Learn About Hearing Loss

The signs and symptoms of hearing loss are different for different children. If you see any of these signs, consult your child’s Doctor, Audiologist, Public Health Nurse, Child Development Center, or other Professional(s) you feel appropriate:

• Does not startle, move, or cry in reaction to unexpected loud noises
• Does not awaken to loud noises
• Does not turn his/her head to the source of a sound
• Pays attention to vibrating noises or noises that can be felt rather than heard
• Does not freely imitate sound
• Inconsistent response to sound
• Does not say single words such as “dada” or “mama” by 1 year of age
• Unclear speech
• Turns up sound on TV or radio
• Does not follow directions
• Does not respond when called
• Often says “huh”

There are 4 basic types of hearing loss:

• Conductive Hearing Loss is caused by problems in the outer and/or middle ear. This type of hearing loss may be permanent or temporary. It can, often times, be medically or surgically corrected.
• Sensorineural Hearing Loss is caused by problems in the cochlea and/or inner ear. This is a permanent type hearing loss that usually cannot be medically or surgically corrected.
• Mixed Hearing Loss is a combination of Conductive and Sensorineural hearing loss.
• Central Auditory Processing Disorder is a condition where auditory signals are not processed by the brain. The child can “hear” sound, but cannot understand what is being heard. The child’s peripheral mechanisms are working, but the information does not reach the brain in a typical or efficient manner.

There are several degrees of hearing loss, ranging from mild to severe. It is possible to have a hearing loss in only one ear (unilateral hearing loss) or in both ears (bilateral hearing loss).

The following is an example of the ability of the brain to hear speech with a hearing loss:

A child may “hear” some sounds, but not hear all the sounds they need to in order to understand. Below are possible impacts hearing loss may have on understanding language and speech:

16-25 dB Hearing Loss

• Compared to the ability to hear when index fingers are placed in ears.
• Difficulty hearing faint or distant speech.
• At 16 dB hearing loss, child can miss up to 10% of speech signal when speaker is at a distance greater than 3 feet. Percentage of speech missed will be greater whenever there is background noise.

26-40 dB Hearing Loss

• Greater listening difficulties than a “plugged-ear” hearing loss.
• Child can “hear” but misses fragments of speech leading to misunderstandings.
• At 30 dB hearing loss child can miss up to 25-40% of speech signal.
• At 40 dB child may miss 50% of classroom discussions.
• Often experiences difficulty learning early reading skills such as letter/sound associations.

41-55 dB Hearing Loss

• At 50 dB hearing loss child may miss up to 80% of speech signal.
• Without early amplification, the child is likely to have delayed or disordered syntax, limited vocabulary, imperfect speech production, and flat voice quality.
• Even with hearing aids, if there is background noise, the child will miss much of what is being said.

56-70 dB Hearing Loss

• Without amplification, a 55 dB hearing loss can cause a child to miss up to 100% of speech information.
• If hearing loss is not identified and appropriately managed before child is one year of age, it is very likely for child to have delayed spoken language, syntax, reduced speech intelligibility and flat voice quality.
• The age at which amplification begins, consistency of hearing aid use and early language intervention is strongly tied to the success of speech, language and learning development.

71-90 dB Hearing Loss

• Without amplification, children with 71-90 dB hearing loss may only hear loud noises about 1 foot from ear.
• The earlier the child wears amplification consistently with parents and caregivers providing language opportunities throughout everyday activities, and/or intensive language intervention (sign or verbal) put into place, the greater the child’s chances are that speech, language and learning will development at a relatively normal rate.
• Individual ability and intensive intervention prior to 6 months of age will determine the degree that sounds detected will be understood by the brain into meaningful input.
• A child with hearing loss greater than 70 dB may be a candidate for cochlear implants; A child with hearing loss greater than 90 dB will not be able to perceive most speech sounds with traditional hearing aids. (Provided by Karen Anderson)

