EHDI Families & Caregivers

More than half of babies born with hearing problems are otherwise healthy and have no family history of hearing loss.  If your baby has a hearing loss, you can still help your baby develop language skills.  Screening for hearing loss as early as possible is important to your baby because:

• Early screening allows for early treatment if hearing loss is detected
• Early treatment can provide earlier sound stimulation for your baby’s brain

There are two types of hearing screenings for infants, both are quick and safe.

• Automated Auditory Brainstem Response (AABR) tests the baby’s ability to hear soft sounds through earphones. Sensors are placed on the baby’s skin, measuring responses to sound at the brainstem level.
• Otoacoustic Emissions (OAE) measure an “echo” response to sound from the ear directly. Both tests are safe, and your baby may sleep quietly through both types of hearing screenings.

There are many reasons why a baby may not “pass” the hearing screening.  If this happens, a follow-up test must be done to find out if the baby has hearing loss.  It is important that you follow the recommendations given by your hospital screening staff, audiologist, and/or physician.  A list of health departments that offer follow-up testing can be found here. 

Follow-up testing by a licensed audiologist is recommended if your child fails or does not pass the hearing screening.  Finding an audiologist who is experienced and comfortable working with infants and young children may be a challenge in some areas of the state. Several directories can help you find what is needed for follow-up testing for your child.

Early Hearing Detection & Intervention Pediatric Audiology Links to Services (EHDI PALS)

EHDI-PALS is a web-based searchable national directory. It helps families, healthcare professionals, and state public health organizations to find pediatric audiology expertise for children ages birth to five. The website provides information about childhood hearing to support families and professionals through the process of screening, diagnosis, and intervention.

This site links you to information, resources, and services for children with hearing loss. At the heart of EHDI-PALS is a national web-based directory of facilities that offer pediatric audiology services to young children who are younger than five years of age.

Learn More about childhood hearing loss, hearing testing, and important questions parents can ask when making appointments. This contains great web resources for parents and professionals.

EHDI partners with Georgia Mobile Audiology to provide follow-up testing in underserved areas of the state. https://www.gamobileaudiology.org/findanaudiologist

Georgia Mobile Audiology aims to reduce health disparities throughout Georgia by bringing audiological services to families. By traveling to children and families in need of quality audiological care, we aim to eliminate barriers to effective intervention so every child will have equal opportunities. By providing diagnostic services to families free of charge, we are able to alleviate financial burdens that create barriers to timely care.

Although it doesn't happen very often, sometimes a baby can pass a hearing screening and still have hearing loss.  Some infants have hearing loss that is not present at birth. These babies are born with normal hearing but, develop hearing loss later. This may happen because of illness or because of a genetic condition. Hearing loss after the newborn period might also happen because of the use of certain medications or from an accident or disease.

If you have concerns about your child's responses to sound or speech development, you should discuss this with your baby's doctor or an audiologist. Regardless of a baby's age, there are safe and accurate tests that can be used to measure how a baby hears. Babies are never too young to be tested – don’t wait to see if your baby “grows out of it”.

Your baby will be referred to a specialist, an Otolaryngologist (ENT) by your doctor and/or audiologist. Hearing technologies such as hearing aids or cochlear implants may be recommended to give your child access to sound.  

The next step is to enroll your child in an “Early Intervention” Program, which offers special services to support your child’s language development.  You may be contacted by a person from Georgia PINES, and Babies Can’t Wait (BCW).  Georgia PINES offers an in-home lesson where a specialist will talk to you about hearing loss and early intervention.  BCW and Georgia PINES offer service coordination to help develop a plan to help your child reach their full potential. There may also be private providers in your area that provide specialized services for children with hearing loss and their families in your area.  You will also be referred to Georgia Hands & Voices. Hands & Voices offers support to families who also have a child(ren) with hearing loss.

Providing children with the services they need helps their language development, which gets them ready to learn to read and write like other children. Every child with hearing loss can achieve their fullest potential if they receive early intervention right away.

