone can work well, but there are differences. For example, vinyl doesn't come in as many colors, and can shrink and discolor over time. However, the material is still flexible and can be easier to put into tiny ears. On the other other hand, silicone is harder to put into ears, as it sticks to the skin, but has a lot more color options.

While there are a lot of different styles of ear molds, most audiologists will suggest a custom-made, full shell, ear mold for children.

For my children, choosing colorful ear molds has been a fun and empowering experience. Choosing their own colors gives my children autonomy and excitement about their hearing aids. While this part of the hearing aid has no actual technology, it has a vital role to play.

5 tips for Choosing your Child's Hearing Aid Ear Mold

1. Let The Ear Molds Stand Out

Back in the day, I remember only seeing skin-colored hearing aids; the classic beige. Thankfully, Phonak has a range of pediatric hearing aids with more than 1,000 color combinations. Plus, you can add additional stickers to personalize the aids. But, creating the perfect hearing aid doesn't stop there. With bright colors and options to add swirls and sparkles, the possibilities for custom ear molds are endless.
Read more: Why you should let your child choose their hearing aid color
When my older child first got his hearing aids, we choose an awesome techy-looking, Phonak Sky Q hearing aid with blue and gray, but we choose a clear ear mold. Now, going through this a second time, we got Sayge the white Phonak Sky V hearing aid, so that we can switch out the ear mold colors as we go. We love the way it looks with the bright pink swirl ear mold.

2. Importance of Ear Molds

If the ear mold is not functioning perfectly or does not fit perfectly, the hearing aid can not work its magic. My 7-month-old daughter, Sayge, just got fitted for her second pair of ear molds. As an infant, Sayge loves to pull out her hearing aids and rub them on her teething gums. Pretty quickly she was able to tear a hole in the tubbing. After taking the ear molds to our audiologist, we learned it was irreparable and needed to be replaced. Sadly, she was not able to wear the hearing aid until the new mold came back.

It's important to keep a close eye on your child's hearing aids, especially when they are infants. Hearing aids are fragile, and it's necessary to care for them so your child can get the full benefit from them.
Read more: Ask Anna: How do I keep my baby's hearing aids in?
3. Know the Signs of a Poor Fitting Ear Mold

My four-year-old son gets new ear molds every 6-8 months, but as my son's growing slows I am hoping this reduces to about every year.

"The ear mold needs to fit well so that it is comfortable to wear first and foremost," says Anna Biggins, Phonak audiologist and Ask Anna columnist. "It doesn't matter how good the hearing aids are if the ear mold is a bad fit. If they are uncomfortable they will not stay in the ear very long."

While I am sure there are many ways to tell if an ear mold is fitting properly, for me there are two main issues I look out for: feedback and fit.

Feedback

Feedback is a ringing sound that happens when the speaker and microphone get too close together. When I begin to hear feedback more often than usual, I tune into the possibility that the mold is coming out more often because of a poor fit. When I have to adjust the ear mold often, I know it's time to get an appointment in the audiologist.

Fit

The second sign I look for is the fit of the hearing aid inside the ear. If there is any room around the ear mold, I know it is time to make an appointment.

If you're unsure if your child's ear mold needs to be replaced the best thing to do is ask your audiologist. We have felt so lucky to have had amazing audiologists throughout our children's hearing loss journey who have given us endless support.

4. Become Aware of the Time it Takes to get New Ear Molds

When I have come to the realization that one of my children needs new ear molds, I plan for the process to take 2-4 weeks. The reason for time is that there are two appointments that have to be made. The first is the impression of the ear mold, and second is the fitting of the ear mold.

Make sure you're not going on holiday and that you have time to complete the process as quickly as possible. You don't want your child to go without a proper fitting ear mold for an extended period of time.

5. Prepare to Distract

While my children are getting their new ear molds, we do a lot of distracting and entertaining to keep them distracted.

First, the audiologist places a sting inside the ear canal. After the string is inserted, the mold material is mixed. The texture of the mixture is like gum and play dough. The audiologist places the goop, which in our experience has been pink, into a syringe. Then they fill the ear with the pink material. The mold needs at least 5 minutes to set. This can be tricky with an infant, so we do a lot of distraction to make sure Sayge does not pull at the unset ear mold. Once the mold has set, the audiologist pulls it out and insures that the impression is good. The audiologist then sends the impressions off to a company that make the actual ear mold.

Why ear molds matter

Ear molds can make a dramatic impact on the function of the hearing aid, and choosing a fun color is a great first step to encouraging your child to embrace them.

If you are a parent of a child with hearing loss, you probably have experienced a whirlwind of emotions - especially in the beginning. Feelings of shame or guilt might be some of those emotions. While this can be strange, these emotions can impact how you choose what color ear mold and hearing aid you choose for your child.

I have been there and know those feelings. However, experience has told me that no matter that what color you choose for your child, you cannot undo their hearing loss. There is no hiding those hearing aids, and there really isn't any reason to! Help your child embrace their hearing aids by embracing them yourself. Once you see the impact their hearing aids make in their learning and development, you'll realize that their hearing loss won't stop them from living the life you've dreamed for them.

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Why you should choose a colorful hearing aid ear mold

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I'll never forget the time when I first saw a child with bold, colorful hearing aids. I was at my son's soccer game when a super-fast, skilled soccer player zoomed past us - with bright blue ear molds in his ears. He was one of the first children with hearing aids that we saw outside of an intentional setting.

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Find your local chapter of this family support program. Connect with other parents of children with hearing loss.

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Hands & Voices is a parent driven, non-profit organization dedicated to providing unbiased support to families with children who are deaf or hard of hearing

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What is real Ear and why are we always doing it? 

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What is real Ear and why are we always doing it? 

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Information on testing with the hearing aid

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Written by Pam Millett, PhD

It is a stressful journey through unfamiliar territory, from a child's first hearing screening, through hearing tests, specialist appointments, and talks about amplification, to earmold impressions and anticipating getting those first hearing aids. Hearing aid fitting day is a day everyone has waited for, usually with a mixture of nervousness, relief and sadness. No matter the child's age or hearing loss, all families have the same questions: "So how well can she hear now?" "How does the audiologist know that these hearing aids are the right ones?" "How do we know that we have done the best we can?" This article describes the three steps involved in finding the answers to these questions.
Step 1: Selecting the right hearing aid
A recent Google search for "hearing aid manufacturers" yields over 3 million results, so how do audiologists even start to choose the best hearing aids? Audiologists start by gathering information from three sources:

i) First, audiologists need to gather as much information as possible about the child's hearing and about the physical characteristics of the child's ear (size, shape, etc.). This is done by using hearing test results and results from a test known as real ear measurement (sometimes also called probe tube or probe mic measurement), which measures how each individual ear shapes the sound coming into it.

ii) Second, they need to consider the circuits, features and accessories we want (What kind of microphone? Should there be a volume control? What about those noise reduction circuits? Do we need a telephone program?, etc.). Cost, is an important consideration, but more "bells and whistles" do not necessarily mean better hearing aids.

iii) Third, audiologists need to calculate targets for the hearing aids for how much volume needed at each frequency (pitch) and what the maximum allowable sound levels should be so the hearing aid doesn't make sound too loud and damage the child's remaining hearing. These targets are generated by a software program known as the Desired Sensation Level Approach (DSL), which is the most extensively researched program for children's hearing aids available today.