• The Importance of Talking… Talking to your child is important for his/her language development. Since children usually imitate what they hear, how much you talk to your child, what you say, and how you say it will affect how much and how well your child talks.
• Look… Look directly at your child’s face and wait until you have his/her attention before you begin talking.
• Control Distance… Be sure that you are close to your child when you talk (no farther than 5 feet). The younger the child, the more important it is to be close.
• Loudness… Talk slightly louder than you normally do. Turn off the radio, TV, dishwasher, etc. to reduce background noise.
• Be a Good Speech Model… (1)Describe to your child daily activities as they occur. (2) Expand what your child says. For example, if your child points and says “car,” you may say “Oh, you want the car.” (3) Add new information. You might add, “That car is little.” (4) Build vocabulary. Make teaching new words and concepts a natural part of everyday activities. Use new words while shopping, taking a walk, washing the dishes, etc. (5) Repeat your child’s words using adult pronunciation.
• Play and Talk… Set aside some time throughout the day for “play time” for just you and your child. Play can be looking at books, exploring toys, singing songs, coloring, etc. Talk to your child during these activities, keeping the conversation at his/her level.
• Read… Begin reading to your child at a young age (under 12 months). Ask a librarian for books that are right for your child’s age. Reading can be a calming-down activity that promotes closeness between you and your child. Reading provides another opportunity to teach and review words and ideas. Some children enjoy looking at pictures in magazines and catalogs.
• Don’t Wait… Your child should have the following skills: By 18 months of age’”3 word vocabulary; by 2 years of age’” 25 to 30 word vocabulary and several 2-word sentences; by 2 1/2 years of age ‘” at least a 50 word vocabulary and 2-word sentences consistently. If your child does not have these skills, tell your doctor. A referral to an audiologist and speech pathologist may be indicated. Hearing and language testing may lead to a better understanding of your child’s language development.

Hearing loss can happen at any time during life… from before birth to adulthood…

Late Onset Hearing Loss (LOHL) is when a child develops a hearing loss sometime after birth but before entering kindergarten. Your child may pass his/her hearing screening at birth, and then development hearing loss later in life. It is important for your child to continue receiving hearing screenings annually after their birth through their preschool years. This will aid in early detection and allow for early intervention for late onset hearing loss.

Hearing plays a vital and often subtle role in the early development of children. Children learn speech and language from listening to others around them. If a hearing loss exists, a child may not be able to receive optimal benefit from spoken language during this period of growth, and as a result, delays in speech and language may occur. Many hearing problems in children are minimal, yet developmentally significant. It is important that even the slightest hearing loss be identified so that appropriate developmental management can be provided. Many hearing losses are temporary and may be successfully treated with medical attention. Be sure to have your child’s hearing screened at birth and then annually through his/her preschool years. To schedule a hearing screening, contact your child’s Primary Care Physician or your local Child Development Center.

1. Every day, 33 babies (or 12,000 each year) are born in the United States with permanent hearing loss.  With 3 of every 1,000 newborns having a hearing loss, it is the most frequently occurring birth defect.
2. In a 1988 report to Congress and the President, the Commission on Education of the Deaf estimated that in the United States, the average age that children with congenital hearing loss were identified was 2-1/2 to 3 years of age, with many children not being identified until 5 or 6 years of age.  Early identification and management of hearing loss in infants is vital to their early learning experiences.  An invisible handicap, hearing loss present at birth commonly went undetected until delays in language development became so acute that parents and professionals eventually were led to investigate a child’s hearing ability.  Deprived of critical language learning opportunities by an unidentified hearing loss, most children with hearing loss experienced concomitant disruptions in social, emotional, cognitive, and academic growth.
3. “If hearing impaired children are not identified early, it is difficult, if not impossible, for many of them to acquire the fundamental language, social, and cognitive skills that provide the foundation for later schooling and success in society.”  The first years in a child’s life are critical to healthy brain development and future academic success.  These years provide a window of opportunity with enormous implications for the rest of a child’s life.  Research shows that high quality care and early learning experiences are linked to children’s success in school and in life, and save money by preventing future expenses for remedial education and life assistance.
4. In 1993, a Consensus Panel convened by the National Institutes of Health concluded “that all infants should be screened for hearing impairment. . . . This will be accomplished most efficiently by screening prior to hospital discharge. . . . Infants who fail . . . . should have a comprehensive hearing evaluation no later than 3 months of age.
5. The American Academy of Pediatrics, the American Academy of Audiology, the Joint Committee on Infant Hearing, and the National Association of the Deaf have recommended that all babies be screened for hearing loss before being discharged from the hospital at the time of their birth.
6. “When early identification and intervention occurs, hearing impaired children make dramatic progress, are more successful in school, and become more productive members of society.”
7. The practicability and cost-efficiency of hospital-based universal newborn hearing screening is demonstrated by the fact that 21 Wyoming birthing hospitals are operating successful universal newborn hearing screening programs.  Wyoming has screened 98% of their newborns for hearing loss since 1998.
8. By providing universal newborn hearing screening for the infants born in Wyoming hospitals since 1998, Wyoming has been recognized at the national level for the quality of the program.  When lost to follow-up rates were threatening the continuance of programs in states across the country, Wyoming was recognized as having nearly a 100% follow-up rate for infants identified through the hearing screening program in Wyoming.
9. The cost for hospital-based universal newborn hearing screening is relatively inexpensive.  Using current technology, the cost ranges from $100-$120 per baby depending on the protocol and technology used.
10. The cost per child identified with congenital hearing loss is about 1/10th the cost per child identified with PKU, hypothyroidism, or sickle cell anemia in metabolic disorder screening programs.  Such metabolic disorder screening programs are required in all 50 states.
11. Research has compared children with hearing loss who receive early intervention before 6 months of ages versus after 6 months of age.  By the time they enter first grade, children identified by 6 months of age and entered into early intervention are 1-2 years ahead of their later-identified peers in language, cognitive, and social skills.
12. Infants with hearing loss can be fit with amplification before they are 1 month old.  With appropriate family-centered intervention, typical language, cognitive, and social development for such infants is likely.  Wyoming Child Development Centers are currently providing individualized Early Intervention Services for infants, toddlers, and preschoolers identified with hearing loss.
13. The evidence for the benefits, practicability, and cost-efficiency of universal newborn hearing screening is so compelling that Wyoming passed legislation requiring hospitals to screen all newborns for hearing loss in 1999.
14. All babies should be screened for hearing loss in the birthing hospital, and comprehensive, family-centered service should be available for identified children and families.  Such statewide early hearing detection and intervention programs are operational in Wyoming.
15. If it remains undetected, even mild hearing loss or hearing loss in only one ear may have substantial detrimental consequences.  For example, research shows that children with hearing loss in one ear are ten times as likely to be held back at least one grade compared to a matched group of children with normal hearing in both ears.
16. Research shows that by the time a child with hearing loss graduates from high school, more than $400,000 per child can be saved in special education costs if the child is identified early and given appropriate educational, medical, and audiological services.  These savings in special education costs will pay for universal newborn hearing screening many times over.

