Hearing Loss  and Early Intervention

Hearing Loss  and Early Intervention

Hearing Loss in Children

Hearing loss can affect a child’s ability to develop speech, language, and social skills. The earlier children with hearing loss start getting services, the more likely they are to reach their full potential. If you think that a child might have hearing loss, ask the child’s doctor for a hearing screening as soon as possible. Don’t wait!

What is Hearing Loss?

A hearing loss can happen when any part of the ear is not working in the usual way. This includes the outer ear, middle ear, inner ear, hearing (acoustic) nerve, and auditory system.

Signs and Symptoms

The signs and symptoms of hearing loss are different for each child. If you think that your child might have hearing loss, ask the child’s doctor for a hearing screening as soon as possible. Don’t wait!

Even if a child has passed a hearing screening before, it is important to look out for the following signs.

Signs in Babies
  • Does not startle at loud noises.
  • Does not turn to the source of a sound after 6 months of age.
  • Does not say single words, such as “dada” or “mama” by 1 year of age.
  • Turns head when he or she sees you but not if you only call out his or her name. This sometimes is mistaken for not paying attention or just ignoring, but could be the result of a partial or complete hearing loss.
  • Seems to hear some sounds but not others.
Signs in Children
  • Speech is delayed.
  • Speech is not clear.
  • Does not follow directions. This sometimes is mistaken for not paying attention or just ignoring, but could be the result of a partial or complete hearing loss.
  • Often says, “Huh?”
  • Turns the TV volume up too high.

Babies and children should reach milestones in how they play, learn, communicate and act. A delay in any of these milestones could be a sign of hearing loss or other developmental problem. Visit our web page to see milestones that children should reach  from 2 months to 5 years of age.

Screening and Diagnosis

Hearing screening can tell if a child might have hearing loss. Hearing screening is easy and is not painful. In fact, babies are often asleep while being screened. It takes a very short time — usually only a few minutes.


All babies should have a hearing screening no later than 1 month of age. Most babies have their hearing screened while still in the hospital. If a baby does not pass a hearing screening, it’s very important to get a full hearing test as soon as possible, but no later than 3 months of age.


Children should have their hearing tested before they enter school or any time there is a concern about the child’s hearing. Children who do not pass the hearing screening need to get a full hearing test as soon as possible.

Rehabilitation :

Many people who are deaf or hard-of-hearing have some hearing. The amount of hearing a deaf or hard-of-hearing person has is called “residual hearing”. Technology does not “cure” hearing loss, but may help a child with hearing loss to make the most of their residual hearing. For those parents who choose to have their child use technology, there are many options, including:

  • Hearing aids
  • Cochlear or brainstem implants
  • Bone-anchored hearing aids
  • Other assistive devices
Hearing Aids
Photo: Baby with hearing aid

Hearing aids make sounds louder. They can be worn by people of any age, including infants. Babies with hearing loss may understand sounds better using hearing aids. This may give them the chance to learn speech skills at a young age.

There are many styles of hearing aids. They can help many types of hearing losses. A young child is usually fitted with behind-the-ear style hearing aids because they are better suited to growing ears.

Cochlear And Auditory Brainstem Implants

A cochlear implant may help many children with severe to profound hearing loss — even very young children. It gives that child a way to hear when a hearing aid is not enough. Unlike a hearing aid, cochlear implants do not make sounds louder. A cochlear implant sends sound signals directly to the hearing nerve.

Persons with severe to profound hearing loss due to an absent or very small hearing nerve or severely abnormal inner ear (cochlea), may not benefit from a hearing aid or cochlear implant. Instead an auditory brainstem implant may provide some hearing. An auditory brainstem implant directly stimulates the hearing pathways in the brainstem, bypassing the inner ear and hearing nerve.

Both cochlear and brainstem implants have two main parts — the parts that are placed inside the inner ear, the cochlea, or base of the brain, the brainstem ear during surgery, and the parts that are worn outside the ear after surgery. The parts outside the ear send sounds to the parts inside the ear.

Bone-Anchored Hearing Aids

This type of hearing aid can be considered when a child has either a conductivemixed or unilateral hearing loss and is specifically suitable for children who cannot otherwise wear ‘in the ear’ or ‘behind the ear’ hearing aids.

