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5 Tips For Treating Hearing Loss in Children
Understanding the intricacies of treating hearing loss in children is crucial for the diagnostic and rehabilitative audiologist. Focusing on these 5 tips for treating hearing loss in children will allow audiologists to provide optimal care for babies/children and their families.
Author: Jodi Little, Au.D.
Dr. Jodi Little is a native of Colorado. She has over 20 years of audiology experience serving both pediatric and adult patients in clinical and educational settings.
With the implementation of universal newborn hearing screening, childhood hearing loss is identified earlier than ever before. It is estimated that 1-6 per 1000 newborns tested have some degree of hearing loss in one or both ears. Some hearing loss in children is not evident at birth, but acquired later in childhood. Childhood hearing loss can be congenital (with or without a known genetic causation), secondary to an anatomical malformation, or conductive in nature - due to middle ear infections or other middle ear involvement. Because children with hearing loss will have an increased difficulty acquiring language, audiologists have a professional obligation to ensure that hearing loss is treated quickly and appropriately. The following tips will ensure that children with hearing loss are properly diagnosed and professionally managed:
Things to consider
1. Early Identification: It is imperative that children are identified as early as possible. Childhood hearing loss leads to language and learning delays if left untreated or undertreated. Current research reveals that infants who begin treatment by 6 months of age will reach language milestones on par with same age peers while later identification/treatment can lead to significant language deficits and learning delays. Initial hearing screening should be performed using Evoked Potentials (ABR, AABR, BAER, ABAER), Evoked Otoacoustic Emissions (EOAE, OAE, TEOAE, DPOAE) or a combination of both test measures. Guidelines are specific by state and should be verified accordingly. Regardless of test methods performed, Audiologists need to act quickly with accurate diagnosis and treatment options. Audiologists should attempt to schedule diagnostic appointments at an infant’s regular naptime to allow a still quiet baby, which makes testing easier and eliminates the need for sedation. It is also helpful if the family brings a pacifier/bottle to quiet a little one if needed during the appointment. If working with a toddler or preschool child, a “bag of tricks” and unique eye catching toys, can be just the trick to keep the child’s interest and attention focused at mid-line when testing in the soundbooth. Behavioral Response and Visual Response Audiometry should be used age-appropriately to obtain a child’s first behavioral responses always working to obtain ear specific behavioral responses as soon as possible. Conditioned play audiometry can eventually be used to gain ear specific responses. The job of the audiologist is to make the proper diagnosis and to present all treatment options to the family. Collaboration with an ENT/Otologist for medical clearance of amplification fitting and any medically based intervention is necessary. Keep in mind that treatment options are always based on parent communication preferences based on the degree of hearing loss and communication preferences selected.
2. Treatment Selection: Depending on the type of hearing loss, several treatment options may be available and parents will need to be counseled through the determination process including the consideration for the mode of communication and treatment selected. Language input is critical and language acquisition (oral or signed) is the primary goal for early intervention services. Introduction to sign language and/or aural stimulation must occur immediately upon diagnosis. If oral/aural methods are chosen, it is important for the audiologist to have a good understanding of the pediatric fitting algorithms used by manufacturers and how to properly work through the programming settings to reach optimal prescriptive targets. Keep in mind to order the hearing aids with battery locks initially to ensure that the infant/child cannot remove a battery as this presents a significant health risk if a battery were to be swallowed. Most manufacturers offer a pediatric fitting kit for parents, which will include the basic tools such as a listening tube, battery tester and earmold dryer. Pediatric kits typically come with family friendly literature including instruction manuals and books designed specifically for young children. Remember that a sleeping baby is an audiologist’s best friend. Most testing as well as earmold impressions can be taken while the child sleeps. Specific test protocol is in place for cochlear implant candidacy and should be diligently followed.