Georgia’s EHDI program has a loaner hearing aid bank, the Georgia Hearing Aid Loaner Bank (GA HALB).  The GA HALB provides temporary hearing aid(s) for children who are in the process of getting their hearing aid(s).  The hearing aid(s) are loaned on a one-time basis per child for 6 months and includes one earmold per hearing aid.  The loaner hearing aid(s) do not cost money and are available to any child in Georgia from birth to 36 months of age.  

Yes. Georgia Hands & Voices and Georgia Parent to Parent are both dedicated to supporting families and parents that have questions or need emotional support.

Cochlear implants 

You may have heard or read about cochlear implants. If you are interested in a cochlear implant for your child, talk to your audiologist or ENT doctor. They can tell you if a cochlear implant might be helpful. They can also help you find a pediatric cochlear implant program near you.

There are a few things to know about cochlear implants:

• Cochlear implants are for children with a severe to profound hearing loss.
• A cochlear implant has an internal part that is surgically placed into the inner ear and an external part that your child wears behind her ear.
• Not all children are candidates for cochlear implants.
• The implant bypasses the normal auditory pathway (outer ear, middle ear, inner ear). It stimulates the auditory nerve directly and the brain learns to interpret this electrical stimulation as speech.
• A cochlear implant “synthesizes” hearing of sounds. Your early intervention provider will help you help your child learn to listen and understand through their cochlear implants.
• With proper follow-up therapy, cochlear implants can help children with severe to profound hearing loss develop better speech and language skills.
• Federal guidelines say that a child with a profound hearing loss should be at least 12 months old at the time of surgery. It is important to start the cochlear implant candidacy process early and speak with the implant team about your child’s potential candidacy.
• Speak with your implant team surgeon and audiologist about the potential risks and benefits of cochlear implantation.

FM systems

FM Systems are wireless electronic devices that send speech directly to the person wearing the receiver, thus helping overcome listening challenges such as distance and background noise. This allows your child to hear the speaker’s voice better. It is helpful in places with a lot of background noise, like school or on the playgrounds.

If you think an FM system would be helpful for your child, talk to your audiologist. When your child enters preschool, you can request that your county school district supply this equipment.

There are a few things to know about FM systems:

• One person (the parent, therapist or teacher) wears a microphone and transmitter.
• Your child wears a receiver.
• The microphone picks up the speaker’s voice.
• The speech sounds are sent to your child’s ears through radio waves.
• FM systems can be used alone, with hearing aids or with cochlear implants.
• FM systems are helpful in the classroom or at home.

Other assistive listening devices

• Alerting devices: These devices help to alert your child of sounds such as the doorbell or telephone ringing. They might provide a visual signal such as a flashing light, or a tactile signal such as a pocket receiver that vibrates. Some of the most common devices used are alarm clocks, smoke alarms, doorknockers, bed vibrators and phone flashers. The Hearing, Speech & Deafness Center (HSDC) Store, and companies such as Harris Communication or ADCO Hearing Products, have on-line stores or catalogs of alerting devices.
• Captioning: Captioning is the text of the audio portion of a video or film displayed directly on the screen. Usually you see captioning on the bottom of the screen. Captioning may include not only the words, but also sounds that are important to understand and the source of the sounds. Open captions cannot  be turned off and closed captions are not visible unless they are turned on for display.
• Communication Access Realtime Translation (CART): CART is verbatim text of spoken presentations provided for live events. Only the text is provided on a computer screen or projected for display on a larger screen. CART is beneficial in large group settings such as classrooms, meetings, workshops, live theater and other events.
• Telephone amplifier: This device makes the telephone signal louder. It can be used with or without a hearing aid.
• Telecommunications Device for the Deaf (TDD): A TDD is a teleprinter—an electronic device for text communication over a telephone line.
  • The typical TDD is the size of a typewriter or laptop computer. It has a keyboard and small screen that displays typed text electronically. In addition, TDDs commonly have a small spool of paper on which text is also printed. Old versions of the device had only a printer and no screen. Text is transmitted live, through a telephone line, to a compatible device (a device that uses a similar communication protocol).
  • A TDD allows a person with hearing loss to use a telephone by typing rather than speaking. A person using a TDD can call another TDD user direct or use a relay service to call someone who doesn’t have a TDD.

