Sarah, a 7-year-old girl with braided, shoulder-length brown hair sits in the back of her second grade classroom. Her teacher is lecturing on homophones. Taped on the whiteboard are pictures of watermelons that range from big to small. Sarah slightly tilts her head to focus on her teacher’s spelling lesson, but it’s no use; a few moments later her face glasses over in a bored haze and she begins scribbling in her notebook. The teacher, seeing that Sarah isn’t paying attention, calls on her to answer which use of “than” or “then” is correct. Sarah doesn’t respond until a classmate nudges her, but by then it’s too late—the teacher puts Sarah in timeout for being insubordinate.
Later in the afternoon the teacher questions Sarah about the incident and learns that Sarah couldn’t hear the lecture. A quick audiology test at the nurse’s office shows Sarah has unilateral hearing loss.
Sarah is imaginary, but nearly 15 percent of real boys and girls between the ages of 6 and 19 have measurable hearing loss in at least one ear. And more than 48 million Americans have significant hearing loss, making it among the most prevalent medical conditions in the United States.
We live in a hearing world. Whether you’re tuning in to a bird’s beautiful melodic chirp, or tuning out a teacher’s English lesson, our ability to hear empowers us to interact with our environment. Sound also affects our cognitive and physical development.
This entire scenario can be overwhelming and scary if you’re a parent whose child has recently been excluded from the important sensory experience hearing offers. And that swimming feeling of ‘what now’ is okay. As a parent, there are a lot of steps you can take if you suspect your child is struggling to hear, or if they’ve recently been diagnosed with hearing loss.
So let’s dive in into The Beginner’s Guide to Your Child’s Hearing Loss.
Types of Hearing Loss
Your child’s audiologist can best tell you what type of hearing issue your kid has, the likely causes and if the loss is mild or profound. But here are the basics.
Hearing loss happens in three places:
- The outer ear, which is composed of the external ear, the ear canal and the ear drum.
- The middle ear, with the ear drum and three small ossicles bones.
- The inner ear, which houses the snail-shaped cochlea, semicircular canals that help with balance and nerves that are attached to the brain.
There are four ways people experience hearing loss within these three sections:
- Conductive Hearing Loss: This happens when something stops sounds from getting through the outer or middle ear, such as a physical deformity, wax, an ear infection, excess fluid or allergies. Conductive hearing loss can often be treated with medicine or surgery, and sometimes less-serious problems like allergies or the flu can resolve themselves.
- Sensorineural Hearing Loss: A sensorineural loss occurs when the inner ear or hearing nerve isn’t working properly. This can result from exposure to loud noise, trauma, an infection, autoimmune disease, familial hearing loss, or even aging. Sometimes hearing aids or surgery can help restore partial hearing, but depending on the causes it’s possible that the person’s hearing is permanently lost.
- Mixed Hearing Loss: Somebody has mixed hearing loss if they have lost hearing from conductive and sensorineural sources. Depending on the root causes, the mixed hearing might be treatable with medications, hearing aids, or a cochlear implant.
- Auditory Neuropathy Spectrum Disorder: This type of hearing loss is when sound enters the ear normally, but the brain can’t understand the sound itself. People with ANSD also struggle with speech perception alongside their hearing loss. ANSD is a relatively recent diagnosis, and the causes and treatment options are still being researched.
Hearing Tests and Diagnosis
Newborns traditionally receive hearing tests before leaving the hospital, and all babies should have a hearing test no later than 1-month-old, the Centers for Disease Control and Prevention recommends. Any child that doesn’t pass the initial hearing test should get a full hearing diagnostic before becoming 3-months-old.
Afterward, your child will probably have their hearing tested again at about 2-years-old, between ages 4 and 5, and then several times throughout their grade school career.
The most common test is painless and uses an audiometer where your child raises their hand upon hearing a specific sound.
Hearing Loss Symptoms
Figuring out if your child has hearing loss ranges from easy to very difficult, and a lot of it depends on your parenting style, your school district and who your kid is.
Outside of audiology exams at school or a family physician, you’ll typically discover your child has a hearing issue when their behavior changes, says Dr. Eve Leinonen, a clinical audiologist and the owner of Affordable Hearing Solutions in Naperville, Ill.
“Maybe in the past their child did really well in school … and now they're struggling to do their homework or pay attention to some things,” she says. “Usually one of the first things that I recommend is to have their hearing checked.”
Other potential hearing-related behavioral issues you might notice include:
- Difficulty understanding what people are saying
- Speaking at a different level or tone than their peers
- Consistently not replying when you call their name
- Responding to a different question than what you asked
- Listens to music or the TV louder than what’s normal or healthy
- Recent academic problems, especially after being moved to a different spot in the classroom
- Exhibits a noticeable articulation delay when responding to a question
- Complains about ear pain or inconsistent noise levels
- They switch ears frequently while talking on the phone
- They say “huh?” or “what?” when they’re obviously paying attention
Dr. Leinonen says that issues like these can be caused by simple blockages like fluid in the ears or wax buildup, but they can also be indicative of more alarming hearing problems. She recommends that parents who notice these behaviors commonly occurring talk to their child and ask if they can hear O.K. If any red flags rise, then take your kid to an audiologist or an ear, nose and throat specialist.
