Hearing loss

Sheena L Carter (scart01@emory.edu)
Mon, 18 Mar 1996 09:25:23 -0500 (EST) 

In response to several recent questions regarding hearing loss in 
premature infants:

As Doug has explained, prematurely born children are at increased risk for 
hearing loss, for a variety of reasons.  The numbers we use say about 
1-3% of low birth weight babies have significant sensorineural hearing 
loss, and up to 20% of very low birthweight babies have some type of 
hearing loss with conductive loss included.  As you can imagine, the 
numbers varying depending largely on how the hearing loss is defined.

	All children should be screened for hearing loss during infancy.  
Babies at highest risk for hearing impairment are generally 
screened for hearing loss before the leave the nursery.  Additional 
follow-up is usually recommended as a nursery screen can only address 
PRESENT hearing loss.  Functional hearing is extremely important in 
infancy, and critically important for children with complex 
developmental needs.  Even mild or intermittent hearing loss may affect
language development to varying degrees.  Normal language development 
begins long before the first word is spoken, and children with inadequate 
hearing can fall behind on the "prerequisites" early.

	This is an area in which early treatment can make an incredible impact. 
Unfortunately, it is also an area of intervention where actual practice has 
lagged far behind available technology.  The "critical period" for 
language passes very quickly.  Appropriate early treatment can literally 
mean the difference between good oral skills versus a life-long struggle 
with language for some children.  Yet, while it is now possible to 
identify hearing loss in the NICU, the average age for obtaining 
appropriate treatment (e.g., hearing aids) is between 2 and 3 years in 
many communities with otherwise good follow-up services.  (This is one of 
MY pet peeves.) 

	This is a multi-faceted problem, and the reasons for it are 
complex.  The cooperation of many people, including parents, pediatricians, 
audiologists, early intervention coordinators, and various therapists is 
necessary for the process of early identification and treatment to go 
well.  The "simple" definition of the hearing loss is typically anything but
simple and can take months of testing and trial treatments.  Therefore, the 
earlier somebody initiates the process, the more likely long-term problems 
can be ameliorated.  

	So parents -- of preemie or full-term babies, high or low 
risk-- please note the following:

	- Any baby who goes through a period of "babbling" and then 
stops, without developing more advanced vocalizations, should be checked 
for hearing loss.  (Even deaf babies babble all sounds.  Babies only 
continue to babble the sounds they hear, however.)

	- Hearing impairment is the number one reason for language 
delay.  Always make sure this is addressed FIRST.  

	- If you THINK your child may not hear, insist on having it checked.  
In my experience (which is supported by the literature), parents usually 
have a basis in reality for their concerns.

	- If your child has a history of ear infections and language 
delay, intermittent hearing loss may have contributed.  This is often 
described as like trying to learn language with your head in a bucket of 
water.  Language therapy may be needed even after the hearing problem has 
resolved.

	- If your child's attempt at words sound very unusual, mention 
this to your pediatrician or follow-up team.  Deaf children's speech 
tends to have a very unusual quality because they cannot hear their own 
sounds to judge how they are coming out.  Same thing goes for children 
who talk too loudly.

	- Children with partial hearing and/or good lip-reading skills 
can often compensate extremely well and their hearing impairment may 
easily be missed.  If your child tends to respond only when he is looking 
at you when you speak, it may not be a matter of attention only.
	
	- Knowing the your child HEARS does not rule out that he or she 
may have some hearing impairment sufficient to interfere with speech 
development.  Only an audiologist can determine this for certain.  
Sometimes children have a problem not with how loud or soft a sound is, 
but rather cannot hear certain tones or discriminate between certain sounds.

	This is not intended to be a complete list.  If you have any 
concerns at all, make sure to mention them to your pediatrician.  He or 
she cannot read your mind and cannot be expected to pick up on worrisome 
behaviors which are not apparent during an office visit.  (We're 
working on this!)  If you are told that you are worrying unnecessarily, 
remember that it is true that most children who are "slow to talk" or who
seem to ignore their parents do not have a hearing problem.  If your child
happens to be one of the few who does, however, you will find that an
audiological exam is well worth the time and cost.

	If this results in even one parent catching a hearing loss early, I 
will consider it worth the alarm it may cause in some of the rest of 
you.  I hope that those of you with hearing children who may now 
unnecessarily have them checked will agree with me.

Sheena