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How many children experience ear infections? 

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We just found out that our child has a permanent hearing loss, but it’s only in one ear. This doesn’t seem like a big deal What should we know?

Why it’s a big deal:

One ear cannot listen the same as two ears in all situations. Two ears working together are needed to figure out where sound is coming from. Two ears help us hear better in noisier places. Also, two ears listening together hear just a bit better than one ear working alone. It is very important for learning both at home and at school for a child to hear as well as possible with both of their ears!

Listening Challenges

Children are like little sponges and learn language by hearing it from the people who are around them every day. Any time when


listening is not easy it will be harder for a child with unilateral hearing loss to pick up new words. One of the biggest challenges for people with hearing loss in one ear is listening in noisy situations. Having the TV on a lot is just noise to a baby and it can make it really hard for your child to pick up new words from you. Hearing from a distance is also a challenge. Your child can hear you best if you are within a few feet of your child when you talk to him. Because of these listening challenges, children with hearing loss in one ear often need help to clearly hear what you say, as well as what teachers say in school, and what their friends say during play. Without this help, children with unilateral hearing loss may be
10 times more likely to fail a grade in school or need special help to keep up in school.
1/3 to 1/2 of children with hearing loss who have not received help to hear better have problems learning in school! Also, because most rules of social interaction are learned via subtle auditory cues and visual cues, rather than direct teaching, it isn’t a surprise that about
1/5 of these children will develop behavior or social issues.

Learning Challenges

Learning issues are largely due to missing incidental speech that occurs in the environment. Even though a child hears typically in one ear, whenever there is noise or the speaker is at a distance the child will miss part of what is said. It is recommended that


children with some usable hearing in their worse ear begin to wear a hearing aid in their poor ear starting in infancy. This will provide more ‘balanced’ hearing and allow the child to pick up incidental language around them, thereby preventing some/all of the possible language delays and behavior/social issues. Waiting to amplify the poorer hearing ear until school age (child is in kindergarten or older) may be too late as their brain will take considerable time to learn how to use the information to localize sound and listen in noise. Until that happens, the child may report that the hearing aid actually makes it more difficult due to amplification of all noise along with speech. Don’t wait! Learning challenges include difficulty learning sound/letter associations in typically noisy kindergarten and grade 1 settings, feeling ‘out of step’ due to missing parts of directions and the inability to hear/understand what peers are saying in the classroom unless they are close and it is relatively quiet.

Hearing Loss in One Ear– This information briefly reviews why parents of young children should be concerned about unilateral hearing loss, what they should watch for, and what they should do.

Possible effect on learning: Relationship of Hearing Loss to Listening and Learning Needs – Unilateral Hearing Loss – This single-page handout can be used to assist in planning a young child’s transition to school. It can also be used to inform teachers, other school staff, and medical providers on the potential effects of unilateral hearing loss on learning.

Article:
Minimal Hearing Loss: From a Failure-Based Approach to Evidence-Based Practice

Accommodations in the Classroom for the Student with Unilateral Hearing Loss

• Teacher inservice is important. Provide teacher with Relationship of Hearing Loss to Listening and Learning Needs – Unilateral Hearing Loss It is also helpful to ask the teacher to wear one noise protection ear plug (purchase at drug stores or hardware stores) and demonstrate listening from various parts of the classroom, with and without noise, with back turned and from different seats in the classroom.
• Seating in the rightmost (for good left ear) or leftmost (for good right ear) row is suggested so student’s better hearing ear will almost always face the teacher.
• Allow child to change seat locations to direct the normal hearing ear toward the primary speaker and to close the classroom door if he/she is bothered by hall noise.
• Student should be encouraged to turn in his or her seat to face a classmate who is speaking. Teacher should summarize key points spoken by classmates so that this information is accessible to the student.
• Use of a personal FM system to enhance reception of the teacher’s voice is usually warranted. The FM is typically placed in the student’s better hearing ear. An alternative that is less effective is placement in a classroom with a sound field amplification system (amplifies what the teacher says for the whole class). Pre/post testing with the
  Listening Inventory For Education will assist in verifying the student’s benefit of assistive amplification.
• Educational monitoring is warranted. Teacher completion of the
  Screening Instrument For Targeting Educational Risk in October (January) and May will allow the student’s function in the classroom in comparison to peers to be easily monitored.
• If using a hearing aid and/or personal FM, the student should be involved in regular amplification monitoring and should receive instruction in how to become his/her own ‘Technology Specialist’.
• Student will benefit from being in contact with other students who have typical hearing in only one ear as a source of mutual support. Facilitated contact through chat rooms, Skype, penpal, or face-to-face formats is strongly suggested so that the student does not feel as isolated and can benefit from brainstorming listening and social issues faced due to unilateral hearing loss.
• Teacher should be aware of the potential impact of unilateral hearing loss on socialization and behavior and provide support when natural opportunities occur to help the student to fit in and be seen as a valuable group member.