Teaching Children about Hearing Loss
Hearing loss can be a scary thing for kids and adults alike. And Dr. Leinonen says how old a child is often determines how they’ll react to the diagnoses and ensuing life changes. The most common questions between children and their parents are why they have hearing loss and what caused it. Answering those questions can be tricky, but audiologists like Dr. Leinonen use anatomic models and pictures to describe all the different parts of the ear, and show where things might not be working properly.
Once children grow up to pre-teen and teenagers, they become more nervous and surprised about their hearing loss and tend to ask more questions—especially if the loss isn’t the cause of trauma, Dr. Leinonen says. But overall, most kids seem to go with the flow.
Hearing Loss and School
Depending on the type of hearing loss your child is facing, their audiologist might contact your kid’s school to figure out what resources the school has at hand. If it is hearing loss that needs amplification, you’ll want to get these resources in place before being able to hear and follow subjects in school becomes an issue for your child, Dr. Leinonen says.
A lot of school districts also have a district audiologist and speech pathologist. This isn’t necessarily somebody involved with special education, but rather somebody who is in charge of making sure that your child has everything they need to succeed in the classroom.
The Individuals with Disabilities Education Act mandates that all public school districts and schools must have access to a hearing assistive technology system, like an FM device or other amplification system. In the case of amplification, the FM device synchs with your child’s hearing aid to ensure that they hear the teacher at a consistent level, regardless of where they’re seated in the classroom.
If amplification isn’t needed, your audiologist will make sure your child sits in the front of the room so they can hear everything that's going on. Plus some districts come up with an individualized plan depending on the type of hearing loss, and what specific services your child needs.
The key to getting children to accept their hearing aids is to make the process exciting, fun and educational, Dr. Leinonen says. “We don't want the child to feel like there is something wrong with them; instead they should feel like they have something really cool to show everybody else.”
And showing off their hearing devices is a skill kids excel at.
Some manufacturers with a pediatric product line have the devices in fun, vibrant colors. If the kids need an ear mold, then an audiologist can swirl different colors into the mold and add glitter or other sparkly materials. And most of Dr. Leinonen’s pediatric patients are exuberant about designing a colorful device that’s completely unique to them and their personality.
“What I love about the kids is that they don't really care about hiding [the hearing aid,]” Dr. Leinonen says. “Whereas a lot of adults want the aids to be discrete; they don't want anybody to know.”
As for the devices themselves, Dr. Leinonen recommends parents look at hearing aids manufactured by brands with dedicated pediatric options that meet your child’s needs. Several manufacturers also have pediatric kits, which include educational materials for kids and parents alike. A few brands even throw in troubleshooting tools for parents, which often include a battery tester, cleaning brushes, an air puffer, drying capsules and a listening tube.
Kid’s hearing aids function essentially the same as an adult’s aid. But there are a few added safety measures like tamper-proof battery doors and a water-resistant treatment. Some models also have LED indicators to notify parents if the hearing aid battery is low or if a volume control has been hit.
Dr. Leinonen recommends that children always get a molded over-the-ear hearing aid, rather than a customized option that adult’s often opt-in for. That’s because your kid’s ears continue growing and changing, and within six months to a year the custom aid might not fit any longer.
Education Prevents Bullying
Children have a tendency to be cruel to each other; whether they’re intending to or not. And because your child has a hearing problem, and possibly a visible hearing device, they can become targets for bullies or uncouth questions. It’s a hard situation for some kids, parents and teachers alike to handle. But Dr. Leinonen says she finds if her patients go into social settings excited and educated, then they typically don’t have any problems.
But kids tend to get nervous about that first encounter, and it can stymy their enthusiasm.
“I have one little girl in particular who was really, really excited — at first. The device going to be her own thing; and I found that it was a really great way to approach it, especially for a 7-year-old,” Dr. Leinonen says. “But as we got closer to it, and when she came in for a fitting, her mom outright told me that her daughter is really nervous because she's afraid that kids are going to think that she's different or she's weird.”
The solution Dr. Leinonen employs, and recommends for parents as well, is to get exited alongside your child about their device. Make it something fun to show their friends, and teach them how to teach their peers about the hearing aid.
“So I told her that it really comes down to that if kids give you a hard time, or if children are making fun, it's just because they don't understand it,” she says. “So take it out; show them how cool it is. Show them all the really neat things you can do with it, and how it lets you hear them better.”
Communication, education and intrapersonal empathy are methods of preventing or stopping bullying. And if your child has a hearing issue, then all three aspects are crucial. Dr. Leinonen recommends that you prepare your child enough to understand the types of questions or comments their friends or classmates will have, and how to answer them with a fun, respectful attitude. She says once all the kids know what’s going on, the questions and bullying seems to disappear and your kid’s friends will think the hearing aid devices are cool.
So as long as your keep the situation very light and fun, the kids are going to be more accepting of it — especially as they get older.