3. Verification Measurements: An electroacoustic measurement system or Verifit will be critical for verification of any pediatric hearing aid fitting. It’s important to remember that some insurance contracts will require proof of verification measurements for payment on claims as well. This measurement can also be used as a counseling tool to provide parents with that extra bit of confidence in knowing they made the right choice when choosing an audiology clinic with audiologists that know their stuff. Verification requires RECD measurements for infants and young children. The key to verification is to work quickly and to employ just the right distraction for the little one to sit through the test measurements. The measurement can be completed in less than 5 minutes per ear so prepare for your pediatric patient prior to the slotted appointment time. It is important to pay particular attention to probe placement, which will ensure an accurate measurement. If the fitting curves look strange to you, check probe placement as well as for any obstruction with the probe microphone. Good toys and a parent willing to help keep the little one occupied is all you need.
4. Consistent Follow-Up Care: Follow-up care will be critical in the treatment of childhood hearing loss. Parent report is imperative to the fine-tuning of the initially fit hearing instruments. Questionnaires that have received excellent peer reviews include: the LittlEARS Auditory Questionnaire (Tsiakpini, et al., 2004) and the Parents’ Evaluation of Aural/Oral Performance of Children (PEACH) (Ching & Hill, 2005). Through the use of questionnaire style reporting, audiologists can gain insight into the functional performance of babies/children with hearing loss in their natural home environment. These parent friendly questionnaires probe parents to take critical note of their child’s auditory behaviors. It is also important that children with hearing loss are connected to state and local agencies that can aide the family in accessing services that will be instrumental in early intervention and/or monitoring of language and communication milestones. Routine hearing aid checks to ensure proper fitting of both the devices and the earmolds will ensure that language milestones are met with age expected outcomes.
5. Parent Counseling: Parent counseling and training are perhaps the most important aspects of treating children with hearing loss. Parents will have many questions when it comes to having their baby’s hearing tested. Carefully walking them through the process will alleviate any fear and help guide them through the diagnostic and rehabilitative phases. When moving forward with amplification options, parents will need to have a full understanding of the goals of the fitting and be fully committed to the implementation of the new devices. Some of the best tools for counseling can be found online via hearing loss simulators and family friendly activities that work through the communication and amplification options available. Making the implementation of amplification usage as easy as possible for parents will help them in the navigation process, as it can be initially quite overwhelming for some. Taking the time to work with the family on how to manage the hearing devices is the first step. Caregivers will need to learn how to check the hearing aid or cochlear implant batteries, check for excess wax (with proper instruction on cleaning and maintenance of the devices), as well as insertion and removal of earmolds. Recommended products for Home Use: parents and caretakers will benefit from several home products to make the implementation of amplification easier and more successful for their child. These include an earmold lubricant for ease of insertion of earmolds (remember to train caregivers that a little bit goes a long way), a battery tester (with training on how to use it), a listening stethoscope (remind caregivers to perform regular listening checks since their little ones can’t self report if something is not working properly), an earmold air blower (with training on recognizing condensation in earmolds), wax removal tools (and how to use them). The use of a retention cord is also recommended as babies are often fidgety about having something in their ears at first and the small-corded clip can save the investment from getting lost. The clips are available in cute designs such as the Critter Clip that has many designs to choose from. Other fun accessories have made a place for themselves in recent years with the introduction of tube riders, colored tubing, casing and earhooks. If moisture is a problem, home moisture solutions are available and should be used in the home as well.
Understanding and utilizing these 5 tips for treating hearing loss in children will ensure successful treatment of hearing loss in children. Keeping the treatment plan moving forward thus allowing for optimal language and learning
development for all children with hearing loss ensures that you are doing the right thing for kids and their families. Clearly there are many variables when it comes to working with children; I hope this article is helpful in serving the little ones and the families that come through your clinic doors.
Additional audiology resources:
More about the author: Dr. Little enjoys all phases of the diagnostic and rehabilitative process and thrives on helping her patients find unique solutions to communication challenges. Dr. Little is passionate about hearing conservation and is a sought after speaker on the topic of hearing loss in the dental field. Dr. Little completed a Master of Science from Portland State University in 1994 and a clinical doctorate in Audiology from the Arizona School of Health Sciences in 2002. Outside of work, Dr. Little enjoys playing tennis and spending time with her husband, children and extended family.