Fact Sheet References

1. White, K. R. (October, 1997). The scientific basis for newborn hearing screening: Issues and evidence. Invited keynote address to the Early Hearing Detection and Intervention (EHDI) Workshop sponsored by the Centers for Disease Control and Prevention, Atlanta, Georgia.
2. Commission on Education of the Deaf. (1988). Toward equality: Education of the deaf. Washington, DC: Author.
3. U.S. Department of Health and Human Services (HHS). (1990). Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Washington, DC: Public Health Service.
4. National Institutes of Health (NIH). (1993). NIH Consensus Statement. Early identification of hearing impairment in infants and young children, 11(1), 1-24.
5. U.S. Department of Health and Human Services (HHS). (1990). Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Washington, DC: Public Health Service. National Institutes of Health (NIH). (1993). NIH Consensus Statement. Early identification of hearing impairment in infants and young children, 11(1), 1-24. American Academy of Pediatrics Task Force on Newborn and Infant Hearing. (1999). Newborn and Infant Hearing Loss: Detection and intervention. Pediatrics, 103(2), 527-530.
6. U.S. Department of Health and Human Services (HHS). (1990). Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Washington, DC: Public Health Service.
7. White, K. R. (1997). Survey of UNHS programs. NCHAM World Wide Web site (www.usu.edu/~ncham/survey.html).
8. Primus, Michael.  (January 2005)  Hearing Review:  Newborn Screening Follow-up.
9. Maxon, A. B., White, K. R., Behrens, T. R., & Vohr, B. R. (1995) Referral rates and cost efficiency in a universal newborn hearing screening program using transient evoked otoacoustic emissions (TEOAE), Journal of the American Academy of Audiology, 6, 271-277. White, K. R., Mauk, G. W., Culpepper, N. B., & Weirather, Y. (1998). Newborn hearing screening in the United States: Is it becoming the standard of care? In L. Spivak (Ed.), Universal newborn hearing screening (pp. 225-255). New York: Thieme. Grosse, S. (September, 1997). The costs and benefits of universal newborn hearing screening. Paper presented to the Joint Committee on Infant Hearing, Alexandria, VA. Mehl, A. L., & Thomson, V. (1998). Newborn hearing screening: The great omission. Pediatrics, 101(1), 1-6 (http://www.pediatrics.org/cgi/content/full/101/1/e4).
10. Johnson, M. J., Maxon, A. B., White, K. R., & Vohr, B. R. (1993). Operating a hospital-based universal newborn hearing screening program using transient evoked otoacoustic emissions. Seminars in Hearing, 14(1), 46-56.
11. Yoshinaga-Itano, C., Sedey, A., Apuzzo, M., Carey, A., Day, D., & Coulter, D. (July 1996). The effect of early identification on the development of deaf and hard-of-hearing infants and toddlers. Paper presented at the Joint Committee on Infant Hearing Meeting, Austin, TX. Moeller, M. P. (October 1996). Early intervention of hearing loss in children. Paper presented at Fourth International Symposium on Childhood Deafness, Kiawah Island, South Carolina.
12. Harrison, M., & Roush, J. (1996). Age of suspicion, identification, and intervention for infants and young children with hearing loss: A national study. Ear and Hearing, 17, 55-62. Strong, C. J., Clark, T. C., & Walden, B. E. (1994). The relationship of hearing-loss severity to demographic, age, treatment, and intervention-effectiveness variables. Ear and Hearing, 15, 126-137.
13. White, K. R. (1997). Legislative activities. NCHAM World Wide Web site (www.usu.edu/~ncham/legislative.html).
14. White, K. R. (1997). Survey of UNHS programs. NCHAM World Wide Web site (www.usu.edu/~ncham/survey.html).
15. Bess, F. H., & Tharpe, A. M. (1986). Case history data on unilaterally hearing-impaired children. Ear and Hearing, 7(1), 14-19.
16. White, K. R., & Maxon, A. B. (1995). Universal screening for infant hearing impairment: Simple, beneficial, and presently justified. International Journal of Pediatric Otorhinolaryngology, 32, 201-211.