“I wanted to thank you for all of the work you do with Supporting Success for Children with Hearing Loss, especially for the publications on unilateral hearing loss (UHL). My six month old daughter has UHL on the left side, with moderate loss at the low and middle frequencies and profound loss at high frequencies. She was fitted for a hearing aid at the end of December and seems to be doing well. We’re still working on getting a hearing specialist through Early Intervention and hope to have that happen soon.”

The post Unilateral Hearing Loss first appeared on Supporting Success For Children With Hearing Loss.

Information on ear infections:
Hearing Loss Related to Childhood Ear Infections

Download a handout with basic information:
Ear Infections and Early Learning
has information that sheds light on the effects of hearing loss that comes and goes on children’s development.

Ear infections typically cause conductive hearing loss. Refer here for more information about what
conductive hearing loss is and what causes it.

What to watch for as your child learns to talk:
Ear Infections and Language Development

Serious consequences! Ear infections if untreated too long can result in the growth of cholesteatomas. Refer to the webpage on
cholesteatomas for more information about this disease and how it can effect learning. Other
permanent damage can also be caused from longstanding hearing loss due to middle ear infection.

Information you can share with a child’s teacher:
fluctuating hearing loss (ear infections)

Impact of Fluctuating Hearing Loss on Learning

Subtle long-term problems that occur with children who have histories of recurrent ear infections and fluctuating hearing loss include:

• Binaural speech perception deficits, specifically in
  spatial listening.
• Inability to listen well when there is background noise. It’s harder for them to “target” the sounds they’re supposed to be listening to (result of spatial processing listening deficits).
• Behavior problems may occur because of inattentiveness. They are unable to stay focused on the classroom task at hand.
• Reading difficulties may occur because language is learned through speech. Thus, a child may not be able to read aloud or understand a word beginning or ending in “f,” a sound that is more difficult than others to hear.
• Speech itself sometimes is affected. But most often, that is corrected by school age.

Research Summary: Otitis media with effusion (OME) often results in hearing loss for children with the condition. In order to provide appropriate and effective audiologic management, it is important to understand the impact of OME on speech recognition ability when hearing loss is present. This study examined the speech recognition abilities of normal-hearing six- and seven-year-old children (n = 12) and adults (n = 12) using monosyllabic words and nonsense syllables presented at two levels of simulated conductive hearing loss characteristic of OME. Average speech recognition scores decreased as the degree of simulated conductive hearing loss increased. Both age groups scored significantly poorer for nonsense syllables than for monosyllabic words. In general, the children performed more poorly than the adults with the exception of the easiest listening condition for word stimuli. Furthermore, children appeared less able than adults to use their knowledge of familiar words to improve performance. These findings suggest that rehabilitative strategies may best be focused on combining familiarization techniques and amplification options.

The post Ear Infections and Learning first appeared on Supporting Success For Children With Hearing Loss.

This information was derived from a meaningful article written for audiologists titled

Anticipate Families’ Most Common Hearing Healthcare Questions

by Joanne Smith and Jace Wolfe in

The Hearing Journal, 68 (4), 22, 23, 26, 28.

Readers are encouraged to refer to the original article.

Questions addressed below:

• 
  
  – What caused my child’s hearing loss?
• – How many hours per day should my child wear hearing aids?
• – What can my child hear?
• – Does my child need other hearing technology in addition to a hearing aid?
• – How much should my child understand when using hearing aids or cochlear implant sound processors?
• – Is my child’s speech, language, and auditory skill development normal?
• – Does my child need a cochlear implant? Is he a candidate?
• – What can I do to help my child learn spoken language?
• – How long should my child’s hearing aids last?
• – How do I take care of my child’s hearing aids?

