Your Child's Hearing Loss

Hearing loss is unique

Each child is unique and so is a child's hearing loss. To help you understand the possible hearing solutions for your child, you should know how the ear works and how hearing loss is diagnosed with degrees and types of hearing loss. Your child's hearing loss doesn't have to get in the way of the ability to learn and live like other children.

How the ear works

We hear with our brains, not our ears

Sound enters through our ears but is processed and understood by the brain. Children with hearing loss have the same listening potential as children born with normal hearing. If they are given access to sound via technology and sufficient spoken language exposure, their brains can learn to listen too.

Understanding how natural hearing works

The ears capture sound and provide the natural pathway for that sound to be transmitted to the hearing nerve where it is translated by the brain. It’s an amazing process. When all parts of the ear are healthy, here's how the process for hearing works:

Outer Ear: Sounds enter the ear canal and travel to the eardrum.
Middle Ear: These sound waves cause the eardrum to vibrate, sending the bones in the middle ear into motion.
Inner Ear: This motion is converted to electric impulses by tiny sensory hair cells inside the inner ear (cochlea).
Hearing Nerve: These electric impulses are sent to the brain, where they are perceived by the listener as sound.

How hearing works illustration

When your child is diagnosed with hearing loss, it means that not all parts of the natural hearing pathway are working properly.

Understanding hearing milestones for children with normal hearing can be important for your child's hearing experience.
Request a free resource guide to learn about hearing and speech milestones and more.

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Understanding signs of hearing loss

Knowing if your child has hearing loss can be difficult, especially in infancy. Here are some typical signs:

Infant or toddler:

No reaction to loud sounds
Does not seek out or detect where sound is coming from
Has stopped babbling and experimenting with making sounds
Still babbles but has not progressed to more understandable speech
No reaction to voices even when being held
Ear is missing or malformed at birth

School-aged child:

Does not follow or understand simple commands
Is easily frustrated or has communication breakdowns
Is falling behind with speech and communication skills
Cannot identify where sound is coming from
Depends heavily on lip-reading
Is exhausted from constant concentration just to understand speech

Signs of hearing loss

How hearing loss is tested

A person of any age can be given a hearing test, even newborns.

Hearing specialists or audiologists use tests including otoacoustic emissions (OAE) or auditory brainstem response testing (ABR) to determine a hearing loss. These tests are performed with a small probe that is painlessly inserted into a child's ear while they are asleep or awake and hearing measurements are taken.

For older children, visual reinforcement audiometry (VRA) and conditioned play audiometry are used. Both tests require a visual response to sounds and often incorporate fun activities.

Understanding the audiogram

During hearing tests, audiologists record information onto an audiogram, which is a visual illustration that shows your child's hearing ability. It records the softest sound your child can hear, or hearing threshold. It shows the pitch or frequency that is measured in hertz (Hz) and the loudness in decibels (dB).

Your child's audiologist will plot your child's hearing loss using "X" or ">" for the left ear in blue and "O" or "<" for the right ear in red. A normal hearing person can detect very soft sounds at 20 dB or less, like a whisper, to a very loud sound of 120 dB, like an airplane. Having access to these sounds is critical in order for your child to learn speech.

The highlighted area on the audiograms represent the "speech banana", which is where the frequencies of consonants and vowels fall in the spectrum of sound. Pictures and letters represent the sounds you can typically hear at different volume and frequency levels, and the sounds above the red and blue lines cannot be heard.

When an audiologist tests your child's hearing, they identify the air-bone gap. The air-bone gap is determined by the difference (or gap) between results of air conduction and bone conduction tests. A greater gap illustrates a higher level of conductive hearing loss.

Example of an audiogram of a child with severe to profound hearing loss in both ears.

Audiogram of profound hearing loss

Example of an audiogram of a child with conductive hearing loss in the right ear.

Audiogram of conductive hearing loss

Degrees of hearing loss

Mild -- A child hears some speech.
Moderate -- A child hears almost no speech.
Severe -- A child hears very little speech at a normal speaking or average conversational level.
Profound -- A child hears no speech at a normal/average conversational level.

Degrees of hearing loss

Types of hearing loss

Approximately two to three out of every 1,000 children in the United States may be born with hearing loss in one or both ears.¹ These fall into four categories:

Type	Description
Sensorineural hearing loss	Sensorineural hearing loss occurs when the inner ear (cochlea) or hearing nerve is damaged or does not work properly. Common causes include: Congenital hearing loss, head trauma and genetics. The Cochlear^™ Nucleus^® Implant System may be a solution.
Single-sided deafness	Sensorineural hearing loss can occur in one or both ears. If the loss is in one ear, it is often referred to as unilateral hearing loss or single-sided deafness. Common causes include: viral infections, head or ear injuries and many other unknown reasons. A Cochlear^™ bone conduction solution may be able to help.
Conductive hearing loss	Conductive hearing loss occurs when damage to the outer ear or middle ear blocks sound vibrations from reaching your child's inner ear or cochlea. Common causes include: Malformations at birth such as Microtia and Atresia, syndromes such as Down, Goldenhar and Treacher Collins. It can also be caused by chronic ear infections and/or draining ears. A Cochlear^™ bone conduction solution may be able to help.
Mixed hearing loss	Mixed hearing loss refers to a combination of conductive and sensorineural hearing loss. This means there may be damage in both the outer or middle ear, and in the inner ear. Common causes include: any of the causes of conductive hearing loss plus any of the causes of sensorineual hearing loss. A Cochlear^™ bone conduction solution may be able to help.

Sensorineural hearing loss

This hearing loss is caused by damage to the inner ear or the auditory nerve pathway. This type of loss is permanent and can be caused by genetics, aging, disease, noise exposure or certain medications.

Single-sided deafness

Sensorineural hearing loss can occur in one or both ears. If the loss is in one ear, it is often referred to as unilateral hearing loss or single-sided deafness. This is when there is little or no hearing in one ear, but normal hearing in the other ear.

Conductive hearing loss

Sound cannot travel through the outer or middle ear because of malformation or other factors. This condition can be treatable depending on the cause.

Mixed hearing loss

Refers to a combination of conductive and sensorineural hearing loss. This means there may be damage in both the outer or middle ear and in the inner ear.

In the United States, the cochlear implant system is intended for use in children 9 to 24 months of age who have bilateral profound sensorineural deafness and demonstrate limited benefit from appropriate binaural hearing aids. Children two years of age or older may demonstrate severe to profound hearing loss bilaterally. In Canada, the cochlear implant system is intended for use in children 9 to 24 months of age who have bilateral profound sensorineural deafness and demonstrate limited benefit from appropriate binaural hearing aids. Children two years of age or older may demonstrate severe to profound hearing loss bilaterally.

References

National Institute on Deafness and Other Communication Disorders. “Quick Statistics About Hearing.” Available from: https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing

Hearing loss is unique

How the ear works

We hear with our brains, not our ears

Understanding how natural hearing works

Understanding signs of hearing loss

Infant or toddler:

School-aged child:

How hearing loss is tested

Understanding the audiogram

Degrees of hearing loss

Types of hearing loss

Sensorineural hearing loss

Single-sided deafness

Conductive hearing loss

Mixed hearing loss

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References