Why didn’t my child pass the Newborn Hearing Screening?
In order to pass the newborn hearing screening, the outer, middle, and inner portions of your baby’s ear must be unobstructed and functioning. A blockage or problem at any one of these sites can cause your child to fail the screening. Your baby may not pass at birth if there is still debris in his ear canal from the birthing process, or if he has fluid behind his eardrum. Your baby with a clear outer ear and middle ear may not pass the screening if his inner ear, the main organ of hearing, is not picking up sounds properly. The screening can detect hearing losses ranging from mild to profound.
My child passed the Newborn Hearing Screening. Does this mean I never have to have his hearing tested again?
The newborn hearing screening establishes your child’s baseline of grossly normal hearing at birth. However, a hearing loss can still set in as your child grows older. Your child with otitis media (ear infection or fluid in the ears) will almost always experience a temporary hearing loss. Your child also may be at risk for developing a hearing loss if hearing loss runs in the family, your child was born prematurely or had a low birth weight, or your child has a genetic syndrome associated with hearing loss. If you begin to notice a change in how your child responds to sound, it’s important to mention your concern to your pediatrician and have your child’s hearing tested by a pediatric audiologist. If your child is at risk for a hearing loss, it is important to have his hearing checked every so often.
What are some milestones I should look out for?
We have different expectations depending on the developmental age of the child. Your newborn baby should startle to a loud, sudden noise nearby. As infants get older, they should show some reaction to familiar voices. By 15 months, we expect them to use single words, such as “Mommy”, “cookie,” doggie.” By 2 years we expect them to be saying simple 2-word sentences such as “Go home,” and “Want milk.” Sometimes a child’s hearing loss will go undiagnosed until they are in school. If your child is inattentive or falling behind in classwork, these may be signs of a hearing loss. (NIH)
No one in my family has a hearing loss. Do I really need to worry about my child’s milestone delays?
80% of children with hearing loss are born to hearing parents. It’s important for parents to recognize the signs of normal hearing to be sure their children are on track.
How do you test young children? How reliable are the results?
We never rely on the results of one test alone when it comes to children. We use a combination of automatic tests- which check the structure and function of your child’s ear- and behavioral tests, where we actually measure how your child performs in real life. The automatic and behavioral results are meant to match one another so that we have full confidence in our interpretations about your child’s hearing.
If I suspect that my child has a speech and language delay, when does he/she need his/her hearing checked?
Your child should have her hearing checked as early as possible in the evaluation process for services. Children actually learn language by hearing other people talk, and by hearing how their own voice sounds as they mimic others. It is understandable that your child might be delayed or speaking unclearly if she is not hearing well! A hearing loss must be ruled out before speech services are begun. If not, your child’s speech therapy might be falling on “deaf ears” and you are not correcting the root of the problem. In addition, you should ensure that your child is hearing all of her therapists- including special education and occupational therapists-normally and clearly in order for it to be as effective as possible.
My child with a suspected speech/language delay hears everything. Why should I have his or her hearing assessed?
It is important to recognize that a hearing loss may be in one or both ears, and it can affect all of your child’s hearing or just part of it. Young children who are learning language need to access the full range of sounds, by many different voices, at many different levels, in many different situations. You may notice that your child hears you well at home where it is fairly quiet; and of course, he is familiar with your voice. But, how well does he hear and learn in a noisy classroom with an unfamiliar speaker and many distractions? This can be very challenging for a young child who doesn’t know how to “fill in the blanks” if he doesn’t hear something right away.Your child may also be working harder than usual to compensate for a hearing problem, which can affect his academic performance or behavior. A formal hearing test is the best way to ensure that your child’s difficulties are not caused by poor hearing.
My child gets a lot of ear infections. Should I be concerned about her hearing?
Ear infections are often associated with a buildup of fluid behind the eardrum. If the fluid is infected, your child may present as irritable and feverish, and she might keep tugging at her ear. Your pediatrician should treat this infection medically. However, your child may still have non-infected fluid built up behind her eardrum. Otitis media, or inflammation of the middle ear, is extremely common in young children and is the most common form of temporary hearing loss. Your child may not complain of pain, but you may notice that your child is misunderstanding you more often, losing attention, or raising the volume on the television. Your child with fluid hears sounds as distorted and muffled- or even inaudible- and their hearing can change from day to day, depending on the thickness and amount of the fluid. You might notice “good hearing days” and “bad hearing days”. If your child is getting repeat ear infections, it is important to have her hearing tested to see how much the fluid is affecting her hearing. As we discussed before, good hearing at this age is crucial for speech and language development. Speak to your pediatrician about medical management for fluid and whether he thinks an ENT referral is appropriate for your child.
My pediatrician says that my child has fluid in ears all the time. Can his hearing be tested with fluid?
Yes, his hearing can still be tested, and our tests can differentiate between a fluid-related and a permanent hearing loss. Fluid is typically in the area behind the eardrum and should not be confused with ear wax, which is in the ear canal. Both of these blockages can cause a temporary hearing loss. If your child is prone to wax buildup, it may be a good idea to have his ears cleaned by your pediatrician before coming for your hearing test.
How can I prepare for my child’s hearing test?
If your child is under 6 months, it is best to schedule your appointment at a time that your baby is sleeping. Testing is computer-based and automatic for this age and gives the most information when your child is resting soundly. If your child is above 6 months, we will need her cooperation for the test. It is therefore a good idea to schedule your appointment at a time that your child is content and not overly tired.
My child hears fine but isn’t doing well in school. What else could be going on?
Once the ear picks up all the sound as it should, it sends the information along the hearing nerve to the brain to be processed, or understood. But sometimes the complete sound at the ear loses its “shape” as it travels up to the brain, causing what’s called a Central Auditory Processing Disorder (CAPD). A child relies not only on good hearing, but on good processing of what he hears. CAPD Testing is more advanced testing of the “higher levels” of hearing, and these tests can offer information on “what we do with what we hear.” After we establish that your child has normal hearing, we would assess his listening skills. How rapidly does he process the speech? How well can he recognize speech in noise? How well can he pay attention to one message when there is another competing message? How well does he organize the sounds of speech in the order that he hears them? Your child may have a weakness in one or more of these areas which is making it more difficult for him to learn and achieve in school. Once we target your child’s weakness, we would recommend specific strategies to build up his listening skills.