The DSL program needs two pieces of information to generate hearing aid targets. The first piece of information is hearing thresholds from the hearing test. DSL does not require a full audiogram, so audiologists can start with partial information and add more information as they get it (for example, partial information from the first hearing tests of babies). The second piece of information is a real ear (or probe tube/mic) measurement of the child's ear canal. Our ear canals actually shape sound as it passes through them to the eardrum, giving a little boost in volume at certain frequencies. The amount of this boost changes as children grow to adulthood. Knowing all about how each individual's ear shapes sound provides a better hearing aid fitting because sound levels from the hearing aid will differ for different sized ears. Think of how loud a balloon sounds when it is popped in a small room versus outside - it sounds much louder in a smaller space. In this same way, a particular hearing aid on an adult can have a maximum sound output of 120 dB. When the same hearing aid at the same settings is placed on a child's ear, the maximum output can be closer to 130 dB because the child's ear canal is much smaller than the adult and could possibly damage hearing.

The DSL program then allows the audiologist to evaluate many different hearing aids and hearing aid settings using the measurement of how the child's ear size and shape boosts sound that is stored in the computer. The audiologist can then choose what he/she thinks will be the best possible hearing aid for that child. There is no one perfect hearing aid for each child; the most important thing is to have carefully fit hearing aids that are worn all of the child's waking hours, each and every day. Expensive hearing aids, even when well fit to the child's hearing loss, will provide little benefit to learning if they sit unworn in a box most of the day.
Step 2: Proving that the hearing aids are providing the right amount of amplification
The day you pick up your child's new hearing aids, your audiologist will need to verify the aids' performance, making sure that the hearing aids are set properly and working the way they should. Years ago, audiologists did this by doing a hearing test with the child wearing his/her hearing aids in the sound room. While it seems to make sense to do this, and to compare a child's unaided and aided thresholds on the same audiogram, these "aided audiograms" are not accurate enough for today's sophisticated hearing aids. Instead, verification using the DSL program provides results in an "SPLogram".

Let's look at an example of an SPLogram. All hearing aid data is measured in a different kind of decibel, dB sound pressure level (or SPL) so the hearing test information and hearing aid information can be compared directly. The DSL program first converts the child's hearing threshold information into dB sound pressure level (SPL). You will see that the SPLogram looks like an upside down audiogram. Frequency (pitch) is still read from left to right along the bottom. Loudness values are now reversed - very soft sounds are at the bottom of the graph and loud sounds are at the top. This picture shows the SPLogram for an audiogram with a 50 dB hearing loss at all frequencies.

The DSL program then calculates targets for different sounds, or how much we want the hearing aid to improve the child's ability to detect sound at each of the frequencies. Our SPLogram shows a child's hearing thresholds (as circles), targets for conversational speech (as +'s) and targets for the maximum output, or the ceiling loudness, of the hearing aid (as *'s). The key to understanding the DSL printouts is to realize that the hearing aid targets are meant to ensure that all speech sounds at that frequency can be heard comfortably in quiet. The levels of sound produced by the hearing aid can then be measured and the audiologist can see if the hearing aid meets all of the DSL targets. If so, this implies that the child should be able to hear all speech sounds in quiet. We always have to keep in mind that being able to hear a sound doesn't necessarily mean being able to understand and make sense of it, but hearing is the first step.

The SPLogram shows what actually happens - that the hearing aid makes speech and other sounds loud enough to be heard. We are not improving the child's hearing levels. A traditional aided audiogram, which shows aided hearing levels as "A's" on a standard audiogram format, often gave the impression that a child's aided hearing was normal, or close to normal. However, we cannot change a child's hearing ability, nor can we restore normal hearing - we can only change how loud the hearing aid makes sounds. The sounds of speech typically are at a loudness of 50-60 dB SPL. If this is too soft for the child to hear clearly, we must make the speech sounds loud enough to fall within the child's range of hearing. The SPLogram shows how well the hearing aid is doing this. It also shows the child's "range of hearing" (the difference between the softest sound one can hear and the loudest sound one can tolerate) can be very small. Some people with sensorineural hearing loss can actually be more sensitive to loud sounds than someone with normal hearing. The SPLogram shows the maximum loudness that a hearing aid should produce, so that the hearing aid is comfortable and does not risk damaging the child's hearing. When we verify a hearing aid using DSL, the graph shows how the hearing aid performs for soft sounds, sounds at the volume of a conversation, loud sounds and very loud sounds.
Step 3: Confirming that the hearing aids are really helping the child as expected
Validating a hearing aid fitting means making sure the child is hearing and learning language with the hearing aids as expected, based on how well she should be able to hear speech with the hearing aids. Validation relies entirely on the eyes and ears of the people in the child's environment. Before leaving the clinic, parents and families should ask the audiologist to explain the testing in terms of how well the hearing aids are able to make speech audible. With more severe hearing losses, sometimes it is impossible for any hearing aid to meet DSL targets, and this is important information to know too so that expectations are realistic. At the end of the appointment, the audiologist can easily demonstrate a quick Ling 6 Sound test to test this (oo, ah, ee, sh, s, m), either in the sound room using the audiometer, or informally in the testing room. This is especially important because some hearing aids (e.g. those with frequency transposing circuits) will give misleading results on real ear measurement, but will prove that they are doing their job with a Ling 6 sound test.

There are many ways that parents, teachers and others can find out how well a child responds to sound in different situations. The Ling 6 sound test can be done in a variety of different ways, in different environments, with different noise levels, with different speakers, at different distances, to get a sense of how well the child is able to detect speech sounds. The Early Listening Function (ELF) from this website is an excellent way to explore a child's ability to hear in different situations. Assessments such as the Functional Listening Evaluation or the Functional Auditory Performance Indicators might be done by your child's teacher of the deaf and hard of hearing, speech-language pathologist, auditory verbal therapist or early interventionist to gather more information about how the child is able to use auditory information. Many more examples of assessment tools can be found in the Tests section of this website. It is important for parents and teachers to have a good sense of how a child hears under different circumstances to set goals and expectations, and to know when a problem (like a malfunctioning hearing aid) arises.

For more detailed information on using DSL to understand how a child hears with hearing aids, go to Understanding Your Student's Aided Hearing using the Desired Sensation Level (DSL) Approach.
Pam Millett, Ph.D. is an educational audiologist and associate professor in the Teacher of the Deaf and Hard of Hearing Education Program at York University in Toronto, Canada. She has over 25 years of experience working with students, teachers, parents, professionals and supportive personnel in schools. She teaches educational audiology, and language and literacy development at York University, and is currently conducting research projects in literacy outcomes for students with cochlear implants and the impact of sound field systems on development of phonological awareness skills for young children.
I read some information that Pam had written on this topic and am happy that she agreed to provide this important information to Supporting Success! Karen L. Anderson, PhD, Director

Published August, 2012

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Written by Pam Millett, PhD It is a stressful journey through unfamiliar territory, from a child's first hearing screening, through hearing tests, specialist appointments, and talks about amplification, to earmold impressions and anticipating getting those first hearing aids. Hearing aid fitting day is a day everyone has waited for, usually with a mixture of nervousness, relief and sadness.

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Hearing aids for unilateral hearing loss

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What features are found in pediatric hearing aids to make them safer

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Children of all ages can use hearing aids. An audiologist can find the best hearing aid for your child.

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Why are daily listening checks so important

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Why are daily listening checks so important

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Why you should be listening to your child's device every day

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How to Practice Daily Listening Checks with Ling Six Sounds

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The goal of the LSL approach is for your child with hearing loss to develop listening and spoken language skills just like their hearing friends. Discover some of the strategies you can use, how to include LSL techniques in your daily routines, and how to prepare for new life experiences as your child grows.

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How to best clean the hearing aid at home

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Caring for Hearing Aids & Earmolds | Children's Hospital Pittsburgh

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Hearing aids are delicate instruments that need attention to ensure good operation. Before you put the hearing aid on your child, follow this checklist.