There are many ways for children with hearing loss and their families to communicate. We hope this section gives you the information you need to begin learning about options for communicating with your child. Communicating with your child is important.  Language (sign or spoken) helps your babies brain develop.  35-45 hours of language (sign and/or spoken) is recommended. 

The communication options you choose should provide your child with full access to communication. It should also use the primary language used in your home (such as English, Spanish, American Sign Language, etc.). When trying a communication option, keep in mind that no one option is best for all children. As your child’s needs change, it is okay to make different decisions.

How Hearing Loss Affects Communication

With the appropriate early intervention, children who are deaf or hard of hearing can develop and learn on par with their peers with hearing. Hearing loss in a young child is different from hearing loss in an adult. This is because a young child hasn’t learned many speech and language skills. Adults with hearing loss already know the rules of language and can apply them in daily conversations. For a child with parents who use spoken language in the home even a mild hearing loss can affect her ability to develop speech and language. Children need to hear all of the sounds of their language to learn how to talk. Similarly, children need to see a lot of visual language such as sign language in order to learn how to sign.

How much a hearing loss affects communication for your child depends on things like:

• The type, degree and shape of the hearing loss.
• Your family’s involvement in your child’s communication development.
• The age at which your child became deaf or hard of hearing.
• The age at which your child’s hearing loss was found.
• The age at which intervention began, how often it occurred and the quality of the intervention provided.

Factors that contribute to a child successfully learning to listen and speak include:

• Consistent use of appropriately fit amplification (hearing aids, cochlear implants, FM systems, BAHAs) in order to have access to sound during all hours that the child is awake.
• Being surrounded by fluent speakers of the child’s language and engaging the child most waking hours.
• Guidance and coaching by an early intervention provider knowledgeable in how to help children develop the ability to communicate and learn through listening and spoken language.

Factors that contribute to a child successfully learning to use sign language:

• Being surrounded by fluent users of your chosen sign system and engaging the child during all hours that the child is awake.
• Guidance and coaching by an early intervention provider knowledgeable in how to help children develop the ability to communicate and learn through the particular language or visual support system.

Communication Options

Below are some of the different ways your child can learn language. You can use this information as a starting point to learn about the options. Your child’s audiologist or BCW Coordinator can provide more information about early intervention programs that may be available for each option. You can also visit programs and watch how other children, teachers and parents communicate.

American Sign Language (ASL) — English Bilingual

• The ASL–English bilingual option focuses on teaching your child ASL as the first language, while also learning English (reading, writing and speaking).
• ASL uses the body, face and hands to communicate language.
• ASL is a separate language from English and has a different sentence structure. The sentence structure is similar to Spanish.
• Your child doesn’t have to wear amplification to communicate this way.
• The use of ASL is part of the Deaf community.
• Members of the Deaf community have a strong cultural identity of their own.

Cued Speech

• Cued speech uses eight hand shapes near the mouth that represent different sounds in spoken language.
• The hand shapes represent sounds that are hard to tell apart from each other with just lip reading.
• The hand shapes, combined with lip reading, give your child visual access to spoken language.
• Amplification is recommended, but not required.
• Families learn to communicate with their child using hand cues while speaking.

Listening and Spoken Language

• Sometimes referred to as  auditory/oral or auditory-verbal.
• Relies on access to sound and speech.
• Consistent use of recommended  amplification (hearing aids or cochlear implant, BAHAs) is necessary with this approach.
• Provides visual cues, like lip reading and gestures, when needed to help a child understand and develop language.
• Does not use sign language.

Total Communication

• Families learn to communicate with their child using a combination of signed and spoken language.
• Children are encouraged to use their eyes, ears, voices and hands to communicate.
• The family learns a sign language system, such as ASL, Signing Exact English (SEE), or Conceptually Accurate Signed English (CASE). SEE and CASE are designed to be used together with speech to help your child understand and use language.

Choosing the best communication option

Many families say that choosing a communication option is one of the hardest decisions they have ever made. Every option requires a commitment from your family to help your child learn language. Many people may tell you their method is best but keep in mind that no one option is best for all children.