What caused my child’s hearing loss?

Fortunately, advances in technology have allowed us to determine the etiology of most types of congenital hearing loss. Almost 60 percent of congenital hearing loss cases have a primary genetic component, and a comprehensive genetic evaluation can identify the specific cause of hearing loss for about 90 percent of these patients. Additionally, as many as 25 percent of congenital hearing loss cases may be attributed to congenital cytomegalovirus.

For many parents, understanding the cause helps them deal with the emotional consequences of hearing loss and support their child. In our experience, it’s common for parents to harbor feelings of guilt because they erroneously assumed that their own actions while the child was in utero caused the hearing loss. In almost all cases the cause of hearing loss is not due to something that resulted from an activity, behavior or choice made by the mother.

It is helpful to know the cause of the child’s hearing loss so to understand the potential for the condition in future children. Understanding the etiology of the hearing loss can also be important for understanding if the child is at risk for progressive hearing loss or other associated medical issues that can occur if hearing loss is just one part of a syndrome. Finally, knowing the cause of a child’s hearing loss can help determine the prognosis associated with hearing aids or cochlear implants.

What can my child hear?

Parents frequently ask this question. Having a clear understanding of what the child cannot hear and how hearing aids helps him or her hear goes a long way in helping families to understand why it is crucial that the hearing aids be worn all waking hours. Many hearing aid analyzers allow audiologists to demonstrate the effects of hearing loss. Hearing loss simulations are often quite useful, and many are available on
this website.

The goal is for a child to hear all of the sounds of speech when spoken with a quiet voice so that verbal language learning can occur naturally. To do this, consistent hearing aid use is necessary AND the hearing aids must be well-fit, meaning aided hearing thresholds in the 20-25 dB HL range.

How many hours per day should my child wear hearing aids?

The quick answer is that every child needs to wear her aids during all waking hours. At Hearts for Hearing, we like to say,
“Eyes open; ears on.”

During the first three years of life, children typically sleep between 13 and 16 hours a day. With that in mind, hearing aid wear time should probably range from seven to eight hours a day for newborns, to nine to 11 hours a day for children 6 months to 3 years of age. Parents often need more information on how to establish these wear-time goals and seek
strategies to achieve them.

Does my child need other technology in addition to a hearing aid?

“Yes,” regardless of whether the child is using hearing aids or cochlear implants. “Language is caught, not taught” meaning that children learn language by hearing it occurring incidentally around them throughout each day. Children must try to interpret speech in the presence of competing noise for at least 70 percent of their day in order to learn language. Infants and young children routinely encounter situations where speech is quieter than background noise. The necessary speech understanding in these situations to learn language at a rate typical of children without hearing loss will only occur with the use of remote microphone technology, often called
FM systems. We know that children should be exposed to about 46 million words by the time they are 4 years old. The ONLY way children who use hearing aids or cochlear implants can reach this goal is by using remote microphone technology.

How much should my child understand when using hearing aids or cochlear implant sound processors?

With today’s hearing technology, it is tempting to say that children who have hearing loss should understand 100 percent of known words while using their hearing aids or cochlear implants BUT, if possible, this could only occur in very quiet conditions when the child is close to the person talking. What we don’t readily know is the degree of limitation of the impaired peripheral auditory system. The inner ear itself is damaged, deformed or has many fewer receptor cells than a typically hearing person, but just how much that impacts how the child will be able to process the sounds that are heard is not easy to estimate, especially in young children. and in our ability to stimulate that system effectively do not allow every patient to understand 100 percent of target words on a linguistically appropriate monosyllabic word recognition test. If a child can understand 80 percent of known single words spoken in quiet without visual cues (lipreading), then – assuming that there have been effective early intervention services, a high degree of parent support and continuing school support – we can expect that child to communicate adequately when using optimal technology (FM), contextual cues, and speechreading in most real-world situations.

Is my child’s speech, language, and auditory skill development normal?

This may be the most important question family members can ask! We must strive for speech and language scores similar to those achieved by hearing children of the same age. Every child should receive formal, standardized assessments of speech and language, at least every 6 months, to ensure that the child is on track to make at least one year of progress in speech and language development for every one year of chronological age. Of course, a child’s neurological/cognitive abilities, and motor development should also be considered as variables that affect spoken language development. Because 40 percent of children with hearing loss have a secondary diagnosis it is critically important to monitor child development closely in early childhood. From the start, we should establish ambitious, yet realistic, goals that reflect the type of future families want for their children. In order to be ready to read in first grade like age peers, it is necessary to have at least 5 years of optimal hearing and attention to language and auditory development.