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Leader Live - Happening now in the speech-language-hearing world

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Approximately 95% of parents of children with hearing loss are hearing themselves (Mitchell & Karchmer, 2004), and trends indicate that many parents are choosing spoken language as the primary mode of communication for their children with hearing loss. In fact, some states such as North Carolina, are reporting that parents are choosing spoken language options for their children with hearing loss more than 85% of the time (Alberg, Wilson & Roush, 2006), especially when they know spoken language is a viable outcome for their child. And, these parents are typically selecting approaches that support listening and spoken language, such as Auditory-Verbal Therapy, without initiating visual communication systems.

With early identification and the use of advanced hearing technology, children with even the most severe or profound hearing losses can access audition and follow an intervention approach focused on achieving typical developmental milestones in listening, speech, language, cognition, and conversational competence. Parents' communication choices are based on their long-term desired outcomes for their child. Once those decisions are made, professionals providing early intervention and habilitative services should support the parents' choices and provide the necessary support and intervention to ensure, to the greatest extent possible, that the child achieves those outcomes.
Definition of Auditory-Verbal Therapy
The Alexander Graham Bell (AG Bell) Academy for Listening and Spoken Language, which is based in Washington, DC, governs the certification of Listening and Spoken Language Specialists (LSLS), the practitioners qualified to provide Auditory-Verbal Therapy. The Academy defines the practice of Auditory-Verbal Therapy as:

"Auditory-Verbal Therapy facilitates optimal acquisition of spoken language through listening by newborns, infants, toddlers, and young children who are deaf or hard of hearing. Auditory-Verbal Therapy promotes early diagnosis, one-on-one therapy, and state-of-the-art audiologic management and technology. Parents and caregivers actively participate in therapy. Through guidance, coaching, and demonstration, parents become the primary facilitators of their child's spoken language development. Ultimately, parents and caregivers gain confidence that their child can have access to a full range of academic, social, and occupational choices. Auditory-Verbal Therapy must be conducted in adherence to the Principles LSLS of Auditory-Verbal Therapy" (AG Bell Academy, 2012).

The Principles of Auditory-Verbal Therapy: Defining Practice
The Academy has endorsed a set of principles that delineate the practice of Auditory-Verbal Therapy:

1. Promote early diagnosis of hearing loss in newborns, infants, toddlers, and young children, followed by immediate audiologic management and Auditory-Verbal Therapy;

2. Recommend immediate assessment and use of appropriate, state-of-the-art hearing technology to obtain maximum benefits of auditory stimulation;

3. Guide and coach parents to help their child use hearing as the primary sensory modality in developing spoken language;

4. Guide and coach parents to become the primary facilitators of their child's listening and spoken language development through active consistent participation in individualized Auditory-Verbal Therapy;

5. Guide and coach parents to create environments that support listening for the acquisition of spoken language throughout the child's daily activities;

6. Guide and coach parents to help their child integrate listening and spoken language into all aspects of the child's life;

7. Guide and coach parents to use natural developmental patterns of audition, speech, language, cognition, and communication;

8. Guide and coach parents to help their child self-monitor spoken language through listening;

9. Administer ongoing formal and informal diagnostic assessments to develop individualized Auditory-Verbal treatment plans, to monitor progress, and to evaluate the effectiveness of the plans for the child and family; and

10. Promote education in regular school with peers who have typical hearing and with appropriate services from early childhood onwards.

The Listening and Spoken Language Specialist (LSLS): Two Paths to Certification
The AG Bell Academy has designated two paths to certification for Auditory-Verbal practitioners: LSLS Certified Auditory-Verbal Therapist (LSLS Cert. AVT) and the LSLS Certified Auditory-Verbal Educator (LSLS Cert. AVEd). The LSLS certification is awarded to qualified professionals who have met rigorous academic, professional, post-graduate education and mentoring requirements, and have passed a certification exam. Typically, LSLS certified practitioners are licensed audiologists, speech-language pathologists, or educators of the deaf who have the required background, training and experience in listening and spoken language theory and practice with children with hearing loss and their families. For additional information about certification as a Listening and Spoken Language Specialist (LSLS), speech-language pathologists and audiologists should contact the AG Bell Academy at academy@agbell.org, visit the website ate www.agbellacademy.org, or call (202) 204-4700.
References
Alberg, J., Wilson, K., & Roush, J. (2006). Statewide collaboration in the delivery of EHDI services. The Volta Review, 106, 3, 259-274.

AG Bell Academy for Listening and Spoken Language (2012). 2012 certification handbook. Available at www.agbellacademy.org

Mitchell, R.E. & Karchmer, M.A. (2004). Chasing the mythical ten percent: Parental hearing status of deaf and hard of hearing students in the United States. Sign Language Studies, 4, 2, 138-163.
Dr. K. Todd Houston, Ph.D., CCC-SLP, LSLS Cert. AVT, is an Associate Professor in the School of Speech-Language Pathology and Audiology at The University of Akron. His primary areas of research include spoken language acquisition in children with hearing loss, strategies for enhancing parent engagement in the intervention process, Auditory-Verbal Therapy, and telepractice. He directs the Telepractice and eLearning Laboratory (TeLL), an initiative to evaluate clinical practices in the area of distance service delivery in Speech-Language Pathology.

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Auditory-Verbal Therapy: Supporting Listening and Spoken Language in Young Children with Hearing Loss & Their Families - Leader Live - Happening now in the speech-language-hearing world

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Approximately 95% of parents of children with hearing loss are hearing themselves (Mitchell & Karchmer, 2004), and trends indicate that many parents are choosing spoken language as the primary mode of communication for their children with hearing loss.

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An approach that teaches a child to use his/her remaining hearing through amplification and the use of speechreading/natural gestures/visual cues to aid the child's understanding of language. The use of any form of sign language communication is not encouraged.
PRIMARY GOALS

To develop spoken language through listening and visual cues.

To develop spoken language and communication skills necessary for school success and integration into the hearing community.

LANGUAGE DEVELOPMENT (receptive)

The child develops internal language through early, consistent listening experiences and developmentally appropriate therapy, which includes speech- reading and the use of hearing technology.

EXPRESSIVE LANGUAGE

Spoken and written English.

HEARING

Early, consistent and appropriate use of hearing technology (hearing aids, cochlear implant(s), FM system) is important with this approach.

Requires ongoing auditory management.

FAMILY/PRIMARY CAREGIVER RESPONSIBILITIES & GUIDANCE

Families are expected to provide appropriate carry-over of goals, strategies and techniques from the child's classroom setting and/or individual therapy sessions into daily routines and play activities.

Parents need to work with the child's teacher(s) and/or therapist(s) to learn strategies and techniques for developing listening, speechreading and speaking skills in an oral learning environment.

More Info and Related Links
Click here for a complete Communication Options Chart

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An approach that teaches a child to use his/her remaining hearing through amplification and the use of speechreading/natural gestures/visual cues to aid the child's understanding of language. The use of any form of sign language communication is not encouraged. To develop spoken language through listening and visual cues.

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Total Communication is an approach that many therapists and settings take, when working with children and adults with Speech, Language and Communication Needs.

Speech is the most common form of communication and is used daily with children and adults of various abilities. Total Communication encourages the use of other communication methods, to support a child or adults understanding and use of language.

What is Total Communication?

Total communication includes;

Who uses Total Communication?

Anyone can use Total Communication! Total Communication is encouraged with children and adults who may have Speech and Language Difficulties, Autism Spectrum Conditions, Down Syndrome, Cerebral Palsy, Learning disabilities and Multi sensory impairment.

Parents, Speech and Language Therapists, family, friends, peers, teachers, teaching assistants, carers or anyone who spends time with a child or adult with communication difficulties should use a Total Communication approach. Particularly using methods of communication which are a strength to that child or adult.