For some children, a combination of methods may be suitable and you can always change your decision later. Here are some things to think about as you explore communication options:

• Make decisions based on the needs of your child and family.
• Ask questions. Talk to adults who are deaf or hard of hearing, as well as to other families with children who have a hearing loss.
• Get as much information as you can about your options by talking to others, reading, and doing your own research.
• Watch your child’s progress and re-evaluate your choice from time to time.

The option(s) you choose should allow your child to:

• Communicate with the entire family (siblings and extended family).
• Have a relationship with all family members.
• Enjoy meaningful conversations.
• Feel like part of the family.
• Know what is going on.
• Have control over the environment.
• Express feelings.
• Join in the world of imagination and play.

You may have questions about how hearing and listening are different or if your child will be able to listen to spoken language. These questions may become important as you consider communication options or communication goals. Talk with your audiologist if you have more questions. 

Hearing, Listening and the Brain

Hearing is a sensory response to sound where the ear transmits information to the brain. Hearing develops before birth and listening begins with hearing. A person who is deaf or hard of hearing may use amplification to hear (hearing aids, cochlear implant or other device). Over time, listening skills develop as the brain begins to understand what it hears.  The brain can develop the ability to understand what it hears and enable understanding and learning through listening.

A child who is deaf or hard of hearing needs specialized therapy and education to develop effective listening skills. Early interventionists, teachers of the deaf, audiologists and speech language pathologists can provide educational and therapy services to develop these skills. Some professionals are certified as Listening and Spoken Language Specialists (LSLS) through the AG Bell Academy for Listening and Spoken Language. Children and families will often receive a combination of these services to help a child who is deaf or hard of hearing develop by listening and spoken language.

Communication FAQs for Parents

Will my child be able to talk?

This question is difficult to answer. It can depend on the how well hearing technology provides access to sound and spoken language, how well your child is able to use her remaining (residual) hearing, how much you talk with your child, and how often your child wears their recommended amplification.  Many children with mild and moderate losses learn to talk well with the help of hearing aids and specialized services for children who are deaf or hard of hearing.  Children with more severe hearing losses will rely on hearing technology in order to develop spoken language and it may take more time to develop spoken language. Your child’s team of doctors, therapists and teachers of the deaf will help your family try to achieve your communication goals for your child.

Things that may help your child learn to talk are:

• Consistent use of amplification.
• Checking your child’s amplification devices daily to make sure they are working.
• Attending follow-up appointments with your child’s audiologist.
• Receiving regular services from professionals trained in working with children who are deaf or hard of hearing.
• Consistent use of strategies that give your child access to spoken language.
• Giving your child many opportunities to practice their skills.

Will my child and family learn to sign?

This is also a difficult question to answer. Deciding to learn to sign is up to your family. Here are some things to consider when thinking about this decision:

Children with hearing loss may benefit from learning some form of visual communication. This can include ASL, SEE, CASE,and Cued Speech (see Communication Options section). Including visual communication may help your child get speech and language information in more than one way.  Learning to sign does not mean your child will not learn how to talk.  Your child will learn how to sign by watching you and others sign.  If you and your family do not already know how to sign, there are classes available to help you learn. Ask your BCW Coordinator or GA PINES Parent Advisor about these classes.

When making a choice in communication for my child, will this decision be for life?

You can always change your decisions about communication.  However, there is a critical period of time for language development and you must take advantage of this time if your child is going to develop age-appropriate language.  Monitor your child’s progress in order to understand the growth she is making in her language development, and if she is not developing age-appropriate language with the current communication option, you mush consider additional communication options

Can my child’s environment affect communication?

There are some situations where listening through a hearing aid or cochlear implant can be very challenging. Background noises such as TV, multiple conversations, air conditioning or fans can reduce your child’s ability to listen. An audiogram estimates what your child can hear in a quiet environment.  Home, grocery stores, parks and playgrounds and other areas can have poor listening environments. Visual “noise” can also be distracting, such as a cluttered or busy environment, repetitive movements and bright or dark lighting.  Talk with your early intervention specialist about options to help lessen problems related to noise.

Coping

Learning that your child is deaf or hard of hearing may have confirmed what you have already suspected or it may have come as a shock. Some parents easily accept a diagnosis. Others have a hard time accepting it, and it is often an ongoing process. Whatever your reaction, it is normal. Please remember that you are not alone.