Does my child need a cochlear implant? Is he a candidate?

This question does not always have a simple answer. Most children with average hearing thresholds of 80 dB HL or poorer will achieve better spoken language development with the use of a cochlear implant for at least one year than they would with bilateral hearing aids. The question becomes more complex for children who have average thresholds in the severe hearing loss range (65-79 dB HL). A child’s candidacy for cochlear implantation does not hinge on the degree of hearing loss alone. If, with consistent hearing technology use and attention to language development, a child does not achieve one year of speech and language growth within one calendar year then the a team should evaluate the effectiveness of the child’s hearing aid technology. If the team determines that the child is using the best hearing technology available, the technology is optimally set for the child, the child has access to a robust model for speech and language development, and additional disabilities are not the primary reason for the delay, then a cochlear implant should be considered.

What can I do to help my child learn spoken language?

It is important for parents to become the sportscaster Bob Costas of their child’s life, providing a play-by-play of every moment throughout the day. For example, when preparing cereal for an infant, the parent might say,

“Oh, you are so hungry. I think it’s time to eat breakfast. Today, we are going to have rice cereal and bananas. The cereal is in the pantry. Uh-oh, Daddy moved the box. It’s on the bottom shelf today. Now we need a bowl from the cabinet. Let’s open the cabinet door. There it is! The bowl has a frog on it.”

Although the preceding example may seem elementary, such a play-by-play description results in a tidal wave of intelligible words, serving as a rich model for spoken language development in a child.

Parents should also sing to their children as much as possible. Singing or talking in melodic tones actively engages both sides of the brain, resulting in rich stimulation of the auditory centers of the nervous system.

Finally, parents should read as many books throughout the day as possible. The simple act of reading age-appropriate books provides a robust model for speech and language development.

Posted to
Supporting Success for Children with Hearing Loss on April 24, 2015 with consent of article authors. Sincere thanks to Jace Wolfe and Joanna Smith for their work and generosity in sharing this information.

The post Questions Families Often Ask about their Child with Hearing Loss first appeared on Supporting Success For Children With Hearing Loss.

Hearing loss is invisible – it is not always apparent that a child is having hearing difficulties. US Hospitals routinely perform hearing screening on infants in the first 24-48 hours after birth. If an infant fails the initial screening, he or she is usually scheduled for a second screening a few weeks later. However, sometimes infants who pass the hearing screening at birth may exhibit signs of hearing loss as they age. 

This section provides information and resources about identifying hearing loss from birth, hearing loss in young children due to ear infections and identifying hearing loss in school-aged children.

Hearing loss may be identified at birth or any time thereafter. If there are any concerns regarding a child’s ability to hear (at home or school) do not hesitate to have their hearing tested. It is never a waste of time for an audiologist to report that a child has normal hearing.

Identifying Hearing Loss at Birth

Most congenital (present at birth) hearing loss can be identified within 1-2 days of birth via hospital hearing screening. In the US, almost all babies have their hearing screened within a day of being born. Approximately 1 out of 10 newborns who fail hearing screening end up being diagnosed with hearing loss. Newborns who spend time in a neonatal intensive care unit (NICU) have a greater chance of being identified with a hearing loss than those children with no birth complications.

The two types of objective test technologies used to screen for hearing loss in newborns are otoacoustic emissions, and auditory brainstem response (sometimes called ABR test or BAER test).

While these screening tests can detect 80 to 90 percent of infants with moderate degrees of hearing loss and greater, it is important to understand that no screening test is perfect.

Children with mild hearing loss may pass newborn hearing screenings, and hearing screenings for newborns cannot identify children with late onset or progressive types of hearing loss.

It is especially important, therefore, that you monitor your child’s developmental milestones for hearing, language, and speech—even if your newborn passed a hearing screening test in the hospital.

If your child was born with visual, cognitive, or motor disabilities, a comprehensive audiological evaluation would be important to ensure that your child’s hearing is completely normal.

