Questions to Ask Your Pediatrician When Your Child Has Been Diagnosed with a Hearing Loss

The issue

Severe to profound hearing loss affects approximately 1 in 1000 live births, with more children affected by mild or temporary losses. There are many different causes of hearing loss including congenital (present at birth), genetic (inherited), acquired during infancy or childhood, or progressive (developing over time). Hearing loss can be either conductive (related to sound getting to the cochlea, the sensory organ of hearing), sensorineural (related to the cochlea or auditory nerve), or both. The introduction of newborn screening has permitted hearing loss to be detected shortly after birth. If appropriate intervention is not provided, however, hearing loss can result in speech, language, and cognitive delays with long-term consequences.

What we know

The management of hearing loss in children depends on the underlying cause, type, and severity of hearing loss. Below are examples of questions parents should ask their pediatrician or other providers (and examples of responses).

What if my child has been diagnosed with temporary hearing loss from chronic ear infections?

We know that pressure equalization tubes (“ear tubes”) placed in the ear drums may improve hearing for children with recurrent ear infections and fluid in the middle ear. These tubes allow the fluid to drain and allow sound to conduct normally again.

What if my child has been diagnosed with a permanent or long-term form of hearing loss?

Your child may benefit from an external hearing aid, the most common amplification device. While hearing aids improve hearing, they do not necessarily restore it to normal levels. Hearing aids vary widely in styles, types, and costs. The choice of which to use for your child should be made on individual needs in consultation with specialists. The best hearing aid for your child is guided by the results of the hearing evaluation, the age of the child, the degree and type of hearing loss, and the preference of the child and family.

What if my child does not qualify for a conventional hearing aid?

If your child is not a candidate for a conventional hearing aid, he or she may benefit from devices that transmit sound directly through the skull called bone conduction hearing aids. These devices can be used in children age 6 years or older and be implanted on one side or both.

What are cochlear implants?

Cochlear implants are surgically-implanted devices that electrically stimulate the auditory nerve to improve hearing. Children with severe to profound bilateral sensorineural hearing loss who have experienced little or no benefit from hearing aid use after six months are candidates for cochlear implants. Cochlear implants can be used as early as 12 months and can be implanted in one ear or both.

What we don’t know

Once the underlying cause of the hearing loss has been addressed and hearing amplification has been chosen, it remains difficult to predict how each child will benefit and respond. Important factors in the response to intervention include the type and degree of hearing loss, the child’s age and duration of hearing loss. It is important to remember that hearing aids and cochlear implants do not necessarily restore hearing to normal, but improved hearing is expected. Further, amplification before the age of six months usually improves language outcomes via exposure to sounds during that critical period in development. Early diagnosis and intervention can help children develop at similar rates to their peers who are able to hear normally. However, for those children who are diagnosed late and do not receive treatment during the optimal time frame, by licensed professionals, their developmental outcomes are more uncertain.

Implications

Hearing loss, even temporary, can have significant effects on speech and language development as well as social and cognitive development. Early identification of hearing loss is crucial as treatments are available and can improve language, communication, and cognitive skills. Children diagnosed with hearing loss should be referred to the appropriate educational agency, as school districts and early intervention agencies are equipped to provide educational guidance for their special needs. Educational options vary according to the degree of hearing loss and cognitive ability of the child and may include preferential seating or the use of assistive hearing devices at school. An individual treatment plan is established for each child with the main goal of developing effective communication skills. Children with hearing loss should also be referred to a pediatric ophthalmologist (eye specialist), as they rely heavily on sight for communication and learning.

Posted on  April 4, 2017 by
Maude Aldridge
Baystate Health
Maude.Aldridge MD {at} baystateheath.org

Adam Kasper
Baystate Health
Adam.Kasper MD {at} baystateheath.org

 

Further reading