Technological Solutions for Children With Hearing Loss
Hearing technology has continued to progress to offer a whole range of technological solutions designed to meet each child’s specific hearing problem. Today there is almost no hearing loss that cannot benefit from the use of appropriate technology. After a clear diagnosis of hearing loss, appropriate technology should be chosen as soon as possible to ensure that the child would benefit from early auditory exposure. Children with hearing loss can benefit from hearing aids, cochlear implants, bone conduction devices, and/or assistive devices depending on the child’s specific hearing problem. Typically, the most appropriate option is hearing aids, which amplify sound. In cases of severe to profound hearing loss, the better option may be a cochlear implant that uses a surgically implanted electrode in the inner ear and an external processor.
Most hearing-impaired children are born to hearing parents. It is natural for parents to feel overwhelmed and uncertain of what to expect. The team at Dallas Ear Institute is prepared to support you on your journey.
How Do Hearing Aids Work?
Hearing aids have microphones that pick up sounds from the environment. The sounds are sent to a processor, which amplifies the signal. The hearing aid will amplify the sounds based on how the hearing aid is programmed. The audiologist programs the hearing aids so that some pitches of the incoming sound may be amplified more than others. After the sound is amplified, it is sent through the hearing aid earhook to a custom earmold. The earhook is a small plastic piece that hooks over the top of the ear. The earmold holds the hearing aid in the ear and directs the sound from the hearing aid into the ear canal.
Hearing Aids Can Be Fit at Any Age
Babies can even be fit with hearing aids. There is no such thing as too young as long as the audiologist has confirmed the hearing loss and determined the degree of hearing loss at various pitches so that the hearing aids can be programmed appropriately for the child.
Pediatric Hearing Aid Styles
Young children will normally be fit with hearing instruments worn behind-the-ear (BTE) that come in a variety of bright, cheerful colors and can help a wide range of hearing losses. This style is most appropriate for several reasons. The outer part of the ear and the ear canal change quickly as the infant and young child grows. An in-the-ear (ITE) style hearing aid is not appropriate because a new one would need to be made frequently to fit the ear. BTE models are attached to an earmold that is placed in the ear canal. It costs much less to have new earmolds made periodically rather than an ITE hearing aid. For infants and young children, new earmolds are needed approximately every 3 to 6 months. Once the child reaches 7 to 8 years of age, the growth of the ear slows and new earmolds are needed about once a year. By early adolescence, the ear has reached its adult size. Even once the ear has reached adult size; there are other reasons for using a BTE style. BTE hearing aids have several options for connecting with a frequency modulation (FM) system in school. This style is also less susceptible to damage from earwax, reducing the number of repairs since the electronic parts are not located in the ear. If a child loses his or her hearing aids, which is not unusual for a child to do at some point, loaner hearing aids can easily be attached to an older pair of earmolds while waiting for the new hearing aids and earmolds to arrive.
Hearing Aid Expectations
Most children with a sensorineural hearing loss are fitted with hearing aids as soon as possible. Through ongoing and consistent testing, your child’s audiologist can choose hearing aids and appropriate settings for your child’s hearing loss. Hearing aids do not cure hearing loss. The primary goal of hearing aids is to make speech be heard as clear as possible by the child; in most cases, this can be achieved. Children with certain degrees of hearing loss can learn to detect and discriminate speech sounds with hearing aids. This will help your child be aware of sounds around him or her and learn to communicate through speech. The amount of benefit a child receives from hearing aids is dependant mainly on the type and degree of hearing loss as well as family support and auditory verbal therapy. Almost all children with hearing loss can receive some benefit from hearing aids, but the extent of benefit will vary greatly from child to child. If hearing aids have been recommended for your child, it is important that the aids are worn on a full-time basis.
Hearing aids do have limitations in managing distance, background noise and reverberation. Certain types of hearing aids are better at handling these limitations than others. For a child to achieve the best hearing possible when listening from a distance or in an environment with background noise and reverberation, he or she should use a frequency modulation (FM) system. FM systems have been designed specifically to pick up speech signals directly at the source and transmit them directly to the child’s ear so that the speaker’s voice is heard as if only about six inches away.
