About half of all children with a hearing loss do not have an identified cause for that hearing loss. Because of this, a number of states in America have instituted universal hearing screening requiring all babies to have their hearing screened before they leave the hospital.
The belief that an accurate hearing test cannot be achieved on a child until they reach the age of five or six years is false. Technology available today allows an accurate assessment of hearing in children within a few hours after they have been born.
Ten states have mandated that newborns have hearing tests performed before they are discharged from the hospital. Children of any age may have their hearing checked through an appropriate hearing test. The form of test that is used is dependent upon the age of the child or their developmental level. There are some hearing tests that do not require a behavioral response; other forms of tests use games which entice a child's interests. Infants and children who are cooperative and between the ages of five months and two years are often tested using a means referred to as, 'Visual Reinforcement Audiometry (VRA).' During the test the child sits on a caregiver's lap.
Reasons to Test a Child's Hearing
Children who have an undetected hearing loss may experience difficulty developing speech, language, or additional cognitive abilities such as thinking, knowing or judgment abilities related to learning. Children who have a hearing loss that remains unidentified until they are two or three years of age may experience permanent difficulties related to language, speech, as well as learning. Early identification of hearing loss allows for both initial treatment and rehabilitation of children who experience a hearing loss at a young age.
A number of people believe that hearing is graded from, 'normal,' to deaf. Hearing loss may range from a mild impairment to what is considered to be a profound loss. The perception that a child's hearing is adequate if they respond to sounds and voices is false. There are a number of gradations between average hearing abilities and deafness; a child's hearing loss may not be readily apparent. A child with what is considered to be a moderate hearing loss may seem to develop both language and speech abilities, yet miss greater than half of what is said to them. A child with a hearing loss of this type will experience a disadvantage in learning and development that can be detected and assisted. Children with a hearing loss can experience unnecessary stress because they do not understand why they are struggling to learn what is apparently simple material, while their family members may not understand why as well, experiencing the same stress. Identification of a hearing loss can prevent these things.
Causes, Risk Factors, and Signs of Hearing Loss in Children
There are many different risk factors for hearing loss in children. Because of this, there are also many different reasons to have a child's hearing checked. Among the different indications for a hearing evaluation of a child are:
Low Apgar scores
Poor school performance
Severe jaundice after birth
A family history of hearing loss
Maternal illness during pregnancy
Low birth weight and/or prematurity
Frequent or recurrent ear infections
Infectious diseases that cause hearing loss: Meningitis, Measles, and Cytomegalovirus [CMV]
Syndromes known to be associated with hearing loss: Down syndrome, Alport syndrome, Crouzon syndrome
Diagnosis of a learning disability or other disorder: Autism or Pervasive Developmental Disorder (PDD)
Medical treatments that may have hearing loss as a side effect: antibiotics and some chemotherapy agents
Parents may suspect their child has a hearing loss when their child does not respond to their name consistently or asks for words, phrases, or sentences to be repeated. Another sign may be that the child does not seem to pay attention to what is said or to sounds. Approximately half of all children who are diagnosed with a hearing loss also have a known risk factor for hearing loss. What this also means is that about half of all children with a hearing loss do not have an identified cause for that hearing loss. Because of this, a number of states in America have instituted universal hearing screening requiring all babies to have their hearing screened before they leave the hospital.
The Person Doing the Testing
Who, exactly, will test a child's hearing? A specialist responsible for testing a person's hearing is referred to as an, 'Audiologist.' An Audiologist must have an advanced degree, commonly a Masters degree, in diagnostic hearing testing techniques and auditory rehabilitation for both adults and children. Testing hearing in children requires particular equipment, training, as well as setup - not all Audiologists test children. When you are referred to an Audiologist to test your child's hearing, confirm that the Audiologist has a pediatric specialty and that they have the appropriate equipment and setup needed in order to test your child's hearing.
Pediatric Hearing Testing
A hearing test for children that is thorough includes an evaluation of their middle-ear system. The middle-ear is the space behind their eardrum; it is a common place where children experience infections. A, 'Tympanogram,' measures the compliance of the middle-ear system mobility, to include the eardrum, and is a means of confirming whether there is anything wrong such as:
A thorough diagnostic test also includes an evaluation of the middle-ear system. The middle ear is the space behind the eardrum and is a common site for ear infections in children.
Fluid behind the eardrum
A hole or perforation of the eardrum
Stiffness of eardrum or middle-ear bones
A Tympanogram is performed through inserting a probe into the ear and creation of a vacuum-tight seal. Air pressure is changed in the ear canal and movement of the person's eardrum is recorded. By measuring the shape and amount of movement, the Audiologist can either signify or exclude various issues. The test is quick, painless, and objective.
A loud sound, when presented to the ear, causes the person's eardrum to contract; something that is referred to as an, 'acoustic reflex.' If this reflex is absent it may confirm problems with the person's middle-ear, or help to identify or even confirm that they have a hearing loss. A Tympanogram and a person's acoustic reflexes are usually tested at the same time. A number of general pediatricians also perform this test in their offices as a screening test to help them diagnose either ear infections or fluid in a child's middle-ear, something referred to as, 'effusions.'
An,'Auditory Steady State Response (ASSR),'evaluation is one of the newer tests that is being used to evaluate hearing in children. The ASSR is being used along with other tests. An ASSR is performed while a child is sleeping or sedated; the test records responses from their auditory nerve as these responses travel up to their brainstem. An advantage of the ASSR is that the stimuli used are more frequency-specific, allowing the Audiologist to predict hearing levels for a broad range of sounds with greater accuracy. The ASSR is quicker and makes the distinction between severe and profound hearing loss clearer.
Treatment of Hearing Loss in Children
Should a hearing loss be identified in a child, a complete search for the cause of the hearing loss will be undertaken. In a number of situations, the child's hearing loss can be due to an ear infection or fluid that is trapped in their middle-ear. If this is the case, a pediatrician can many times prescribe antibiotics to treat the infection. If the infection persists, or the child continues to experience a hearing loss after antibiotic treatment, the child will then be referred to a doctor that specializes in ear diseases and the auditory system, commonly an Otolaryngologist or Ear, Nose and Throat (ENT) specialist. An Otolaryngologist will many times administer additional testing. Sometimes they will recommend forms of therapy such as ear tubes. If the child's hearing loss is persistent, or if it is related to either inner-ear problems or nerve damage, an Otolaryngologist may recommend an evaluation by an Audiologist for hearing aids or rehabilitative therapy. Rehabilitative therapy can include both speech therapy and social integration.
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