You will have many decisions to make about your child’s care. You may also need to make important decisions while feeling overwhelmed. Keep in mind that parents make decisions based on the information they have at that time and what works best for their child and family. As your child develops and grows and your family gathers new information, your plans can change to meet your family’s needs or in response to new information.

What Can You Do Right Now?

The first few weeks and months after learning your child is deaf or hard of hearing can be a busy and overwhelming time. Here are some ideas to help you:

• Interact with your child. Look into your baby’s eyes. Talk. Sing. Laugh. Read.
• Start communicating with your baby now. It’s never too early.

Bonding between a baby and parents happens naturally through close face-to-face interactions, playing and communicating during daily routines. Your baby can learn how to read your face and body, even if she can’t fully hear your spoken words.

Babies learn from things you do and say in everyday life. Talk to your child as you do daily tasks such as changing a diaper, giving a bath, or feeding a meal. Your child will also learn when you sing songs, do finger plays, and play games like peek-a-boo, pat-a-cake, and so-big.

Contact the District Early Hearing Detection and Intervention (EHDI) Coordinator for your county

An EHDI Coordinator is a very valuable resource who can help with everything from getting connected in your community to financing hearing aids or transitioning to school. Find your EHDI Coordinator here.

Keep a journal or notebook for your child

A notebook is the perfect place for keeping copies of clinical reports and important forms. Take this notebook to your child’s appointments too. If the doctor needs copies of reports, you will have them with you and you will have a place to store new materials too.

Seek support from family and friends

People who are close to you can be a great support. Invite the support people in your child’s life to participate in visits to the audiologist, early intervention meetings and parent groups.

What is a hearing aid?

A hearing aid is a small electronic device that your child wears behind her ear(s). It makes some sounds louder.  A hearing aid has three basic parts: a microphone, an amplifier and a speaker.

The hearing aid receives sound through a microphone, which converts the sound waves to electrical signals and sends them to an amplifier. The amplifier increases the power of the signals and then sends them to the ear through a speaker.

Hearing aid technology:

• Increases sound digitally.
• Adjusted by an audiologist with use of a computer.
• The hearing aid program can be customized to fit your child’s hearing loss.
• Processes noise and speech in a way that may help your child understand speech better.
• Offer increased flexibility to accommodate changes in your child’s hearing over time.

Earmolds

Earmolds are a small piece of soft plastic that is custom made for your child’s ear.  Earmolds fit inside of your child’s ear canal.  The earmold helps to hold the hearing aid in place.  Because young children grow very fast, earmolds will need to be replaced as your child grows. Replacement will occur more often during early infancy. Earmolds tend to last longer for older children.

Hearing Aid Styles

There are many hearing aid styles. Your audiologist will help you select the best hearing aid for your child.

• Behind the ear (BTE) hearing aids are usually worn by small children.
• In the ear (ITE) smaller hearing aids are not recommended for small children.
• Soft band retained sound processor or BAHA, are a better fit for some children with conductive hearing losses that cannot be medically or surgically corrected and can’t wear a traditional hearing aid.  The processor transmits sound via a bone oscillator (vibrator) that sits on the bone behind the ear. This is mounted on a soft band.

Important features of hearing aids for infants and toddlers

• The hearing aid should have enough power to allow your child to hear speech sounds.
• It should have Direct Audio Input (DAI) and microphone–telecoil (M–T) switching options. These options allow the hearing aid to be paired with other listening devices, such as FM systems.
• It should be flexible to make changes in tone, output and gain. This allows audiologists to adjust them as they learn more information about your child’s hearing.
• It should have tamper-resistant battery doors because hearing aid batteries are toxic and can harm your child if swallowed.
• The hearing aid should have a microphone that is right for your child’s listening needs.
• It should have comfortable, customized earmolds which may need to be replaced as recommended by your audiologist because of your growing child.

Your audiologist can talk to you about other accessories for your child’s hearing aids. Accessories include battery testers, dehumidifiers, hearing aid stethosets (so you can listen to your child’s hearing aid), safety clips and volume control covers.

How to obtain a hearing aid:

The process to fit your child with hearing aids will take a few weeks. This may seem like a long time but several steps must happen first.