Other Assistive Devices

Besides hearing aids, there are other devices that help people with hearing loss. Following are some examples of other assistive devices:

  • FM System
    An FM system is a kind of device that helps people with hearing loss hear in background noise. FM stands for frequency modulation. It is the same type of signal used for radios. FM systems send sound from a microphone used by someone speaking to a person wearing the receiver. This system is sometimes used with hearing aids. An extra piece is attached to the hearing aid that works with the FM system.
  • Captioning
    Many television programs, videos, and DVDs are captioned. Television sets made after 1993 are made to show the captioning. You don’t have to buy anything special. Captions show the conversation spoken in soundtrack of a program on the bottom of the television screen.
  • Other devices
    There are many other devices available for children with hearing loss. Some of these include:
  • Text messaging
  • Telephone amplifiers
  • Flashing and vibrating alarms
  • Audio loop systems
  • Infrared listening devices
  • Portable sound amplifiers
  • TTY (Text Telephone or teletypewriter)

Medical And Surgical

Medications or surgery may also help make the most of a person’s hearing. This is especially true for a conductive hearing loss, or one that involves a part of the outer or middle ear that is not working in the usual way.

Photo: perscription bottles

One type of conductive hearing loss can be caused by a chronic ear infection. A chronic ear infection is a build-up of fluid behind the eardrum in the middle ear space. Most ear infections are managed with medication or careful monitoring. Infections that don’t go away with medication can be treated with a simple surgery that involves putting a tiny tube into the eardrum to drain the fluid out.

Another type of conductive hearing loss is caused by either the outer and or middle ear not forming correctly while the baby was growing in the mother’s womb. Both the outer and middle ear need to work together in order for sound to be sent correctly to the inner ear. If any of these parts did not form correctly, there might be a hearing loss in that ear. This problem may be improved and perhaps even corrected with surgery. An ear, nose, and throat doctor (otolaryngologist) is the health care professional who usually takes care of this problem.

Placing a cochlear implant, auditory brainstem implant, or bone-anchored hearing aid will also require a surgery.

Learning Language

Without extra help, children with hearing loss have problems learning language. These children can then be at risk for other delays. Families who have children with hearing loss often need to change their communication habits or learn special skills (such as sign language) to help their children learn language. These skills can be used together with hearing aids, cochlear or auditory brainstem implants, and other devices that help children hear.

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Speech & Language Pathology

Speech Therapy

Speech Therapy

Speech therapy is treatment for problems with speaking, language, and swallowing. It is given by a speech therapist, also called a speech-language pathologist. Speech therapy helps with using the voice properly and using the muscles to make the right sounds. It helps people understand language and express themselves. Speech therapy can also help a person learn to swallow again after a stroke or brain injury.

What is Speech Therapy?

Speech therapy, or speech and language therapy, is treatment for problems with speaking, language, and swallowing. A person who gives this treatment is called a speech therapist or speech-language pathologist.Speech therapy helps with the following problems:

  • Speech problems. These are problems with making the right sound, using the voice fully, and not straining.
  • Language and communication problems. These are problems with understanding language, expressing thoughts, or responding in a social situation.
  • Swallowing and feeding problems. These are problems with using the muscles in the mouth and throat to swallow.

What are the risks and/or side effects?

There are some things to consider before you choose to do speech therapy.Speech therapy can take a lot of time. It works best when the person goes to therapy appointments and practices every day. For children who need speech therapy, parents or guardians must make sure the children can practice at home and school.Costs for speech therapy can be a concern. Speech therapy may not be covered by health insurance, depending on your insurance plan and the problem being treated. Find out about insurance coverage before you start speech therapy.

What are the benefits?

Communication allows people to express their needs, connect with others, and succeed in work or school. Speech therapy makes this possible for people with communication problems. Below are some benefits of speech therapy:

  • Helps people do activities of daily life
  • Gives people more confidence and success at school and work
  • Gives people who cannot speak the ability to communicate in other ways
  • Prevents injury or overuse of the vocal cords, or heals an injury
  • Helps people who have had a brain injury or stroke learn to swallow

How do I prepare?

To prepare for your first speech therapy appointment:

  • Send or bring a copy of your medical records about the speech problem to the speech therapist
  • Write down your notes and questions about the problem
  • If you are a parent or guardian, write down the speech or language problems you have seen in your child
  • Come ready to learn and do the daily work of speech therapy
  • Check your insurance benefit for speech therapy

How is it done or administered?

A speech therapist usually meets one-on-one with a patient about once a week. The speech therapist may do any of these treatments:

  • Teach new ways of breathing and speaking to use the voice better
  • Teach exercises for using the lips, tongue, and other muscles in the mouth and throat
  • Help with learning new words, especially for children or those who have lost language because of a stroke or brain injury
  • Help with organizing thoughts or improving memory
  • Teach how to use augmentative and alternative communication. These are ways to communicate besides speaking. Some examples are finger spelling, picture communication, or speech devices.

When will I know the results?

