Hearing loss can have a lifelong impact on children. It can affect their speech, language and learning, their social, physical and emotional development, and their long-term education and employment opportunities.

Colds, infections, allergies and flu can temporarily affect your child’s hearing, however some children have or develop permanent hearing loss. In Australia, between 9-12 children in every 10,000 will be born with a moderate or greater hearing loss in both ears. Around another 23 children per 10,000 will acquire a hearing impairment that requires hearing aids by the age of 17 through accident, illness or other causes.

Most Australian newborns are tested before they leave hospital to identify if they require further hearing and middle ear function testing. If a hearing loss is diagnosed, other tests may include blood tests, an electroencephalogram and a CT scan of the middle and inner ear. The earlier you find out your child has a hearing impairment, the earlier they can begin therapy and develop language to communicate with. It also means you and your family can receive advice and support as soon as possible, all to help give your child the best start in life.

Degrees of Hearing Loss in Children

There are various degrees of hearing loss, classified as mild, moderate, moderate to severe, severe or profound.

Mild hearing loss
Children with mild hearing loss usually have normal speech and can hear normal conversation but may not hear whispers or soft sounds, and will have trouble in the school setting because it will be difficult to hear speech from more than 4 metres away or when there is background noise. Some children with a mild loss are not suspected of poor hearing until they reach grade one. They are often thought to be ‘slow’ learners because they cannot understand when the teacher speaks from a distance and, therefore, respond erratically. When these children receive hearing aids, they usually find that school is easier and their school performance improves.

Moderate hearing loss
Children with moderate hearing loss can clearly hear speech only when the speaker is very close – less than one metre away. They need hearing aids to hear the softest sounds and to acquire understandable speech. If they receive hearing aids before four years of age, they usually progress rapidly in learning speech. They can attend regular schools, but may need some special help.

Moderate to severe hearing loss
Children with moderate to severe hearing loss need conversations to be very loud to be able to hear them. Even when speech is loud, not all words and sounds will be heard clearly. Speech and language development will be affected and specialised professional help will be beneficial.

Severe hearing loss
Children with severe hearing loss will not hear normal conversation and will only be able to pick out a few loud sounds and words. Speech and language development will be affected and hearing aids and specialised professional help will be needed.

Profound hearing loss
Children with a profound hearing loss receive even less auditory information. No sounds can be heard without the help of a hearing aid. The younger a child is when fitted with hearing aids or a cochlear implant, the greater the likelihood he/she will develop improved speech. Children with a profound loss often depend greatly on their vision to perceive speech.

Types of Hearing Loss in Children

There are two main types of hearing impairment, based on which part of the ear is affected: conductive or sensorineural.

Conductive hearing loss
Conductive hearing impairment indicates there is a problem with the mechanism that conducts sound from the environment to the inner ear. It can be caused by a wax blockage, middle ear infections (otitis media), a punctured eardrum, a build-up of fluid or abnormal bone growth. This kind of hearing loss can usually be corrected by medication or surgery. If it cannot be corrected, the child with conductive hearing loss can usually do very well with hearing aids.

Sensorineural hearing loss
In the case of sensorineural hearing impairment, there is damage to the innermost part of the ear (cochlea) or to the nerve which carries hearing (the auditory nerve). It can be caused by abnormal inner ear development, a physical injury to the inner ear, or damage to the ear from diseases such as meningitis and rubella, or a tumour. This type of hearing loss is usually permanent. However, children with sensorineural hearing loss can benefit from hearing aids, FM systems, cochlear implants, communication therapies, and a careful analysis and implementation of educational and communication approaches.

Some children can have both types, which is called a mixed hearing loss, or another type called retrocochlear.

Causes of Hearing Loss in Children

Hearing loss can either be congenital or acquired. Congenital means that the hearing loss was present at the time of birth, or occurred very soon after birth. An acquired hearing loss occurs after birth, often as a result of an illness or an injury.

Congenital hearing loss
There are various causes of congenital hearing loss, though they are not always easily identified. There are both non-genetic and genetic factors that might cause hearing loss.

Non-genetic factors include:

• Birth complications
• Premature birth
• A nervous system or brain disorder
• The use of ototoxic medication by the mother during pregnancy
• Infections that occur during pregnancy such as measles and toxoplasmosis
• Maternal diabetes
• Drug or alcohol abuse by the mother, or smoking during pregnancy

The above causes of congenital hearing loss are all non-genetic factors. However, non-genetic factors account for only around 25 percent of congenital hearing loss. Experts agree that genetic or hereditary factors cause more than 50 percent of all hearing loss in children, whether the loss is present at birth or manifests later in life.

Genetic factors that might cause congenital hearing loss include:

• Autosomal recessive hearing loss, which is the most common type of genetic congenital hearing loss. It means that neither parent has a hearing loss, but each parent carries a recessive gene that gets passed to the child. Parents are usually surprised when their child is born with this type of hearing loss because people typically aren’t even aware they have the recessive gene.
• Autosomal dominant hearing loss, which means that one parent carrying a dominant gene for hearing loss passes it to their child. This parent may or may not have hearing loss, but he or she might have other symptoms or signs of a genetic syndrome.
• Genetic syndromes like Usher syndrome, Treacher Collins syndrome, Waardenburg syndrome, Down syndrome, Crouzon syndrome and Alport syndrome.