Why use Total Communication ?

Further information

If you would like to make your home environment or setting more accessible, and you would like to adapt a Total Communication approach, get in touch with us and one of our therapists can provide the support and training you may need.

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Total Communication is an approach that many therapists and settings take, when working with children and adults with Speech, Language and Communication Needs. Speech is the most common form of communication and is used daily with children and adults of various abilities.

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What is Deaf Culture?

Although some people may consider being deaf or hard of hearing a physical difference, many consider it to be a cultural/linguistic identity. As Carol Padden and Tom Humphries described in their book, Deaf in America: Voices from a Culture:

We use the lowercase deaf when referring to the audiological condition of not hearing, and the uppercase Deaf when referring to a particular group of deaf people who share a language - American Sign Language (ASL) - and a culture.... Fewer than 10 percent are born to parents who are also Deaf. Consequently, in contrast to the situation in most cultures, the great majority of individuals within the community of Deaf people do not join it at birth.

Although members of the Deaf Community are very unique and differ in many ways, there are some general commonalities. American Sign Language (ASL) is the preferred mode of communication. There is a deep respect for Deaf history, residential schools, Deaf associations, and social ties. Again, from Padden and Humphries:

Deaf Culture is a powerful testimony to both the profound needs and the profound possibilities of human beings. Out of a striving for human language, generations of Deaf signers have fashioned a signed language rich enough to mine for poetry and storytelling. Out of a striving to interpret, to make sense of their world, they have created systems of meaning that explain how they understand their place in the world. That the culture of Deaf people has endured, despite indirect and tenuous lines of transmission and despite generations of changing social conditions, attests to the tenacity of the basic human needs for language and symbol.

Why is Deaf Culture important to parents?

We typically receive the news that our child is deaf or hard of hearing from hearing medical professionals. They are usually very skilled and knowledgeable about the diagnostic process and perhaps the medical interventions that a parent can pursue. However, that medical professional may have limited knowledge or training about Deaf Culture and may not understand or value the option of using sign language or participating in the Deaf Community. It means that we as parents may need to look elsewhere to understand all available communication opportunities before making decisions, and recognize each strength and weakness when listening to advice.

Striving to understand Deaf Culture can be a critical step forward in showing respect for a community with a rich history. There are many stories and books written by Deaf adults who have felt cheated by not being exposed to the Deaf Community or sign language when growing up. Some will describe "coming alive" when first entering a residential school, seeing sign language after being raised orally, or attending Gallaudet University in Washington, D.C. (See the Minnesota Hands & Voices Resource Directory - National Organizations.)

Your child may struggle with his or her own identity at some point. You may decide to help shape your child's identity by involving him in the Deaf community and using sign language in your home. On the other hand, you may decide not to use sign or attend Deaf events. It is your family's choice. One day, your child may question why you made the decisions you did. The choice, the decision, and your answer to your child's questions are yours and yours alone.

Whether you actively involve your child in Deaf social activities or schools or not, you will come in contact with members of the Deaf Community. Using the right terminology is another important way to show respect. The terms "hard of hearing" and "deaf" can be confusing to parents. As described in the National Association of the Deaf Community and Culture FAQ:

How people "label" or identify themselves is personal and may reflect identification with the deaf and hard of hearing community, the degree to which they can hear, or the relative age of onset. For example, some people identify themselves as "late-deafened," indicating that they became deaf later in life. Other people identify themselves as "deaf-blind," which usually indicates that they are deaf or hard of hearing and also have some degree of vision loss. Some people believe that the term "people with hearing loss" is inclusive and efficient. However, some people who were born deaf or hard of hearing do not think of themselves as having lost their hearing.

Because in the Deaf Community deafness is regarded to be a cultural phenomenon, rather than a disabling condition, it can be considered offensive to use the words "hearing impaired" or "disabled." The terms "deaf" or "hard of hearing" are more acceptable.

Deaf Culture is also relevant in that many of the decisions we make as parents have a Deaf perspective. Where your child attends school, what communication option you choose, or whether you decide to pursue a cochlear implant all may have a Deaf Culture perspective. In weighing options for your child, it is important to know how some members in the Deaf Community view that decision so you understand the reactions you may encounter later on.

Benefits of the Deaf Community

Membership in the Deaf Community can offer many benefits. These may include:

Improved self-esteem

Sense of pride in one's history

Respect and use of sign language

Emphasis on one's strengths

Community acceptance

Fellowship

There are many Deaf churches, political, and social organizations. Knowledge of, or your child's participation in, events hosted by such organizations can provide modeling of sign language by native users, adult mentoring, and your child's feeling of support by others like himself or herself. Many members of the Deaf Community are well informed about current technology and devices that can be of benefit in everyday life, simply because they use them often.

Regardless of a parents' degree of involvement in the Deaf Community, adult role models who are deaf or hard of hearing can have a huge positive impact on the life of child. All children want to know they are not alone. Parents who meet adult role models can find reassurance that their child will have a successful future. Parents are strongly encouraged to seek out individuals who are willing to share their precious gift of life experience to foster their child's self-esteem.

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Early Hearing Detection and Intervention (EHDI) refers to the practice of screening every newborn for hearing loss prior to hospital discharge. Infants not passing the screening receive diagnostic evaluation before three months of age and, when necessary, are enrolled in early intervention programs by six months of age. All 50 states and the District of Columbia have Early Hearing Detection and Intervention (EHDI) laws or voluntary compliance programs that screen hearing.

More info

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What is Deaf Culture? Although some people may consider being deaf or hard of hearing a physical difference, many consider it to be a cultural/linguistic identity.

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If you are the parent of a child who has just been identified as deaf or hard of hearing, you probably have a lot of questions. What will my child's life be like? How will this affect our family? How will we communicate?

The deaf community is comprised of the adult children of parents like you - loving, concerned individuals who want the best for their child. While members of the deaf community have varied backgrounds and experiences, they are drawn together by their use of American Sign Language (ASL), the value they place on visual communication, and their shared experiences. Some deaf individuals have used sign language from birth, while others learned it as a child or even an adult.

As a young child, your child is at an optimum time to learn sign language. Research shows that with language and communication, earlier is better. There are many tools to help children and their families learn sign language.

You can request American Sign Language instruction from your child's early intervention system. Early intervention systems are designed to help your child develop in all areas. These systems also are designed to provide services to families so that families can support their child. The Individuals with Disabilities Education Act, the federal law that governs early intervention, requires these systems to provide sign language services ¹ for families who choose sign language. The law intends for teachers of the deaf to be included as service providers in early intervention services. ² If you wish for your child and family - even extended family members - to learn sign language, you can request these services from your early intervention provider.

Technology can help many families learn to sign. The Internet offers many signing web sites, and many families benefit from using books and videos. Some libraries carry collections of sign language materials. (For example, this.)

There may be deaf community events in your community that you and your family can participate in. Contact us for NAD affiliates in your area. Many families appreciate the opportunity to meet deaf adults, learn from their experiences, and practice signing. Deaf adults can help answer many of your questions and give you tips on how to make communication easier in your home.

Recently it has become popular to use American Sign Language with hearing babies. Researchers have found that it promotes earlier language development in these babies. Some communities have sign classes for families with hearing children, and many Internet resources for this purpose are available. In addition, many elementary schools now teach sign language, and many high schools offer ASL classes for foreign language credit. This move toward bilingualism benefits both deaf and hearing people.

Some parents have been told that if their child signs s/he will not learn to speak. Research shows that signing does not interfere with speech, and in fact, expressive language ability, including sign language ability, is a significant predictor of speech. ³ Some parents of children with a cochlear implant have been told that they should not sign with their child. Again, there is nothing about signing that interferes with the use of a cochlear implant, and signing with a child who has a cochlear implant may help his/her speech ability. ⁴ Some parents have been told that since their child has some hearing, s/he will not "need" sign language. Actually, there is no harm in signing with your child, and many individuals with residual hearing communicate both through sign language and through speech.

