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Hearing and hearing loss

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Hearing well is important to your child's development. If there are any difficulties hearing, finding them early is important.  If children who are born with a hearing loss receive help by 6 months of age, they have a good chance of developing speech and language as well as children who hear normally.

A baby or child is never too young to have a hearing test. Babies can be tested when they are less than one day old.  Have a look at the topic Your baby's newborn hearing screening for more information about this test.

ALERT!
If a child or adult has a hearing loss that comes on suddenly, he should be seen urgently by a doctor.

Contents

Hearing milestone

Here are some of the milestones that you can check whether your baby reacts normally to sounds.

Shortly after birth:

A baby can be startled by a sudden noise such as a hand clap or door slamming, and may blink or open their eyes widely or stiffen their arms and legs in response to loud sounds.

By 1 month:

Your baby will begin noticing sudden long sounds, like the noise of a vacuum cleaner. They listen to these sounds when they begin, and notice when they stop.

By 4 months:

Your baby quietens or smiles at the sound of a voice, even when they cannot see you. A baby may turn their head or eyes towards you if you speak to them from the side.

By 7 months:

Your baby should turn immediately to your voice across the room, or to very quiet noises made on each side of them, unless they are too busy with other things.

By 9 months:

A baby listens to familiar everyday sounds, and looks in response to very quiet sounds made out of sight, both to the side or above and below them. Your baby should also show pleasure in babbling loudly and tunefully.

By 12 months:

Your baby should show some response to their own name and other familiar words, and may also respond when you say 'no', or 'bye-bye', even when they cannot see you.

Hearing loss should be considered in babies who do not do these things.

If you are not sure that your baby is hearing well, have your baby's hearing tested by a qualified audiologist

Older Children:

Older children who are not hearing well may not respond to speech or noises consistently, may appear to be inattentive or may often ask you to repeat what you have said. They may prefer to have the television louder and may show difficulty hearing or understanding you when you are some distance away, or there is a lot of other noise around. 

Children who do not hear well may start talking later than other children, use incorrect words or sounds, or have unclear speech.  If the child does not hear most of what is said, they will not learn the correct way to say words and sentences.  Most children with delayed or unclear speech have normal hearing, but assessing their hearing is an important part of working out why a child’s language skills are delayed.  

Hearing loss may affect a child’s learning, behaviour and their social development if it is left undetected and unmanaged.  Most children with school or behaviour problems have normal hearing, but an assessment of their hearing can help to determine if the hearing loss is causing or aggravating their behaviour.

How is a child's hearing tested?

Birth to 6 months:

  • Children under six months are unable to tell us when they can’t hear and generally only respond to quite loud sounds and familiar voices
  • Your child’s hearing can be screened very quickly using an Automated Auditory Brainstem Response (AABR) test which tests your child’s hearing pathway all the way through to the brain.  This test is usually done by the hospital midwife or community health nurse. 
  • If the child does not pass this test, they may be referred for an Auditory brainstem Response (ABR) assessment, which gives more detailed information on your child’s hearing.  The ABR is performed by a paediatric audiologist and testing is offered at a number of locations in South Australia.  Have a look at the topic Your baby's newborn hearing screening for more information.

6 months to 4 years:

  • In this age group, hearing assessments usually involve watching the child’s response to different sounds from a speaker and rewarding them when they react to the sounds
  • A tympanometry assessment can indicate whether your child’s ears are healthy
  • Otoacoustic Emission (OAE) testing can also be used with older children to make sure their inner ears are working well.

From 4 years:

  • Children 4 years and older are generally willing to wear headphones and are happy to participate in a ‘listening game’ to show us what sounds they can or can’t hear
  • This type of testing is usually supported by tympanometry and OAE testing to ensure that the ears are healthy and that the inner ears are working well
  • Speech Assessments (asking the child to repeat words or sentences or asking them to point to different objects) can sometimes be used with children over the age of 18 months to check whether they are hearing speech clearly

A child is never too young for a hearing test. There are hearing tests suitable for a child of any age or stage of development. The tests become more accurate and precise as the child gets older.

What does hearing loss mean?

Children diagnosed with hearing loss are unable to hear sounds in the same way as other children. Having a hearing loss means that a child has lost some hearing in one ear (called unilateral) or both ears (called bilateral). There are different levels of hearing loss. These are measured in decibels (dB), which is the loudness, or volume, and Hertz (Hz), which is the pitch of sounds (whether they are a low or high tone).

  • Hearing loss is usually described as mild, moderate, severe or profound. These results are used to work out what the next best step is for each child.  Regardless of the name given to your child’s hearing loss, it’s important to remember that each hearing loss is unique.

Degree of Hearing Loss

Mild hearing loss (21dB- 40dB)

  • Your child can hear normal conversation in quiet situations but may not hear whispers, soft sounds, or some word endings.  Background noise in playgroup, kindergarten, classrooms and other environments, (for example parties or family gatherings), may make it harder for your child to hear. Hearing aids may be recommended.

