Hearing is one of the five senses. It is an intricate process of picking up sound and connecting meaning to it.
The human ear is fully developed at birth and responds to sounds that are very faint as well as sounds that
are very loud. Even in the uterus, infants respond to sound. It is well recognized that hearing is critical to
speech and language development, communication, and learning. Children with listening difficulties due to
hearing loss or auditory processing problems continue to be undiagnosed and have insufficient services
available. The earlier hearing loss occurs in a child's life, the more serious the effects on the child's
development. Similarly, the earlier the problem is identified and intervention begun, the less serious the
There are four major ways in which hearing loss affects children
1. It causes delay in the development of receptive and expressive communication skills (speech and
2. The language impairment causes learning problems that result in reduced academic achievement.
3. Communication difficulties often lead to social isolation and poor self-worth.
4. It may have an impact on career choices.
Detecting Hearing Loss
According to the National Institutes of Health (NIH), nearly 12,000 babies are born each year in the United
States with a hearing impairment. It is estimated that serious hearing loss occurs in about one to three of
every 1,000 healthy newborns, and in two to four of every 100 babies in newborn intensive care units.
Without screening or testing, hearing loss may not be noticed until the baby is more than 1 year old. If
hearing loss is not detected until later years, there will not be stimulation of the brain's hearing centers. This
can affect the growth and development of hearing, and can delay speech and language. Social and emotional
development and success in school may also be affected.
Most hearing loss is congenital (present at birth), but some babies develop hearing loss after they are born.
Hearing loss is more likely in premature babies and babies with respiratory problems who have required long-
term use of breathing machines, those with previous infections, and those taking certain medications.
Because of these risks, many health organizations including the National Institutes of Health (NIH) and The
American Academy of Pediatrics (AAP) now recommend universal infant hearing screening. This means all
newborn babies should be screened for hearing loss. Most states have laws that require universal newborn
Beyond the newborn period, the parents may be the first to detect hearing loss in their child. Unfortunately,
many children with severe hearing loss from birth are not diagnosed until 2 1/2 or 3 years of age. Other
children may not be diagnosed until 4 years of age.
Different Types of Hearing Loss
Hearing loss can be categorized by many different types. Two types of hearing loss are sensorineural and
conductive. Both types of hearing loss can be present at birth or acquired after birth.
Sensorineural hearing loss (or nerve-related deafness) involves damage to the inner ear caused by aging,
pre-natal and birth-related problems, viral and bacterial infections, heredity, trauma, exposure to loud noise,
fluid backup, or a benign tumor in the inner ear. Almost all sensorineural hearing loss can be effectively
treated with hearing aids
Sensorineural – a loss of function within the inner ear or with the connection to the brain. Causes of this
type of hearing loss include:
Congenital factors – conditions present at birth, such as: Infection by the mother with toxoplasmosis,
rubella, herpes, or syphilis.
Genetic factors- syndromes the child has at birth
Low birth weight
Hereditary – in the family
Conductive hearing loss involves the outer and middle ear that may be caused by blockage of wax,
punctured eardrum, birth defects, ear infection, or heredity, and often can be effectively treated medically or
surgically. Conductive hearing loss is a problem in the outer or middle ear where sound waves are not sent
to the inner ear properly. Conductive hearing loss is the most common type of hearing loss in children and is
usually acquired. Factors that may cause this type of hearing loss are: Congenital factors (conditions present
at birth), such as:
• Conditions of the pinna (the outside of the ear)
• Conditions of the tympanic membrane (eardrum)
• Conditions of the external ear canal
• Conditions of the ossicles (the three tiny bones that deliver the sound waves to the middle ear)
Mixed hearing loss refers to a combination of conductive and sensorineural loss and means that a problem
occurs in both the outer or middle and the inner ear.
Central hearing loss results from damage or impairment to the nerves cells of the central nervous system,
either in the pathways to the brain or in the brain itself.