Hearing Aid Fitting Process
The fitting of hearing aids should be as soon after the diagnosis of hearing loss as possible. The process of fitting hearing aids on children is very different than fitting hearing aids on adults. The hearing aids must be fit individually for each child. When hearing loss is identified in young infants, there may be several test sessions within a short amount of time and throughout the hearing aid fitting process so that the audiologist can refine the hearing test results to more precisely program the hearing aids. The audiologist will consider the degree and shape of the child’s hearing loss, the durability of hearing aid models, and compatibility with frequency modulation (FM) systems used in schools. An adult can tell the audiologist how well a hearing aid seems to work, if certain sounds are too loud or soft, or if speech is unclear. Young children cannot tell the audiologist these things. The audiologist can use probe microphone testing to verify the hearing aid settings to be appropriate for the individual child. During this test, a small, soft microphone is placed in the child’s ear with the earmold. This microphone measures the amount of sound being delivered to the child’s ear. Because infants and young children have much smaller ear canals than adults, it is important that the ear size be measured. For very young children, the audiologist can make a measurement of the ear with the small, soft microphone and use that information with measurements in a test box to verify the hearing aid settings to be appropriate for the individual child. The most important goal for the hearing aid fitting is making speech loud enough for the child to hear; the probe microphone measurements enable the audiologist to determine how much of speech will be heard by the child with hearing aids.
Suggestions for Helping Your Child Wear Hearing Aids
It is important that your child wear the hearing aids as much as possible. A child who has worn hearing aids since birth will probably wear them consistently without resistance, but a child who is a new hearing aid user, may resist wearing the hearing aids regularly.
You can start by having your child wear the hearing aids only during fun activities and then increase the wear time until he or she is wearing the hearing aids during all waking hours; however, shortened wear times should not continue past a few weeks. Wearing times should be controlled by the parent and not by the child; young children should learn that only adults should remove the hearing aids. Older children may be more interested in their hearing aids if they are able to choose a fun color for the earmolds and hearing aids.
A lot of parents have problems keeping the hearing aids on their baby’s little ears. There are several ways to secure the hearing aids to your child’s ears. You can try using two-sided toupee tape, Huggie Aids, lightweight pilot caps, transparent headbands, and hearing aid clips. Your audiologist can discuss these options with you to help you find the best method for your child.
Feedback, a sound like “whistling”, from a hearing aid occurs when sound comes out of the hearing aid and then is picked back up by the hearing aid microphone and amplified again. Feedback is mostly caused by high pitched sounds, which easily can leak out of the earmold and be re-amplified. It is typical for feedback to be heard when the hearing aid is out of the ear, or when the hearing aid is in the ear and the ear is covered with a hand, hat, or other object. If feedback occurs when the hearing aid is in the ear and no object is close to the ear, it could be a result of a poor fitting earmold. If the earmold is not tight enough to fit correctly in the ear, there is room for the sound to leak out of the earmold. With severe and profound hearing loss, feedback may occur more frequently because of the amount of amplification being driven through the earmold.
Why Does My Child Have to Wear Hearing Aids Before Getting a Cochlear Implant?
Although the current diagnostic hearing tests for infants and young children are reasonably accurate, hearing professionals never want to base all treatment decisions in children on the level of hearing loss determined by these tests alone. Using hearing aids for a period of time helps to confirm the severity of hearing loss. Even if your child has profound hearing loss in both ears, there is almost always some component of hearing perception that can be stimulated with hearing aids. Therefore, using modern hearing aids can at least begin the process of auditory brain development even as your child is being evaluated for a cochlear implant. In addition, the use of hearing aids acclimates him or her to wearing a hearing device on his/her ears which makes the adjustment to a subsequent cochlear implant easier.
What is A Cochlear Implant?
The cochlear implant is a two-part electronic device that provides a means for receiving sound. Through a surgical procedure, a wire containing numerous electrodes is placed in the cochlea. A magnetic receiver is implanted in the mastoid bone just behind the ear. This couples to an externally worn device that provides a signal to the electrode array in the cochlea. The cochlear implant works differently than a hearing aid, which amplifies sound in the outer ear, because the cochlear implant bypasses the external and middle ear and delivers sound information directly to the hearing nerve.
What Are the Hearing Loss Requirements for a Cochlear Implant?
For a child to be considered for cochlear implantation, he or she must be evaluated for the degree of hearing loss. Through testing, a child must be found to have bilateral, severe to profound sensorineural hearing loss. It must also be determined that a child is not receiving adequate benefit from hearing aids for normal speech and language development. Our cochlear implant multidisciplinary team will consider factors including genetic and medical history, speech and language abilities and psychosocial and developmental factors.
What Is the Ideal Age for a Child to Receive a Cochlear Implant?