Moderate hearing loss (41dB- 60dB)

  • Your child may not hear normal, conversational speech clearly. However, they will hear a person if they speak in a loud voice. A moderate hearing loss makes it hard for your child to understand what you are saying, especially when there is background noise. This can affect their speech and language development because not all words and sounds are heard clearly. Amplification devices, like a hearing aid, can help.

Severe hearing loss (61-90dB)

  • Your child will not hear most speech sounds and may only be able to pick out a few loud sounds and words. This makes it difficult for them to continue developing speech and language, if sounds and speech are not amplified for them by hearing aids or other assistive listening devices.

Profound hearing loss (91dB and above)

  • Your child will be unable to hear people talking and most sounds in the environment. With this degree of hearing loss, it is very hard to develop clear speech and language without the help of a hearing aid. In some cases, a cochlear implant may be used to increase the amount of sounds the child can hear. In some cases, families may choose to use sign language as a way to communicate with their child until their child is able to use their residual hearing to continue developing spoken language.

Unilateral hearing loss

  • A unilateral hearing loss is the term used when there is hearing loss in one ear but the other ear has normal hearing. This creates an imbalance in the hearing. The amount of hearing loss can vary from mild, moderate, severe, or profound.
  • The effects of a unilateral hearing loss are not always immediately obvious as the child can hear well with one ear and in some circumstances may have developed speech and language at a similar rate as their normally hearing peers.
  • Children with a unilateral hearing loss can usually hear well in most situations. However, hearing well in only one ear can mean a child may have difficulty:
    • Locating where a sound is coming from
    • Hearing or understanding softly spoken speech when in noisy situations, such as in a group or a classroom, or with background noise from the TV.
    • Understanding what someone says unless they are close by
    • Hearing when someone speaks to them on the side with the hearing loss.
  • There is no set road to take when your child is diagnosed with a unilateral hearing loss. Sometimes using a hearing aid or other assistive listening device on the ear with the hearing loss can help. It depends on the amount and type of hearing loss.
  • Ask your child's audiologist about a hearing aid or other amplification options. The audiologist will be able to advise you if an amplification device may help your child. It is also important to keep monitoring the hearing in the ear with normal hearing.   Using hearing strategies at home and in the classroom may also be of benefit to children with a unilateral hearing loss.

Types of hearing loss

Professionals usually talk about four different types of hearing loss:

  • Conductive hearing loss
  • Sensorineural hearing loss
  • Mixed hearing loss
  • Auditory Neuropathy Spectrum Disorder (ANSD)

To understand what they mean, it’s important to know the ear has 3 parts: the outer ear (including ear canal), the middle ear (including the ear drum and middle ear bones), and the inner ear (cochlea) and balance organ (semi-circular canals).   Each part has a different role in hearing. In a healthy ear, sound travels through the outer ear and middle ear which are filled with air. A tube called the Eustachian tube leads from the middle ear to the back of the nose and throat and helps to ensure that air can reach the middle ear.  Sound then travels through to the inner ear which is filled with fluid and then to the brain by the auditory nerve, where it is processed and we can make sense of the sound.

                                    diagram of the inner ear

  •  Conductive hearing loss occurs when sound cannot reach the inner ear (cochlea) loud enough. It can be caused by a number of things including impacted wax in the ear canal or fluid in the middle ear. This type of hearing loss is usually temporary and is often treatable medically or surgically.
  • Sensorineural hearing loss can occur when there is damage to the inner ear (cochlea) or auditory nerve going from the cochlea to the brain. This type of hearing loss may affect how loud and clear sounds seem. A sensorineural hearing loss is most likely permanent.
  • Mixed hearing loss is a combination of conductive and sensorineural hearing loss at the same time. It occurs when sound is not being transferred from the outer to the inner ear (cochlea) efficiently and there is also damage to the inner ear.
  • Auditory Neuropathy Spectrum Disorder (ANSD) sometimes called auditory neuropathy or auditory dysynchrony, is a rare condition where sound enters the ear normally, but there is a problem with the sound being transmitted along the auditory nerve from the cochlea to the brain.  The cochlea receives the sound, but the sound is not properly recognized by the brain.

Common Causes of Hearing Loss in Children

Middle ear infections (otitis media)

  • Bacteria and viruses that cause colds and flus, tonsillitis and sinusitis are the most common cause of a middle ear infection.  If these bacteria enter the middle ear, they can cause ear pain and fever. 
  • If inflammation of the middle ear occurs as the result of an infection, fluid from surrounding tissue may enter the middle ear space.  This fluid can persist in the middle ear space long after the ear infection itself is resolved. 
  • The fluid may also begin to affect your child's hearing as it stops the ear drum and middle ear bones from moving as they should. 
  • In most cases, the fluid will resolve by itself within three months, but occasionally can persist longer than this, meaning that medical management of your child's ear health may be needed.
  • If a child has many middle ear infections, fluid may be in the middle ear most of the time. It can get very thick and sticky – this is called 'glue ear'.
  • Read more: Middle ear Infections: http://kidshealth.org/parent/infections/ear/otitis_media.html  
     (See our topics Middle ear infections (Otitis Media), Adenoids and Tonsillitis.)