• By law, your child must have approval or “medical clearance” from an Ear, Nose and Throat (ENT) doctor—an otolaryngologist—to wear hearing aids.
• The audiologist must make impressions of your child’s ears. These impressions will be used to make custom earmolds for your child.
• Your child must have a special measurement called the Real Ear to Coupler Difference (RECD) made with their earmolds in place. Your child’s RECD measurement helps the audiologist adjust the hearing aids. The RECD measurements are made before or at the same time as your child’s hearing aid fitting.

*Sometimes your child may have medical clearance and earmolds, but you may still be waiting for funding for the hearing aids. In these cases, your child’s audiologist may fit him with a “loaner” hearing aid during the waiting period. This is because it is important that your child start wearing amplification as soon as possible.

Tips for keeping hearing aids on infants and small children

Keeping hearing aids on a small child can be a challenge, especially at first. As your child gets adjusted to their hearing aids and learns that they can hear better with them on, it will get easier.

Troubleshooting your child's hearing aids

Be sure to talk with your child’s audiologist if you have questions or any of the problems listed below.

Feedback

Feedback is a normal function of any sound system. It occurs when sound travels through a microphone to a speaker and is re-amplified. This creates a feedback loop that sounds like a squeal or fluttering sound. It happens when the hearing aid is turned on but not in the ear or if the hearing aid is touched while in the ear. If it occurs when your child has their hearing aids on, you can try these troubleshooting tips:

• Check to see if the earmold is inserted correctly. If feedback does not stop, check to see if the earmold orearhook is damaged.
• Remove anything that is touching the hearing aid (for example a hat or blanket).
• Check to see if the earmold fits your child properly. 
• Check to see if the child has a build-up of wax in the ear.
• Is there any redness or irritation from the earmold or hearing aid?  Notify your audiologist for an adjustment.

Sore spots

• Sometimes new earmolds have uneven areas that can cause redness or a sore spot in your child’s ear. If this happens, your audiologist can often file the earmold smooth. Check your child’s ears for redness whenever they gets new earmolds.
• A sore spot may be the reason your child doesn’t want to wear the hearing aids.

Ear infections

• If your child has an ear infection they may not want to wear the hearing aids because of soreness to the ears. If you think your child has an ear infection, be sure to talk to your child’s doctor or audiologist. They may recommend that your child doesn’t wear the hearing aids until the infection clears. If your child’s ears are actively draining, remove the hearing aids until the ear infection clears.

Does my child need assistive technology?

Hearing loss decreases the amount of sound your child’s ears and brain receive. If your child isn’t able to hear some or all of the sounds of speech, then they will have difficulty learning spoken language.  If you want your child to learn to communicate with listening and spoken language, your child will need to use hearing aids, cochlear implants, BAHAs, and/or an FM system as recommended by your audiologist.  The sooner you get amplification the sooner your child can begin hearing speech sounds.  If you are considering cochlear implants, it is important to begin the cochlear implant candidacy process early.  Speak with your child’s audiologist about this process.  Some parents may choose a communication option that uses only sign language and require the use of hearing aids or cochlear implants.

Your audiologist will be able to give you more information and answer your questions. Assistive technology and assistive listening devices are also called amplification.

There are many ways to test your child’s hearing. The kind of test your child has depends on your child’s needs and abilities.  

Objective Hearing Tests

Objective hearing tests are done while your child is sleeping or resting quietly. They don’t require your child to respond to sound. There are three main kinds of objective tests: ABR, OAE, and tympanometry.

Auditory Brainstem Evoked Response (ABR) Test

This test measures how well your child’s hearing nerve responds to sound.  It is used for infants and young children who are too young to respond to sounds by turning their heads. It may also be used for older children who cannot do behavioral hearing tests. Sometimes a ABR test can confirm results of a behavioral hearing test.  It is done while your child is sleeping or resting quietly.

During an ABR test:

• Your child may or may not be sedated depending on the child’s age.
• Your child’s skin is cleaned and sensors are put on their forehead and behind each ear.
•  Sounds are played into each ear through a soft foam or rubber earphone.
• A computer records the response of your child’s hearing nerve.
• Your child’s audiologist looks for the softest sound your child’s hearing nerve responds to.