Since birth to age 3 are the most critical years for language and speech development, the earlier a child receives an implant, the easier it will be for him or her to adapt and begin learning how to interpret auditory information. A thorough evaluation by our team of specialists can help determine whether a child is a good candidate for cochlear implantation. Infants age 12 months with severe to profound hearing loss who have not made sufficient progress with traditional hearing aids can be considered candidates for cochlear implants. In some cases, as when meningitis is the cause of deafness or for profound hearing loss, younger infants may be candidates for a cochlear implant.
Who Can I Contact to Start the Evaluation Process to Consider a Cochlear Implant for My Child?
You can start the process by contacting Dallas Ear Institute at 972-566-7600 to schedule an appointment for your child to see a physician.
Bone Conduction Hearing Technology
There are two ways we hear sound, through air conduction and through bone conduction. They both work together to help us hear sound. Bone conduction hearing technology uses bone conduction, the body’s own natural ability to conduct sound, to provide hearing. Rather than sound traveling through the air conduction pathway of the outer ear to the middle ear, the bone conduction sound processor picks up sounds, converts them into vibrations and transmits the sound through the skull bone directly to the healthy inner ear, a principle known as bone conduction.
Bone conduction hearing technology is an option for children with conductive hearing loss, mixed hearing loss and single-sided deafness. In cases where the outer ear is missing or not fully formed, chronic ear drainage, or when one ear does not function, a bone conduction hearing system is a more effective solution than air conduction hearing aids. Instead of trying to send sound through the damaged area, the bone conduction hearing system reroutes it directly through the skull bone.
Bone Conduction Technology – Regardless of Age
For children with hearing loss to successfully develop speech and language skills, stimulation of the inner ear should be provided as early as possible. Bone conduction hearing technology can be used by a hearing-impaired person of any age, even infants. However, for very young children, the bone conduction sound processor is worn on a softband. A softband consists of an adjustable, elastic headband and a plastic snap connector that connects to the bone conduction sound processor to allow even the youngest child to receive early stimulation with a bone conduction hearing system. Wearing the sound processor on a softband is also a good way to evaluate the benefit the child is receiving from the sound processor before deciding to have an implant surgically placed.
Bone Conduction Implant
When a child reaches the age of 5, a bone conduction implant can be considered. The age at which children can receive a bone conduction implant varies from person to person. The parents, the audiologist and the surgeon should agree on the timing of the implant surgery. A bone conduction sound processor on an implant often provides better amplification than on a softband, especially in the higher frequencies. When there is sufficient bone thickness, implantation is a better hearing solution. Following bone conduction implant surgery, the child can generally resume his or her normal routine within just a few days; unlike other types of ear surgery, there is no damage to the hearing. After the bone has had time to osseointegrate to the implant, the audiologist will program the bone conduction sound processor with settings that are appropriate for the child’s hearing needs.
Asisstive Listening Devices
Frequency Modulation (Fm) Systems
Better hearing begins with the choice of the correct hearing aids. However, even hearing aids properly set for a child’s hearing needs cannot always guarantee good hearing in all listening environments such as noisy situations, reverberant and windy environments, and across distances. In some cases, frequency modulation (FM) systems may be needed instead of or in addition to hearing aids.
The best way to overcome such problems is to use a wireless communication system, called an FM system. FM systems have been designed specifically to pick up speech signals directly at the source and transmit them directly to the child’s ear. An FM system consists of a transmitter with a microphone that is worn by the speaker (e.g., parent, teacher, coach). A small receiver, which can be attached to or integrated into the hearing aid worn by the child, receives the signal. The FM system guarantees that the speaker’s voice is heard above the level of the background noise; even at a distance, the child hears the speaker’s voice as if only about six inches away.
The FM system can overcome listening challenges by helping a child understand the speaker, no matter where they are – whether at the park, in a stroller, classroom or car, or on the playing field. In a classroom, where the teacher is a distance from the child or there are many children talking or moving around, it may be difficult for the hearing-impaired child to differentiate between important speech signals. In these situations, an FM system makes the difference; the child is able to just simply listen and learn. Car journeys are difficult listening situations due to the loud hum of the engine and road noise. An FM system enables a child to better hear his or her parents’ voices during travel. When playing sports, because of distance and surrounding noise, kids may miss hearing useful advice from the coach; an FM system makes it easier to listen, improve, and get in the game. Even young infants are utilizing FM systems as a means of optimizing their hearing during the critical early years of language development.
Wireless Communication Accessories
There are many situations that can be a listening challenge even with the most advanced hearing aids. With the addition of wireless accessories, a child can capture more of the conversation by wirelessly connecting to audio technology, such as cellphones, Bluetooth devices, MP3 players, and the television. These wireless hearing aid accessories can give an extra boost in hearing in challenging situations.