Learning to sign does take commitment, practice, and time. Many hearing parents do become proficient or fluent. Do not be afraid to start learning. Good communication, starting as early as possible, will enhance your relationship with your child throughout your lives.

¹ 20 U.S.C. § 1432(1)(E)(iii).

² Individuals with Disabilities Education Improvement Act of 2004 Conference Report 108-779, p. 236.

³ Yoshinaga-Itano, C. & Sedey, A. (2000). Early Speech Development in Children Who are Deaf or Hard of Hearing: Interrelationships with Language and Hearing. The Volta Review, Vol. 100(5), 181-211.

⁴ Marschark, M., Lang, H., & Albertini, J. (2002). Educating Deaf Students: From Research to Practice. New York: Oxford University Press.

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If you are the parent of a child who has just been identified as deaf or hard of hearing, you probably have a lot of questions. What will my child's life be like? How will this affect our family? How will we communicate?

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Bilingual: American Sign Language & English 

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Bilingual: American Sign Language & English 

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laurent clerc national deaf education center

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Frequently Asked Questions: Considerations for Using an ASL and Spoken English Bilingual Approach with Young Children who are Deaf and Hard of Hearing

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This FAQ, developed at the Clerc Center, responds to questions related to bilingual development in two modalities. It discusses evidence supporting an ASL and spoken English approach and the planning process essential to implementing this approach with young children. It provides references and resources related to this topic.

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What is SEE? Signing Exact English (SEE) is a sign system that matches signs with the English language. It is one of the first manual English systems to be published (1972) and has become extremely popular in the schools.

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About Cued Speech | National Cued Speech Association

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Cued Speech was created originally to enable parents of children who are deaf or hard of hearing to easily make their spoken language clearly visible, so that their children could internalize the appropriate phonemic language base for literacy through exposure.

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What effects does hearing loss have on speech and language

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How does hearing loss affect how well children perform in school

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During her years teaching, former Oklahoma teacher Bonnie Stone encountered several students who were flagged as having learning, language and behavioral challenges when in reality, they had hearing loss.

"I taught first grade and discovered six children in three years with hearing loss," Stone said. "One was a Spanish-speaking boy who was profoundly deaf, but his lack of oral speech was dismissed because 'he doesn't know English.'"

Another student was about to undergo testing for learning disabilities when Stone suggested to the mom that her daughter get her hearing checked first.

"The next day, the mom comes in and tells me her daughter had impacted earwax in both ears and had them cleaned. By the end of the year, the girl tested in the top quartile for first grade," Stone said.

Misdiagnosis leads to real learning problems

When treated with pediatric hearing aids or cochlear implants, kids with hearing loss are just as capable as their peers. However, if childhood hearing loss is left undiagnosed and untreated, it can have an impact that's similar to a learning or behavioral disorder.

A child who can't hear well will struggle to keep up, may get restless and act out in class, or disengage from lessons. Unfortunately, this may lead to getting screened for other conditions, such as learning disabilities or ADD and ADHD. Eventually, this can affect their self-esteem, too, leading to behavioral problems.

"Hearing loss is a real and possible cause of behavioral and learning problems," she explained in a blog post about her experience. "ALWAYS assume hearing loss first and have the child screened."

Even a mild hearing loss can affect
academic performance.

How common is childhood hearing loss?

According to the CDC, about 15% of children ages 6 to 19 have hearing loss of at least 16 decibels in one or both ears. Around .1% have severe hearing loss.

Even hearing loss in only one ear has a tremendous impact on school performance; research shows anywhere from 25 to 35% of children with unilateral hearing loss are at risk of failing at least one grade level.

Hearing and learning are connected

Untreated hearing loss causes delays in the development of speech and language, and those delays then lead to learning problems, often resulting in poor school performance.

Even mild hearing loss can make it hard to keep up-yet mild hearing loss is the hardest to detect and diagnose, because kids learn quite early how to compensate for their hearing loss, and the milder it is, the easier it is to compensate. And parents may not realize that their child can hear but not understand. Over time, though, this catches up to them in school.

Untreated hearing loss leads to a very real learning gap

According to the American Speech-Language Hearing Association ( ASHA), children who have mild to moderate hearing loss but do not get help are very likely to be behind their hearing peers by anywhere from one to four grade levels.

And for those with more severe hearing loss, intervention services are even more crucial; those who do not receive intervention usually do not progress beyond the third-grade level.

What are the reasons behind this education gap? It's certainly not a question of intelligence; just because a child has hearing loss doesn't mean he is any less capable of doing well in school than his hearing peers. Sometimes the classroom environment itself doesn't support a child with hearing loss. A busy teacher who has many students to tend to, or a teacher with a poor understanding of hearing loss, often is unable to alter his teaching style or keep a student's hearing loss in mind while teaching a lesson or assigning homework.

Speech, language and vocabulary development

For example, if a teacher turns his back on the students while teaching, his voice will be directed toward the blackboard, causing a student with hearing loss to miss part of the lesson. Oral changes to homework assignments, an unfamiliar accent or a teacher who talks too rapidly can all hinder the learning progress of a student with hearing loss.

In addition to the classroom environment, certain subjects are just intrinsically more difficult for a child with hearing loss. While the ability to hear affects all aspects of academic achievement, perhaps the areas most affected are those involving language concepts. Vocabulary, language arts, sentence structure and idiomatic expressions are extremely difficult for a child affected by hearing loss to grasp.

New vocabulary, language arts, sentence structure and idiomatic expressions are extremely difficult for a child affected by hearing loss to grasp.

Frustration and confusion can also play a big part in poor academic performance. Though he might have perfectly normal speech, a child with only mild hearing loss can still have trouble hearing a teacher from a distance or amid background noise. Imagine the difficulty and confusion of not being able to hear the high-frequency consonants that impart meaning in the English language (ch, f, k, p, s, sh, t and th) and you can begin to understand some of the academic struggles a child with hearing loss faces on a daily basis. "Chick" and "thick" may sound identical to a child with hearing loss, for example.

Social struggles due to communication challenges

In addition to academic struggles in school, children with hearing loss can also experience trouble socially. Communication is vital to social interactions and healthy peer relationships; without the ability to communicate effectively they often experience feelings of isolation and unhappiness.

If a child with hearing loss is excluded from social interactions or is unwilling to participate in group activities due to fear of embarrassment, the result is that she can become socially withdrawn, leading to further unhappiness. Children with hearing loss are also slower to mature socially, which hinders peer relationships.

Hearing aids and other interventions make all the difference

The good news? Hearing aids help language development in kids with hearing loss.

Children who receive hearing aids or devices like cochlear implants can make great strides and perform just as well as their peers, according to research.

How to help hearing-impaired students in the classroom

Teachers are in a unique position to help learners with hearing impairments by arming themselves with the knowledge as to how a student with a hearing loss receives and understands information, as well as comprehensive knowledge of an individual student's capabilities and level of comprehension. Since early intervention is key, signs teachers can watch for in the classroom include:

Inattentiveness

Inappropriate responses to questions

Daydreaming

Trouble following directions

Speech problems

A child who is struggling in school, especially if she has a family history of hearing loss or has had r ecurring ear infections, should be seen by a hearing care professional for an evaluation.

Depending on the results a proper course of intervention and hearing loss student accommodations can then be recommended. Intervention is crucial because a child who is supported both at school and at home has the best chance of success, academic and otherwise.

If you believe your child is suffering from hearing loss, take her to a pediatrician or your local hearing healthcare professional today. Check out our hearing care directory for one near you.