Acquired hearing loss

There are various causes of acquired hearing loss, including:

• A perforated eardrum
• Otosclerosis or Meniere’s diseases, which are progressive
• Infections like meningitis, measles, mumps or whooping cough
• Taking ototoxic medications
• A serious head injury
• Exposure to very loud noise over long periods
• Untreated or frequent ear infections (otitis media)
• Exposure to second-hand smoke

However, in some cases it may not be possible to identify the cause of deafness or hearing loss. Children of all ages should undertake a full hearing evaluation if they have experienced diseases that can cause hearing loss, if they have been taking medications that list hearing loss as a side effect, or if you have a family history of hearing problems.

Symptoms/Signs of Hearing Loss in Children

Awareness of communication milestones can help identify early signs of hearing loss.
Hearing impairment in infants may be difficult to detect, but the sooner hearing loss is detected, the better the chances for your child to socialise, communicate, learn, accept their hearing loss, and learn how to live with it.

Some signs that your infant may have hearing impairment include that they:

1. 1. Do not startle at the sound of loud noises by four months of age, or do not turn towards the source of a sound

2. 2. Notice you only when they see you

3. 3. Do not make sounds other than gargles and other vibrating noises that they can feel

4. 4. Need to search right and left to find the voice or sound

5. 5. Have delayed speech or are hard to understand by 15 months of age

6. 6. Do not always respond when called

7. 7. Hear some sounds but not others

8. 8. Have trouble holding their head steady, or are slow to sit up by themselves or walk

Older children could also acquire hearing loss that is either permanent or temporary. Here are some things to look for if you think your toddler or preschool-age child might have hearing loss:

1. 1. Has difficulty understanding what people are saying

2. 2. Speaks differently than other children of similar age

3. 3. Doesn’t reply when you call their name, or doesn’t seem to notice that you have spoken to them

4. 4. Responds inappropriately to questions (misunderstands)

5. 5. Turns up the TV volume incredibly high or sits very close to the TV to hear

6. 6. Has problems academically, especially if they weren’t present before. This can develop into apparent ‘behavioural problems’ at school (which are in fact masking a hearing problem)

7. 7. Has speech or language delays or problems articulating things

8. 8. Watches others in order to imitate their actions, at home or in school

9. 9. Complains of ear pain, earaches or noises

10. 10. Cannot understand over the phone or switches ears frequently while talking on the phone

11. 11. Says “what?” or “huh?” several times a day

12. 12. Watches a speaker’s face very intently. Many children’s hearing loss escapes detection because they are very successful lip readers

13. 13. Appears inattentive and prone to daydreaming

14. 14. Starts to develop low self-esteem. Teachers and peers may conclude that a child is cognitively delayed if they are missing information due to a hearing loss, and the child may start to believe they are not capable of doing the things their peers can

15. 15. Acts shy particularly around people they don’t know (because they can’t understand everything they say)

16. 16. Becomes quiet and withdrawn at school if they can’t hear the teacher well or follow instructions

17. 17. Appears exhausted by the end of the day because hearing takes a lot of energy

Treatment Options

If your child suffers from hearing loss, hearing aids are one of the remedies that can help them to improve their hearing ability and minimise the adverse effects of their hearing problem. The choice you make about which type of hearing aids will depend on a number of factors including the type and degree of your child’s hearing loss; your child’s general abilities and level of activity (the hearing aids must be robust and able to withstand the impact from normal playing, and be resistant to dust and moisture. Many hearing aids for children also include special coverings and other accessories to ensure that young children don’t remove or misplace their hearing aids); your child’s age and school level (hearing aids for older children must have audio ports for hooking-up to radio transmission in classrooms and elsewhere); your child’s personal taste (children often like colourfully finished hearing aids and there are many options and styles to choose from).

There are several models of hearing aid devices to choose from, including behind-the-ear (BTE), in the ear (ITE) or in the canal (ITC) hearing aids.

BTE hearing aids:Young children will normally be fitted with hearing aids worn behind-the-ear (BTE). These come in compact sizes and a variety of bright, cheerful colours.

ITE hearing aids:Older children may be candidates for in-the-ear (ITE) hearing aids, which are custom made and fit inside the ear. These can help for children with mild to moderate hearing losses.

ITC hearing aids:One option for older children is in-the-canal (ITC) hearing aids. The microphone remains in the ITC casing but the receiver is externally placed in the ear canal. This allows the hearing aid to be smaller and more cosmetically appealing.

The Sky V and Sky Q from Phonak, Sensei from Oticon, Motion M, Motion P and Aquaris from Seimens, Supremia Super Power from Bernafon, and the ReSound Up Smart from ReSound are a few examples of hearing aid options available for children.

When your child has begun using hearing aids, you must remember that it takes time to get used to them. Getting used to hearing aids requires strong motivation, support and participation from you as a parent. Advanced, well-fitted hearing aids are not very useful if the child does not wear them or if they are not maintained.

At Ear & Hearing Australia, we are here to help you find the right hearing aid for your child, fit and adjust it, and inform you about all relevant aspects of hearing impairment and hearing aids. Do not hesitate to contact us on 1300 761 667 or find a clinic near you to discuss your child’s individual hearing needs.