Hearing Loss and Other Developmental Issues

There are a variety of syndromes that are associated with hearing loss. Diagnosis of any of the following syndromes may suggest the possibility of a hearing loss:

Read more about hearing loss and additional disabilities on the Hearing Loss Plus Additional Disabilities page.

Hearing Loss: Possible Impact on Development

The American Speech-Language Association recommends the following speech and hearing milestones  to help you determine the potential need for a hearing assessment.

From birth to four months, your infant should:

• Startle at loud sounds
• Wake up or stir at loud noises
• Respond to your voice by smiling or cooing
• Calm down at a familiar voice

From four months to nine months, your infant should:

• Smile when spoken to
• Notice toys that make sounds
• Turn its head toward familiar sounds
• Make babbling noises
• Understand hand motions like the bye-bye wave

From nine to 15 months, your infant should:

• Make various babbling sounds
• Repeat some simple sounds
• Understand basic requests
• Use its voice to get your attention
• Respond to name

From 15 to 24 months, your infant should:

• Use many simple words
• Point to body parts when you ask
• Name common objects
• Listen with interests to songs, rhymes and stories
• Point to familiar objects you name
• Follow basic commands

** Please note that this is NOT a conclusive hearing assessment but rather a guide to determine the possible need for one.

Resources:
Hearing Screening Resources
NCHAM Newborn Hearing Screening 
Boys Town –  By Baby’s Hearing
Hearing Loss Related to Ear Infection
Hearing Loss and Ear Deformities

Hearing Loss Identified in Childhood: Impact on Behavior

As mentioned above, children with mild or progressive hearing loss may pass their newborn hearing screening. As a result, only about half of children with hearing loss will have their hearing loss identified at birth – there continue to be children who will develop a hearing loss as the years progress. This can be due to a hearing loss that worsens over time, an accident causing damage to structures of the ear, over-exposure to noise or specific medications that cause damage to the cochlea. A later on-set hearing loss may not be obvious and therefore may go undiagnosed for a long period of time. In a developing child hearing loss can look like:

• Not following directions
• Immature social skills (awkward, out of step)
• Unclear speech production (articulation issues or unintelligibile speech)
• Inattention
• Distractible
• Plays alone at an age when other children actively play together
• Limited vocabulary (noticeable gaps to substantial delays)
• Lack of understanding of idioms, figurative language, humor
• Lack of readiness to read (delayed phonemic awareness)
• Passivity (never speaks up or takes a leadership role with peers)
• Bossiness (controls or hijacks conversations)
• Has difficulty understanding what people are saying.
• Speaks differently than other children her or his age.
• Doesn’t reply when you call his or her name.
• Responds inappropriately to questions (misunderstands).
• Turns up the TV volume incredibly high or sits very close to the TV to hear.
• Has problems academically, especially if they weren’t present before.
• Has speech or language delays or problems articulating things.
• Watches others in order to imitate their actions, at home or in school.
• Complains of ear pain, earaches or noises.
• Cannot understand over the phone or switches ears frequently while talking on the phone.
• Says “what?” or “huh?” several times a day.
• Watches a speaker’s face very intently – many children’s hearing loss escapes detection because they are very successful lip readers.

Not all children with a hearing loss will present with learning issues that will trigger a hearing evaluation. In fact, the referral for a hearing test often depends on whether the family or teacher thinks that the child’s learning issues are due to hearing loss. From the list of potential observable behaviors above, it isn’t surprising that many children with hearing loss are misidentified as having attention deficit disorders (ADD),  behavior disorders, speech and language disorder (delay due to limited access – not a disorder), or even cognitive/developmental delay.

It is only through mass hearing screenings that we will be able to identify children with previously unidentified hearing loss in a systematic manner. In the absence of such mass screenings, if your child or student demonstrates the above behaviors please have them seen by an audiologist for a hearing assessment.

Resources:

The American Speech-Language Assocication’s speech and hearing milestones can help you determine the potential need for a hearing assessment.

Hearing Screening Resources
Relationship of Hearing Loss to Listening and Learning
Hearing Loss Related to Ear Infection
Hearing Loss and Ear Deformities

Posted March 2017. Our thanks to Krista Yukow, educational audiologist, for contributing to this content

The post Hearing Loss Identification and Diagnosis first appeared on Supporting Success For Children With Hearing Loss.