Hearing loss is invisible and kids may not know they have it

Hearing loss in kids can be mistaken for many different problems, but is easily diagnosed with a hearing evaluation, either at school or with a doctor. Stone, the retired first grade teacher, can't stress doing this enough.

"Unlike vision, it cannot be recognized by a student who squints or tells you they can't see the board. Children with hearing loss may not even realize they aren't hearing properly," Stone, the former teacher, said. "So it is up to us, as their teachers and parents and caregivers, to be observant, educated, and aware of the signs. And to offer support and help."

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Hearing loss can mimic learning disorder in kids, leading to school problems

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During her years teaching, former Oklahoma teacher Bonnie Stone encountered several students who were flagged as having learning, language and behavioral challenges when in reality, they had hearing loss. "I taught first grade and discovered six children in three years with hearing loss," Stone said.

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Assistive technology for the classroom

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Interesting in hearing better in group settings? You may want look into FM and DM systems. Using microphones and receivers (including hearing aids), these systems help you hear better and reduce background noise. Common in school settings, they help filter out unwanted noise.

Both systems improve the signal-to-noise ratio, explains clinical audiologist Sarah Sparks, Au.D, founder of Audiology Outside the Box PLLC in Washington, DC.

"They take sound that is farther away and bring it closer to the listener," Sparks says.

Find out more about how these systems work, along with who might consider taking advantage of them, when FM/DM systems are ideal for use, and more.

What exactly are FM/DM systems?

Teachers or other speakers can wear a
remote microphone that transmits sound
via FM/DM signals to a person's hearing
aid or similar device.
Photo courtesy of Oticon

The FM stands for "frequency modulation" and DM stands for "digital modulation."

Here's how it works: The speaker uses a microphone, while the listener wears a receiver. The receiver can be a simple pair of headphones, ear-level receivers that deliver the sound into the ears, or a hearing device, such as cochlear implants or hearing aids, Sparks explains.

An FM or DM system "is not a substitute for a hearing aid," says Rhee Nesson, AuD, founder of Hearing Doctors of New Jersey -but these devices are often added to hearing aids, she says.

FM vs. DM

If you see "FM" and think "radio" you're on the right track-this type of system uses FM radio signals designated by the FCC to transmit sound, Nesson says.

DM systems use similar digitized signals, and tend to have better sound quality while avoiding potential for interference (think: the staticky sound of another FM station coming through), Sparks says.

"My own experience of using DM systems is that their sound quality is significantly clearer than that of FM systems, which reduces the challenges of the listening situation," Sparks, who is deaf, notes.

Note: While they use different signals, perhaps since they operate fairly similarly, and FM has been around for a while, both systems are often referred to as FM. Audiologists and hearing instrument specialists prefer the term "remote microphone hearing assistive technology" (RM-HAT), since it's inclusive of both types of systems.

Who benefits from using one? / Who should consider using FM/DM systems?

There's a wide range of people who might benefit from using an FM/DM system:

Students

FM/DM systems are often used with children who are deaf or hard of hearing.

"Children that don't have hearing loss sometimes would benefit from an FM system as well," Nesson says-that includes both children with an auditory processing disorder or students with difficulty hearing when there is background noise.

"For children in schools, these systems are often included in IEPs and 504 plans," Sparks says. These plans put in place legally binding required accommodations to help kids with hearing loss.

Hearing aid candidates

At panel conversations, church, concerts, and other situations where hearing may be a challenge, adults who are hearing aid candidates might take advantage of these devices.

"Sometimes, asking for accessibility devices like FM and DM can be the beginning of a person's journey toward having their hearing tested and being fit with appropriate hearing devices," Sparks says.

Adults with hearing aids in crowded settings

If you are fitted with hearing aids, using an FM/DM system can help reduce background noise. So in tricky hearing environments-such as a loud restaurant-having your dining companion wear a microphone can help. Your hearing aid manufacturer likely sells its own clip-on microphone device.

More: Wear hearing aids? Here's why you may want a remote microphone

Anyone, really

Even people with no difficulty hearing can benefit when FM/DM microphones are connected to loudspeakers and used in auditoriums, Sparks points out-that includes people with ADHD or auditory processing disorders, and non-native speakers. "Having a clearer and more accessible sound signal can help with understanding of the message," she says. This also reduces listening fatigue.

It's more common for kids to use FM/DM systems. "But that's not because adults don't benefit!" Sparks says-she notes that adults might have to put in some legwork, asking for them to be provided.

"Because of the stigma that is attached to reduced hearing sensitivity, many adults are hesitant to request these types of accommodations for work and university-level education," she notes.

How do they work?

The simple version is as stated above: A microphone and receiver are paired up. But of course, there's a bit more to it than that.

There are several types of microphones that can be used with these systems:

Table-top microphone: When placed in the center of a table, these mics will pick up all the voices at the table. These are suitable for conference rooms or quiet restaurants. Some feature omnidirectional sound, picking up sounds in all directions. Others "might have a pointing option where the accelerometer in the microphone allows it to change directionality and pick up sound in the direction that it is pointing, but then return to omnidirectional mode when it is flat on a table," Sparks says.

Clip-on or lapel microphones: These hang around a person's neck on a lanyard or are clicked to the speaker's shirt at chest-level. Make sure they're within six inches of the speaker's mouth for the strongest possible speech signal.

Handheld: This type of microphone can be passed around.

Boom microphone: These microphones hang off the ear, positioned about three inches away from the face. Picture the style of microphone that pop singers or customer service representatives wear.

"For some DM systems, multiple types of microphones can be linked to each other within a single system so that listeners can hear from different speakers at different times," Sparks says.

Then, there's the receiver end:

Ear-level receivers: "Ear-level receivers can be attached to hearing aids and cochlear implant processors so that deaf and hard of hearing people can receive the sound signal directly," Sparks says. Sometimes referred to as a "hearing aid boot," ear-level receivers are the most integrated solution for people who wear hearing aids. Children with hearing loss wear these receivers in school. But, they're also available for people without hearing problems, Sparks says.

Neckloop receivers: This type of receiver, also called an induction loop, is worn around the neck and transmits the signal to your hearing aids via electromagnetic energy. This receiver requires the use of telecoil in your hearing aids. Or, for people with typical hearing, they can be attached to headphones, Sparks says.

Loudspeakers: Sounds can also be transmitted to loudspeakers throughout a space.

Body-worn receiver: Body-worn receivers can be slipped into a pocket or clipped to a waistband. Although bulkier, they are portable. Paired with traditional headphones, they are a perfect solution for someone who does not wear hearing aids, or is temporarily without hearing aids during a repair. Physicians often use this type of receiver to talk with patients who have hearing loss but don't wear hearing aids.

Plus, some systems can be paired with other technology-for instance, Sparks pairs her DM system with her laptop and uses it during video chats.

Where you can use FM/DM systems

Movie theaters and other venues often
have accessibility systems for people
with hearing loss.

These can easily be used in many locations, including:

Theaters and auditoriums: Many large auditoriums have the capabilities to provide excellent sound quality without interference. FM technology in a movie or theater setting allows you to use your hearing aid with an FM receiver, and the signal goes straight through to the device so that the sound is clear. For those who don't wear hearing aids, FM systems paired with traditional headsets may be available for you to wear during the show. Don't be shy-ask at the box office.

Classrooms and lecture halls: Some classrooms use a sound-field amplification system so that all children may benefit from an amplification of the teacher's voice. A sound-field amplification system uses a microphone to amplify the speaker's voice through a loudspeaker system that is positioned strategically in the classroom. This way all students can benefit from the amplification, and kids with hearing loss are freed from the burden of wearing a special receiver.