The following are risk factors often associated with infant and childhood hearing loss.  If one or more of the items below apply, your child may be at risk for hearing loss.  If you have questions regarding any of these risk factors or feel your child is at risk for hearing loss, contact your child’s physician, the EHDI Program, or your local Child Development Center for more information and to have your child’s hearing screened.

• Family history of children with hearing loss.
• Head, face, or ears may be shaped or formed in a different way   than usual.
• Bad injury to the head (that needed medical care).
• Ear infections with fluid that last more than four months.
• Spent 48 hours or more in the Neonatal Intensive Care Unit (NICU).
• Has a neurological disorder that is associated with hearing loss. (Check with your healthcare provider).
• Exposed to infection before birth.
• Infection around the brain and spinal cord caused by bacterial (Bacterial Meningitis).
• Bad jaundice (Hyperbilirubinemia) in babies that needed a special procedure (Exchange Transfusion).
• You are worried about your child’s hearing.

The following is a list of some things a baby with normal hearing should be able to do:

Birth to 3 Months of Age:

• Blinks or jumps when there is a sudden, loud noise
• Quiets or smiles when spoken to
• Makes sounds like “ohh” and “ahh”

3 to 6 Months of Age:

• Looks for sounds with eyes
• Starts babbling
• Uses many sounds, squeals, and chuckles

6 to 9 Months of Age:

• Turns head toward loud sounds
• Understands “no-no” or “bye-bye”
• Babbles, for example “ba-ba”, “ma-ma” and “ga-ga”

9 to 12 Months of Age:

• Repeats simple words and sounds you make
• Correctly uses “ma-ma” or “da-da”
• Responds to singing or music
• Points to favorite toys and objects when asked

There are many possible causes of hearing loss in children. Some causes are congenital (present at birth), while others are acquired (cause of hearing loss happens sometime after birth). Acquired hearing loss is also known as Late Onset Hearing Loss(LOHL).

• Genetics/Inherited
• Malformation of the outer ear, ear canal, or middle ear
• Prenatal infection, illnesses
• Toxemia during pregnancy
• Maternal diabetes
• Prematurity

As a parent/caregiver, it is important to do what you can to keep your child’s ears healthy. One way to do this is to monitor the noise levels that your child is exposed to. Even brief exposure to loud sounds can result in permanent hearing loss. If your child is exposed to loud noises such as these, hearing protection devices such as ear plugs should be used.

• Loud Toys
• Concerts/Music Events
• Personal Stereos
• Sporting Events
• Band Class
• Motorbikes
• Shop Class
• Arcades
• Farm Equipment
• Firearms
• Firecrackers/Fireworks

1. Conductive Hearing Loss is caused by problems in the outer and/or middle ear. This type of hearing loss may be permanent or temporary. It can, often times, be medically or surgically corrected.
2. Sensorineural Hearing Loss is caused by problems in the cochlea and/or inner ear.  This is a permanent type hearing loss that usually cannot be medically or surgically corrected.
3. Mixed Hearing Loss is a combination of Conductive and Sensorineural hearing loss.
4. Central Auditory Processing Disorder is a condition where auditory signals are not processed by the brain. The child can “hear” sound, but cannot understand what is being heard. The child’s peripheral mechanisms are working, but the information does not reach the brain in a typical or efficient manner.