Acquired hearing loss includes:
• Loud noise exposure
• Damage from certain medications that can be harmful to the ears
• Excessive ear wax
• Foreign bodies in the ear canal, such as beads or popcorn kernels
• Tumors of the middle ear
• Problems with the Eustachian tube (a passage from the tympanum of the ear to the pharynx). The
thin, semitransparent, oval-shaped membrane that separates the middle ear from the external ear.
• Ear infections such as ottis media is inflammation of the middle ear, or middle ear infection.
• Chronic ear infections with fluid in the middle ear
• Damage of the eardrum
Facts on Hearing Loss in Children
Every day in the United States, approximately 1 in 1,000 newborns (or 33 babies every day) is born
profoundly deaf with another 2-3 out of 1,000 babies born with partial hearing loss, making hearing loss the
number one birth defect in America.
Of the 12,000 babies in the United States born annually with some form of hearing loss, only half exhibit a
risk factor – meaning that if only high-risk infants are screened, half of the infants with some form of
hearing loss will not be tested and identified. In actual recognition risk-based newborn hearing screening
programs identify only 10-20% of infants with hearing loss. When hearing loss is detected beyond the first
few months of life, the most critical time for stimulating the auditory pathways to hearing centers of the
brain may be lost, significantly delaying speech and language development.
Only 69% of babies are now screened for hearing loss before 1 month of age (up from only 22% in 1998).
Of the babies screened, only 56% who needed diagnostic evaluations actually received them by 3 months of
age. Moreover, only 53% of those diagnosed with hearing loss were enrolled in early intervention programs
by 6 months of age. As a result, these children tend to later re-surface in our schools’ special education
(IDEA, Part B) programs.
When children are not identified and do not receive early intervention, special education for a child with
hearing loss costs schools an additional $420,000, and has a lifetime cost of approximately $1 million per
Hearing Loss Treatment
Recent research indicates that children identified with a hearing loss who begin services early may be able to
develop language (spoken and/or signed) on level with their hearing peers. If a hearing loss is detected in
your child, early family-centered intervention is recommended to promote language (speech and/or signed
depending on family choices) and cognitive development. An audiologist, as part of an interdisciplinary team
of professionals, will evaluate your child and suggest the most appropriate audiology intervention program.
Specific treatment or hearing loss will be determined by your child’s physician based on:
• Your child’s age, overall health, and medical history
• Extent of the condition
• Your child’s tolerance for specific medications, procedures, or therapies
• Your opinion or preference
Management of Hearing Loss
Management of hearing loss may include one or more of the following:
Use of hearing aids – electronic or battery operated devices that can amplify and change sound. A
microphone receives the sound and converts it into sound waves. The sound waves are then converted into
electrical signals. The hearing aid fitting process typically consists of six stages: assessment, treatment
planning, selection, verification, orientation, and validation. The widespread use of computers has made the
process of fitting hearing aids more accurate and efficient.
Over 60% of individuals with hearing loss are fit with two hearing aids (binaural). The benefits of wearing
two hearing aids are enhanced ability to (a) hear better in the presence of background noise, (b) determine
where sound is coming from, and (c) hear soft sounds at lower levels.
Cochlear implants – a surgically placed appliance that helps to transmit electrical stimulation to the inner
ear. Only certain children are candidates for this type of device. Nearly half of all cochlear implant recipients
are children. Cochlear implants can help an estimated 200,000 children in the United States who do not
benefit from hearing aids.
Hearing Loss Early Intervention Services
Early intervention and detection of hearing loss is necessary to prevent additional problems with speech and
language development. A healthcare team approach is usually applied when a child is diagnosis with some
degree of hearing loss. Team members include the following:
Audiologist – a professional who specializes in evaluation and management of hearing and balance problems
in people of all ages. Audiologists are also involved with the fitting and management of hearing aids and other
Otolaryngologists- a physician with precise training in medical and surgical treatment for disorders of the
ear nose and throat.
Speech Pathologist – a professional who helps evaluate and manage speech, language and hearing problems.