Restaurants: Once you have the equipment, you can use either a tabletop microphone or one that's worn by the speaker during meals.

These systems are useful whenever there's background noise and you want to listen to one other person, Sparks says. In some cases, ADA accessibilty laws may stipulate that FM/DM systems are provided.

How much do they cost?

FM systems can be purchased online, in electronics stores and through your local hearing healthcare professional. If you don't know how to get started or what device might work best for you, talk to your hearing care practitioner, and ask for a demonstration.

"An audiologist would be able to tell a person which receiver is most appropriate for their needs," Sparks says. You'll also need the microphone (which often can pair with several different receivers).

Be prepared for a wide price range with these devices, which can cost as low as $150 or be several thousand dollars.

Madeleine Burry is a Brooklyn-based freelance writer and editor. She's written about health for several online publications, including Women's Health, Prevention, Health, Livestrong and Good Housekeeping. You can follow her on Twitter @lovelanewest. Read more about Madeleine.

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Personal FM systems reduce background noise, improve clarity and reduce listening fatigue. Find out if this tried-and-true technology can help you or your child hear better.

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We provide information and tools to help increase your communication and participation in school and other activities.

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Thanks to a wide choice of Phonak hearing aids and wireless communication accessories, there's a solution for every child.

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Children are busy growing and learning. They experience a huge range of sound environments every day, and their ability to understand speech wherever they are is vital to their development and confidence. Unique to Oticon's speech processing features inside, Sensei preserves the fine details of sound that help your child perceive speech clearly, naturally and distinctly.

Sensei is designed for child development and adapts to provide optimized hearing for any child with hearing loss, in whatever environments they participate in - school, sport, hobbies or play. The array of advanced, automatic and coordinated systems - such as complex signal processing, adaptive directionality, noise management and feedback cancellation systems - give your child speech intelligibility in any listening situation. Thanks to BrainHearing™ technologies, your child is able to develop their auditory systems as naturally as possible, minimizing their cognitive load. Oticon Sensei offers you peace of mind at every step of your child's journey to adulthood.

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Hearing aids for kids & children | Oticon Sensei

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Children are busy growing and learning. They experience a huge range of sound environments every day, and their ability to understand speech wherever they are is vital to their development and confidence. Unique to Oticon's speech processing features inside, Sensei preserves the fine details of sound that help your child perceive speech clearly, naturally and distinctly.

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What Is Auditory Neuropathy Spectrum Disorder (ANSD)?

The ear gathers sounds from the environment and changes them into messages the brain can understand. But sometimes these messages are jumbled. Other times, the sounds don't reach the brain. When this happens, it's called auditory neuropathy spectrum disorder (ANSD).

Kids with ANSD may:

have trouble telling one sound from another

not understand speech clearly

hear sounds that fade in and out

seem as though their hearing changes

The good news is that kids with ANSD can learn strong language and communication skills with the help of medical devices, therapy, and visual communication techniques.

What Causes ANSD?

Auditory neuropathy spectrum disorder happens when there is damage somewhere along the hearing (auditory) nerve. This is the pathway between the inner ear's cochlea (which takes sounds and turns them into messages) and the brain.

Children who are born early or have a family member with ANSD are more likely to have it. So are kids who:

had severe jaundice at birth

had low oxygen before or after birth

get some kinds of medicines that may cause damage to the inner ear or hearing nerve

have genetic or neurologic conditions, such as Charcot Marie Tooth

had a head injury

What Are the Signs & Symptoms of ANSD?

Symptoms can start at any age, but most kids with ANSD are born with it. Hearing loss can be mild to severe. Some kids hear sounds normally but still have trouble understanding speech clearly.

Even if a child passes a newborn hearing screening, hearing problems might be noticed over time. Talk to the doctor if your child does not reach these hearing milestones in the first year of life:

For newborns, startling or "jumping" to sudden loud noises.

By 3 months, recognizing a parent's voice.

By 6 months, turning the eyes or head toward a new sound and repeating sounds (like "ooh" and "aah").

By 12 months, making babbling sounds, responding to their name, imitating words, and saying a few words, such as "mama" or "bye-bye."

As your child gets older, signs of a hearing problem may include:

limited, unclear, or no speech

not seeming to pay attention or follow directions

not responding to conversation-level speech or answering inappropriately

being easily frustrated when there's a lot of background noise

needing a higher TV volume

learning problems

Talk to your doctor if you have concerns about your child's hearing.

How Is ANSD Diagnosed?

ANSD is diagnosed by an audiologist. An audiologist specializes in testing and helping people with hearing loss. Hearing tests that can help diagnose ANSD include:

Otoacoustic emission (OAE): This test measures how well the cochlea works. It's done when the child is lying still or asleep. Tiny earphones are placed in the ear canal. Clicking sounds or tones are made and electrodes (tiny stickers with wires attached) pick up the response from the inner ear (cochlea).

Auditory brainstem response (ABR): This test measures how well the hearing nerve sends sound from the inner ear to the brainstem (the lower part of the brain). This test can show if the brain is not receiving the information in a clear way. Tiny earphones are placed in the ear canal. Clicking sounds or tones are made and electrodes measure the hearing nerve and brain's response to the sounds. ANSD is likely when the OAE is normal and there is little or no response during the ABR.

Middle ear muscle reflex (MEMR) test: Inside the ear is a tiny muscle that tightens when we hear a loud noise. This is called the middle ear muscle reflex (MEMR). For this test, a soft rubber probe tip goes in the ear canal. A series of loud sounds are sent through the tips into the ears. A machine records how well the middle ear muscle reflex reacts to the sounds. In a child with ANSD, loud sounds don't trigger the reflex or sounds need to be louder to trigger it.

Newborn hearing screening programs may use a simple version of OAE and/or the ABR to test a baby's hearing. The complete version of these tests is used to diagnose ANSD.

Children diagnosed with ANSD may need more testing, including:

MRI: to look for inner ear problems and to see if there are hearing nerves in both ears

genetic testing: to see if ANSD is part of a genetic condition

neurologic testing: to look for any other nerve problems

vision testing: Hearing and vision problems often go together, so it's important for kids with ANSD to see an eye doctor.

How Is ANSD Treated?

Children with ANSD get care from a team of specialists, such as an audiologist, ear, nose, and throat (ENT) doctor, speech-language therapist, and education specialist. Treatment depends on the child's age, what part of the hearing nerve is not working, and how much hearing loss there is.

Most kids with ANSD benefit from an assistive listening device. These work best when combined with ongoing speech-language therapy to help improve speaking and hearing skills. Assistive listening devices include:

Frequency modulation (FM) systems: An FM system helps reduce background noise and makes a speaker's voice louder. The person talking (like a teacher) wears a tiny microphone and a transmitter. The transmitter sends an electrical signal to a wireless receiver that the child wears either on the ear or directly in a hearing aid. It's portable, and can be helpful in classrooms and other loud settings.

Hearing aid: A hearing aid amplifies sounds coming into the ear. Hearing aids can help some children with ANSD, especially when used with an FM system. Hearing aids used alone do not help kids with ANSD because they only make the disorganized sound louder.

Cochlear implant: A cochlear implant is an option for some kids with ANSD. This surgically placed device bypasses the parts of the ear that are not working properly. It stimulates the hearing nerve directly. With training and therapy, kids with a cochlear implant can learn to hear and speak well.

What Else Should I Know?

Besides using assistive listening devices, kids with ANSD may learn visual communication skills, such as:

Sign Language is a special language with a grammar, vocabulary, and syntax all its own. It is meant to be used in place of spoken language.

Cued Speech is a technique where the speaker makes hand gestures around their mouth. The person watching the speaker uses these hand cues to tell the difference between lip movements that look the same (such as "b" and "p"). Cued speech can be used in any language and can be very useful for bilingual families.