Wax blocking the ear canals

  • Having some wax in your child’s ear canal is a good thing – wax can protect the ear from infection and other foreign bodies. In most people, wax gradually works its way out of the ear naturally – it does not usually build up and block the ear canal. Significant wax build-up may sometimes completely block a child’s ear canal and cause a hearing loss.
  • To keep ears clean, it is only necessary to clean the outer shell of the ear with a soapy finger or wash cloth. Poking a cotton bud into the ear canal is not recommended as it is likely to push wax deeper into the canal. Your doctor may recommend ear drops to soften the wax before it is removed. If your child still cannot hear well after wax has been removed, there may be something else causing the hearing difficulties, in which case your child should be seen by a qualified audiologist, your G.P. or an Ear, Nose and Throat specialist.

Middle ear infections and wax blockage are some of the most common causes of temporary hearing loss in children.

Permanent hearing loss

1 to 2 children in every 1,000 are born with a significant permanent hearing loss. It is very important for your child's speech and language development to identify and manage the hearing loss as soon as possible.

  • Permanent hearing loss is usually due to damage to the sound-sensitive nerve endings in the inner ear (the cochlea). This is called 'sensorineural hearing loss'.
  • Permanent hearing loss in children is usually present at birth. 
  • Less often, it can occur later – e.g. arising from certain infections. 
  • Medicine cannot usually improve this, nor can grommets (ventilation tubes).

Causes of permanent hearing loss

  • About 50% of permanent hearing loss in children is inherited. This may be due to a 'dominant' gene inherited from one parent (where there is a history of deafness in previous generations), or it may occur when there are two 'recessive' genes, one from each parent, (when there is no deafness in the parents or past generations, but there may be a brother or sister with hearing loss).
  • Some permanent hearing losses occur in children who needed nursing in a special or intensive care unit for more than 48 hours after birth (maybe due to a difficult or very premature birth).
  • Permanent hearing loss can occur following meningitis and contracting other viral infections (e.g. cytomegalovirus or rubella) during pregnancy (see the topics Cytomegalovirus and Rubella).
  • Sometimes the cause of the permanent hearing loss may never be identified.

Management of permanent hearing loss

It is important to make sure children with permanent hearing loss can hear adequately so they can develop speech and language, and that their learning will not be compromised. Examples of interventions for children with permanent hearing loss include:

  • Hearing aids – a hearing aid can amplify sounds so that your child can hear better. A hearing specialist will help make sure that your child gets the correct hearing aid for him or her.
  • Implants – for some children with serious hearing problems, when hearing aids have not helped. These children may get cochlear implants, which is an electronic device that helps with hearing.
  • Other hearing devices - There are also many other devices that can help children with hearing loss. Ask a hearing specialist about what might be right for your child.

The topic Children with hearing loss has a lot of information about management of permanent hearing loss.

How common is hearing loss in children?

  • In Australia, 3 to 6 children in every thousand have some degree of hearing loss.
  • One to two in one thousand children have a permanent hearing impairment from birth.
  • Two to three in one thousand children have a permanent hearing impairment before they turn five.
  • More than 11,000 Australian Children under the age of 17 years of age are fitted with hearing aids or cochlear implants.
  • Research has shown that early diagnosis and early intervention do make a difference. Children who are diagnosed early, start receiving early intervention services and begin wearing hearing aids early have better language and learning outcomes than those who begin later.

Where can a child's hearing be tested?

Testing a child’s hearing is best done by an audiologist who specialises in testing children’s hearing.
It is best for a parent to discuss any worries about hearing with the family doctor and if you then decide to seek further hearing tests, you can get a referral to for a hearing test.

South Australia

There are several public services that specialise is testing children’s hearing in South Australia including:

  • Newborn and Children's Hearing Service
    295 South Terrace
    Adelaide   SA  5000
    Tel. (08) 8303 1530
    (Also test at various other metropolitan and country sites – see referral forms below)
    Please read this before you fill in the referral form (PDF - 78kb)
    Form - Referral for an assessment of hearing (PDF - 537kb)
  • Audiology Department
    Flinders Medical Centre
    Flinders Drive
    Bedford Park   SA 5042
  • Audiology Department
    Women’s and Children’s Hospital
    72 King William Road
    North Adelaide   SA   5006

There are also a number of privately run hearing services for children.  Ask your G.P about ones which may be available in your local area.

Additional Information

Raising Children Network http://raisingchildren.net.au/

Australian Hearing (AH)
http://www.hearing.com.au

Better Health Channel
www.betterhealth.vic.gov.au

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

This topic may use 'he' and 'she' in turn - please change to suit your child's sex.

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