OAE (Otoacoustic Emission) Test

This test measures how well your child’s cochlea—or inner ear—works.  Your child needs to be still and very quiet for this test.

During an OAE test:

• A soft foam or rubber earphone is placed in each of your child’s ears.
• Sounds play through the earphones.
• A computer measures the response of your child’s inner ear.
• The audiologist evaluates the response.

Tympanometry Test

This test helps the audiologist find out how well your child’s middle ear is working.

During a tympanometry test:

• The audiologist puts a rubber tip in your child’s ear.
• The tip is connected to a machine that changes the air pressure in your child’s ear. The machine prints out a graph.
• The graph gives information about whether the eardrum is moving well. If the eardrum is not moving well, it could mean that fluid is present in the middle ear space which can temporarily affect hearing.

Behavioral Hearing Tests

Behavioral hearing tests require your child to respond to sound. Your child will respond by turning his head, playing a simple game or raising his hand.  Your child must be at least 6–7 months developmental age to do a behavioral hearing test. They need to be able to sit up by oneself and have good head control.

There are four main kinds of behavioral tests for infants and children:

• Visual Reinforcement Audiometry
• Conditioned Play Audiometry
• Speech Awareness Threshold
• Speech Reception Threshold

Understanding Your Child’s Audiogram

An audiogram is a graph of the softest sounds your child hears. Your child’s audiogram can answer these questions:

• Is the hearing the same in both ears or is it different?
• How much hearing loss does your child have? (degree of hearing loss)
• Is there more hearing loss in some frequencies (pitches) than others?
• Is there a difference in air conduction and bone conduction hearing? (air-bone gap)

Your audiologist will be able to explain your child’s audiogram in full detail, but below are a few tips that will help you understand the graph.

• Across the top of the graph are the frequencies, or pitches - the frequencies are organized like a piano keyboard. The low tones are on the left and the high tones are on the right.  These pitches or frequencies are measured in Hertz (Hz).
• Down the side of the graph is the intensity, or loudness of sounds - the sounds at the top of the graph are soft. The sounds at the bottom of the graph are loud.  Loudness is measured in decibels (dB).
• The marks on your child’s audiogram represent the softest sounds your child responded to during the hearing test.  When using speakers, only your child’s better-hearing ear is tested.
  • X = left ear
  • O = right ear
  • S =  your child was tested using speakers.

This section may help answer questions about your child’s hearing and what your child’s hearing loss means.

Parts of the Ear

There are three parts to the ear—the outer ear, the middle ear and the inner ear. Each of the three main parts has several smaller parts:

Outer ear

• The part we see (pinna or auricle)
• Ear canal

Middle ear

• Eardrum
• Three tiny bones (ossicles):
  • Hammer (malleus)
  • Anvil (incus)
  • Stirrup (stapes)
• Auditory tube (Eustachian tube)

Inner ear

• Parts that help with balance (vestibular system including semicircular ducts)
• Balance nerve (vestibular nerve)
• Hearing organ (cochlea)
• Hearing nerve (cochlear nerve)

How Does My Child Hear Sound?

• Sound comes into the ear and travels down the ear canal to the eardrum (tympanic membrane). This is where it reaches the middle ear.
• The sound causes the eardrum to vibrate, which causes the three middle ear bones (ossicles) to move.
• The movement of the middle ear bones causes pressure changes in the fluid of the inner ear or cochlea.
• These pressure changes cause a structure in the inner ear (basilar membrane) to stimulate hair cells in the cochlea.
• The movement of the cochlear hair cells sends the signal through the hearing (auditory) nerve to the brain.

MED-EL has helpful videos on YouTube that show how hearing works.

About Hearing Loss

Hearing loss is more common than many people think. Approximately 33 babies are born with hearing loss in the United States every day. The American Academy of Pediatrics (AAP) recommends that:

• By 1 month of age – baby's hearing screened for hearing loss, preferably before hospital discharge
• By 3 months of age – baby should have a diagnosis
• By 6 months of age – baby should be enrolled in early intervention services and wearing hearing aids (if appropriate)

What is hearing loss?

Hearing loss is a reduced ability to detect sounds. A hearing loss can be described in various ways, including by its type and degree. 