Signing Exact English (SEE) is a sign system that matches exactly what is spoken in English. It includes sign language, but its sentence structure and grammar are taken from English.

Cued Speech and SEE directly translate what's being said. Both are meant to be used with spoken language to help people understand anything they can't comprehend through lip reading.

Parents play an important role in helping their kids with ANSD learn to communicate by working closely with the care team. You also can find more information and support online at:

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Auditory Neuropathy Spectrum Disorder (ANSD)

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Some kids have hearing loss due to auditory neuropathy spectrum disorder (ANSD), a problem in the transmission of sound from the inner ear to the brain.

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What is auditory neuropathy?

Auditory neuropathy is a hearing disorder in which the inner ear successfully detects sound, but has a problem with sending sound from the ear to the brain. It can affect people of all ages, from infancy through adulthood. The number of people affected by auditory neuropathy is not known, but current information suggests that auditory neuropathies play a substantial role in hearing impairments and deafness.

When their hearing sensitivity is tested, people with auditory neuropathy may have normal hearing or hearing loss ranging from mild to severe. They always have poor speech-perception abilities, meaning that they have trouble understanding speech clearly. People with auditory neuropathy have greater impairment in speech perception than hearing health experts would predict based upon their degree of hearing loss on a hearing test. For example, a person with auditory neuropathy may be able to hear sounds, but would still have difficulty recognizing spoken words. Sounds may fade in and out or seem out of sync for these individuals.

What causes auditory neuropathy?

Researchers report several causes of auditory neuropathy. In some cases, the cause may involve damage to the inner hair cells-specialized sensory cells in the inner ear that transmit information about sounds through the nervous system to the brain. In other cases, the cause may involve damage to the auditory neurons that transmit sound information from the inner hair cells to the brain. Other possible causes may include inheriting genes with mutations or suffering damage to the auditory system, either of which may result in faulty connections between the inner hair cells and the auditory nerve (the nerve leading from the inner ear to the brain), or damage to the auditory nerve itself. A combination of these problems may occur in some cases.

What are the roles of the outer and inner hair cells?

Outer hair cells help amplify sound vibrations entering the inner ear from the middle ear. When hearing is working normally, the inner hair cells convert these vibrations into electrical signals that travel as nerve impulses to the brain, where the brain interprets the impulses as sound.

Although outer hair cells-hair cells next to and more numerous than inner hair cells-are generally more prone to damage than inner hair cells, outer hair cells seem to function normally in people with auditory neuropathy.

Are there risk factors for auditory neuropathy?

There are several ways that children may acquire auditory neuropathy. Some children diagnosed with auditory neuropathy experienced particular health problems before or during birth or as newborns. These problems include inadequate oxygen supply during or prior to birth, premature birth, jaundice, low birth weight, and dietary thiamine deficiency. In addition, some drugs used to treat pregnant women or newborns may damage the baby's inner hair cells, causing auditory neuropathy. Adults may also develop auditory neuropathy along with age-related hearing loss.

Auditory neuropathy runs in some families, and in some cases, scientists have identified genes with mutations that compromise the ear's ability to transmit sound information to the brain. Thus, inheritance of mutated genes is also a risk factor for auditory neuropathy.

Some people with auditory neuropathy have neurological disorders that also cause problems outside of the hearing system. Examples of such disorders are Charcot-Marie-Tooth syndrome and Friedreich's ataxia.

How is auditory neuropathy diagnosed?

Health professionals-including otolaryngologists (ear, nose, and throat doctors), pediatricians, and audiologists-use a combination of methods to diagnose auditory neuropathy. These include tests of auditory brainstem response (ABR) and otoacoustic emissions (OAE). The hallmark of auditory neuropathy is an absent or very abnormal ABR reading together with a normal OAE reading. A normal OAE reading is a sign that the outer hair cells are working normally.

An ABR test uses electrodes placed on a person's head and ears to monitor brain wave activity in response to sound. An OAE test uses a small, very sensitive microphone inserted into the ear canal to monitor the faint sounds produced by the outer hair cells in response to auditory stimulation. ABR and OAE testing are painless and can be used for newborn babies and infants as well as older children and adults. Other tests may also be used as part of a comprehensive evaluation of an individual's hearing and speech-perception abilities.

Does auditory neuropathy ever get better or worse?

Some newborn babies who have been diagnosed with auditory neuropathy improve and start to hear and speak within a year or two. Other infants stay the same, while some get worse and show signs that the outer hair cells no longer function (abnormal otoacoustic emissions). In people with auditory neuropathy, hearing sensitivity can remain stable, get better or worse, or gradually worsen, depending on the underlying cause.

What treatments, devices, and other approaches can help people with auditory neuropathy to communicate?

Researchers are still seeking effective treatments for people with auditory neuropathy. Meanwhile, professionals in the hearing field differ in their opinions about the potential benefits of hearing aids, cochlear implants, and other technologies for people with auditory neuropathy. Some professionals report that hearing aids and personal listening devices such as frequency modulation (FM) systems are helpful for some children and adults with auditory neuropathy. Cochlear implants (electronic devices that compensate for damaged or nonworking parts of the inner ear) may also help some people with auditory neuropathy. No tests are currently available, however, to determine whether an individual with auditory neuropathy might benefit from a hearing aid or cochlear implant.

Debate also continues about the best ways to educate and improve communication skills in infants and children who have hearing impairments such as auditory neuropathy. One approach favors sign language as the child's first language. A second approach encourages the use of listening skills-together with technologies such as hearing aids and cochlear implants-and spoken language. A combination of these two approaches may also be used. Some health professionals believe it may be especially difficult for children with auditory neuropathy to learn to communicate only through spoken language because their ability to understand speech is often severely impaired. Adults with auditory neuropathy and older children who have already developed spoken language may benefit from learning how to speechread (also known as lip reading).

What research is being done on auditory neuropathy?

Scientists have identified genes involved in causing some cases of auditory neuropathy, and are working to identify what goes wrong in the auditory system when a person inherits a mutant gene. Researchers are also continuing to investigate the potential benefits of cochlear implants for children with auditory neuropathy, and are examining why cochlear implants may benefit some people with the condition but not others.

Where can I find additional information about auditory neuropathy?

The NIDCD maintains a directory of organizations that provide information on the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language.

For more information, contact us at:

NIDCD Information Clearinghouse
1 Communication Avenue
Bethesda, MD 20892-3456
Toll-free voice: (800) 241-1044
Toll-free TTY: (800) 241-1055
Email: nidcdinfo@nidcd.nih.gov

NIH Pub. No. 03-5343
September 2016

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Auditory neuropathy is a hearing disorder in which the inner ear successfully detects sound, but has a problem with sending sound from the ear to the brain. It can affect people of all ages, from infancy through adulthood.

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These organizations can provide you with valuable information regarding communication options, early intervention, and community support services for children who are deaf or hard of hearing.

National center for hearing Assessment and management

NCHAM works to ensure early detection of hearing loss and serves as the National Technical Resource Center for all state-based Early Hearing Detection and Intervention (EHDI) programs in the US. Popular links:

American Society for Deaf Children

ASDC is a parent-to-parent organization that provides valuable and trustworthy resources for families with deaf children. Popular links:

HANDS & VOICES

Hands & Voices is a parent-driven organization dedicated to providing non-biased information about communication methodologies. They believe that families can make the best choices for their child if they have access to good information and support.

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These organizations can provide you with valuable information regarding communication options, early intervention, and community support services for children who are deaf or hard of hearing. NCHAM works to ensure early detection of hearing loss and serves as the National Technical Resource Center for all state-based Early Hearing Detection and Intervention (EHDI) programs in the US.