The time it takes for speech therapy to work varies widely and depends on a few factors:

  • How severe the problem is
  • How committed you are to practicing daily, or being involved in your child’s therapy
  • Whether you (or your child) are dealing with other problems, such as stroke recovery or developmental disabilities

What are follow-up requirements and options?

Depending on the problem, the speech therapist may recommend that you follow up with another specialist. In some cases, more speech therapy may be needed after the first treatment.
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Cochlear Implant

Cochlear Implant


A cochlear implant is an electronic medical device that does the work of damaged parts of the inner ear (cochlea) to provide sound signals to the brain.

How does a Cochlear Implant work?
Many people suffer hearing loss because their cells in the inner ear (Cochlear) are damaged. The cochlear implant enables the sound to be transferred to your hearing nerve and enables you to hear.
A sound processor worn behind the ear or on the body captures sound and turn it into digital code. The sound processor has a battery that powers the entire system.

The cochlear implant converts the digitally coded sound into electrical impulses and sends them along the electrode array placed in the cochlear.
The implant electrodes stimulate the cochlear hearing nerve which then sends the impulses to the brain where they are interspersed as sound.

What is Auditory Verbal Therapy?

Auditory Verbal therapy is a highly specialist early intervention programme which equips parents with the skills to maximise their deaf child’s speech and language development. The Auditory Verbal approach stimulates auditory brain development and enables deaf children with hearing aids and cochlear implants to make sense of the sound relayed by their devices.  As a result, children with hearing loss are better able to develop listening and spoken language skills, with the aim of giving them the same opportunities and an equal start in life as hearing children.

Through play-based therapy sessions, parents are given the tools – Auditory Verbal techniques and strategies – to develop their child’s listening and spoken language. Auditory Verbal therapy enables parents to help their child to make the best possible use of his or her hearing technology and equips parents to check and troubleshoot it in collaboration with their audiology team. This will maximise a child’s access to sound so that listening and spoken language skills can be developed to the fullest extent possible.

AVT differs from other speech and language therapy approaches in a number of ways:
AVT concentrates on developing the listening part of the brain (the auditory cortex) rather than relying solely or partly on visual cues. There is a narrow window within which to develop the brain as a listening brain (rather than predominantly a visual brain, for example), and AVT seeks to make the most of this window of neural plasticity in the first three and a half years of life.
AVT focuses on coaching the parents or carers of the child in the use of Auditory Verbal strategies and techniques in everyday activities and play so that every opportunity is used to develop their child’s listening brain and spoken language skills.
AVT is an early intervention programme. By working intensively with the child in their first few years they should require much less additional support for the rest of their life.
AVT aims to develop the child’s social skills and theory of mind; the ability to understand that their mind differs from another’s.  This prepares them to make and keep friends at school.
AVT is delivered by an Auditory Verbal therapist who is a qualified Teacher of the Deaf, Speech and Language Therapist or Audiologist who has undergone three years of post-graduate training to become a listening and spoken language specialist (LSLS Cert AVT), auditory Verbal approach is distinctive in the way it makes the most of a child’s use of hearing as the main sense for developing spoken language. Auditory Verbal therapy is government-funded in Australasia and Denmark and is a mainstream approach in Canada and the United States for teaching children with permanent hearing impairment to listen and speak.

Through play-based sessions using the Auditory Verbal approach, the child develops a listening attitude so that paying attention to the sound around him or her becomes automatic. Hearing and listening become an integral part of communication, play, education and eventually work. All learning from the sessions carries over into daily life. This means that at home, parents can make everyday activities such as setting the table or reading a story into a fun listening and learning opportunity.



Who Is an Audiologist ?

Audiologists are health care professionals who identify, assess and manage disorders of hearing, balance and other neural systems.

What does an audiologist do?

  • Helps patients ranging in age from newborns to older adults
  • Selects, fits and dispenses hearing aids and other listening devices
  • Helps prevent hearing loss by providing and fitting protective hearing devices and educating patients on the effects of noise on hearing
  • Aids in research pertinent to the prevention, identification and management of hearing loss, tinnitus and balance system dysfunction,

What are the educational requirements to become an audiologist?

Audiologists earn a master’s degree in audiology from an accredited university. Today many audiologists have a doctorate in audiology (AuD).

Audiologists serve a fellowship or externship year and must pass boards to receive licensing and accreditation. Further, audiologists enroll in continuing education credits to fulfill licensing requirements.

Typically, audiologists achieve certification from the national association, ASHA, as well as state licensing (such as the Maryland State Board) in order to practice audiology. Audiologists can stay abreast of changes in the field through associations such as the American Academy of Audiology.