You may hear different terms used for people who are deaf or hard of hearing. The appropriate term to use depends on how the person identifies himself, rather than a specific degree of hearing loss. 

• deaf, when spelled with a little or lower case d, means “audiologically deaf.” This term is used to describe a severe to profound degree of hearing loss. This term is often used when a child cannot hear speech sounds.
• Deaf, spelled with a capital or upper case D, is used to identify a member of the Deaf Community who is “culturally Deaf.” The Deaf Community is a diverse group of people who are part of a cultural group that shares a common language and similar experiences. Hearing people who know sign and/or work with individuals who are deaf or hard of hearing can take part in the Deaf Community.
• hard of hearing is used if a child has a mild to severe degree of hearing loss.
• hearing impaired is a term that is not culturally sensitive to the Deaf community. Deaf or hard of hearing are the preferred words to describe an individual with a hearing loss.

Types of Hearing Loss

Conductive Hearing Loss

• Hearing loss caused by something that stops sounds from getting through the outer or middle ear
• May be medically correctable, but sometimes a hearing aid is used to help the person hear

Sensory Hearing Loss

• Hearing loss that occurs when there is a problem in the inner ear (cochlea)
• This type of hearing loss is generally not medically correctable and requires amplification to access speech

Neural Hearing Loss

• Sound enters the inner ear normally but the transmission of signals from the inner ear to the brain is impaired
• Permanent type of hearing loss and cannot be treated with medications or surgery
  • Example of neural hearing loss is Auditory Neuropathy Spectrum Disorder (ANSD)
    • People with ANSD may have normal hearing, or hearing loss ranging from mild to severe; they always have trouble understanding speech clearly.
    • Often, speech perception is worse than would be predicted by the degree of hearing loss.

Mixed Hearing Loss

• Combination of the types of hearing impairments and occurs when more than one type of hearing impairment contributes to the hearing loss.

Your child’s decreased hearing levels may affect one ear or both ears.

• Unilateral means hearing loss in one ear.
• Bilateral means hearing loss in both ears.

Degrees of Hearing

Your child’s hearing level is measured in degrees. There are six degrees of hearing loss. Degrees of hearing loss are measured in decibels (dB). Decibels refer to the intensity or loudness of the sound. The larger the number is, the louder the sound.

• Slight hearing level: Sounds softer than 16–25 dB are not heard                                       
• Mild hearing level: Sounds softer than 26–40 dB are not heard                          
• Moderate hearing level: Sounds softer than 41–55 dB are not heard               
• Moderately-severe hearing level: Sounds softer than 56–70 dB are not heard
• Severe hearing level: Sounds softer than 71–90 dB are not heard                                     
• Profound hearing level: Sounds softer than 91 dB are not heard

Your child’s hearing may not fall into just one of these categories. For instance, his hearing level could be called mild to moderate or severe to profound.  Here is how different degrees of hearing levels can affect your child’s spoken language. Keep in mind that the same hearing level can affect children in different ways.

Starkey Hearing Technologies has a hearing level simulator you can use to understand how things might sound to someone who is deaf or hard of hearing.

Questions You May Have About Your Child’s Hearing

What percentage of hearing does my child have?

• Hearing is difficult to describe in terms of percentage. Instead, you will hear it defined in terms of the type, degree and shape of hearing loss. If someone refers to your child’s hearing as a percentage, talk to your audiologist for a better description.

Will my child’s hearing get better or worse?

• This is difficult to determine. If your child has a conductive loss, it can sometimes get better. If your child has a sensorineural hearing loss, it will probably not get better. Some hearing losses can get worse over time. These are called “progressive hearing losses.” Checking your child’s hearing on a regular basis helps to make sure that any change in hearing is known and that he is getting appropriate amplification. Your audiologist or Ear, Nose, and Throat (ENT) doctor may be able to give you more information about the chances of your child’s hearing getting worse over time.

What caused my child to be deaf or hard of hearing?

• There are multiple causes of hearing loss, talk to your Ear Nose and Throat provider regarding potential causes.  Further testing (MRI, CT scan, genetic testing, and vision testing) may be needed to explore the potential cause of hearing loss.