Chapter 13:
Pediatric Hearing Loss
Copyright ©2006 by Pearson Education, Inc.
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Upper Saddle River, New Jersey 07458
Communication Sciences and Disorders: An Introduction All rights reserved.
13.1
Focus Questions
• What is pediatric hearing loss?
• How is pediatric hearing loss classified?
• What are the defining characteristics of
prevalent types of pediatric hearing loss?
• How is pediatric hearing loss identified?
• How is pediatric hearing loss treated?
• What is an auditory processing disorder,
and how is it identified and treated?
Copyright ©2006 by Pearson Education, Inc.
Justice
Upper Saddle River, New Jersey 07458
Communication Sciences and Disorders: An Introduction All rights reserved.
13.2
Introduction
• Importance of hearing: recognize familiar
voices, differentiate among wide range of
sounds
• Detection, categorization, and
comprehension of sounds
• Complex auditory system, so can result in
many types of hearing problems
• Specialists can help children learn to listen
and speak through the use of assistive
technology or specialized teaching
methods that foster learning
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Upper Saddle River, New Jersey 07458
Communication Sciences and Disorders: An Introduction All rights reserved.
13.3
Case Study #1: Mesha
• 12-month old with profound sensorineural
hearing loss
– her father and other family members are also deaf
and immersed in the Deaf community
• Mesha’s parents do not want her to be conflicted
between a hearing a deaf world, so parents
believe she should have a strong identity as a
“Deaf person”
• Mesha is producing a few words right now in
sign and actively communicates with her family
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Justice
Upper Saddle River, New Jersey 07458
Communication Sciences and Disorders: An Introduction All rights reserved.
13.4
Case Study #1 Questions
• If you were an interventionist working with
Mesha and her parents, would you
endorse their decision? Why or why not?
• What challenges face children who are
raised in the Deaf versus hearing
community?
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Communication Sciences and Disorders: An Introduction All rights reserved.
13.5
Case Study #2: Jack
• 30-month old child
• 18 months old: Jack’s mom had concerns
about language and upon pediatrician’s
inspection, noticed severe bilateral otitis
media
• Went through medical intervention
(antibiotics), but at two years, Jack’s mom
went to consult an SLP
• Jack was diagnosed with moderately-
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severe mixed hearing loss Copyright ©2006 by Pearson Education, Inc.
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Communication Sciences and Disorders: An Introduction All rights reserved.
13.6
Case Study #2 Questions
• In your opinion, what is Jack’s prognosis
for achieving normal speech and language
milestones in the next few years?
• Why wasn’t Jack’s hearing evaluated as
soon as his mother noted a delay in his
communication skills?
• How might Jack’s future be different if his
sensorineural loss had been identified
earlier? How much difference do you think
the delay in identification will make?
Copyright ©2006 by Pearson Education, Inc.
Justice
Upper Saddle River, New Jersey 07458
Communication Sciences and Disorders: An Introduction All rights reserved.
13.7
Case Study #3: Lilly
• 12-year old girl with congenital profound
sensorineural hearing loss and a syndrome with
affects the electrical system of her heart
• Pediatrician refused to approve a referral for a
hearing evaluation until 2 years of age; at age 3,
Lilly was diagnosed with hearing loss
• Parents decided that they wanted Lilly to use an
auditory-verbal approach, be home-schooled, and
have cochlear implants
• Now, Lilly is well-adjusted, articulate, reads and
writes above grade level, and wants to advocate
for other children with hearing loss
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Justice
Upper Saddle River, New Jersey 07458
Communication Sciences and Disorders: An Introduction All rights reserved.
13.8
Case Study #3 Questions
• What role can parents of children with
hearing loss play in advocating for the
needs of individuals with hearing loss?
• What factors likely contributed to Lilly’s
positive outcomes?
Copyright ©2006 by Pearson Education, Inc.
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Upper Saddle River, New Jersey 07458
Communication Sciences and Disorders: An Introduction All rights reserved.
13.9
I. What is Pediatric Hearing Loss?
• a condition in which a child or adolescent
is unable to detect or distinguish the range
of sounds at the level normally possible by
the human ear
• Hearing loss: results from damage to the
outer, middle, or inner ear, or the auditory
nerve
• Auditory processing disorder: hearing loss
resulting from damage to the processing
centers of the brain
Copyright ©2006 by Pearson Education, Inc.
Justice
Upper Saddle River, New Jersey 07458
Communication Sciences and Disorders: An Introduction All rights reserved.
13.10
Varieties of Hearing Loss
• Location of damage (outer, middle, inner,
auditory nerve)
• Whether it affects one or both ears
– Unilateral or bilateral
• Extent of impact on communication
• Chronicity
– Short-term, fluctuating, permanent or progressive
• Timing
– Congenital, prelingual, acquired, postlingual
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Communication Sciences and Disorders: An Introduction All rights reserved.
13.11
Hearing Loss and Communication
• Hearing loss varies in the extent to which it
affects speech, language, and
communication
• Affects ability to develop relationships,
succeed academically, and be involved
with extracurricular activities
• Can result in delayed receptive and
expressive speech and language
development, can affect any domain of
language
Copyright ©2006 by Pearson Education, Inc.
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Communication Sciences and Disorders: An Introduction All rights reserved.
13.12
Early Identification
• Family needs to respond early, proactively,
and responsively
• Newborn hearing screenings increase
likelihood of early identification
• Parental decisions: communication mode,
communication “orientation” (Deaf vs.
deaf)
• Best age for identification and initiation of
intervention: prior to six months
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Communication Sciences and Disorders: An Introduction All rights reserved.
13.13
Terminology
• Hearing impairment, hearing disorder,
deafness, hard-of-hearing
• Prefer the term hearing loss:
– Focuses solely on the present physical
condition
– Carries no connotation regarding impairment,
disability, or handicap
• True deafness (inability to hear at all) is
extremely rare
• Deaf vs. deaf (community orientation)
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Communication Sciences and Disorders: An Introduction All rights reserved.
13.14
Prevalence and Incidence
• Early Hearing Detection and Intervention
(EDHI) program: 5 to 6 out of every 1000
infants born with hearing loss
• Eight percent of school-age children have
“educationally significant” hearing loss
– Includes cases of acquired hearing loss due
to middle ear infections (35% children
experience ongoing middle ear infections
throughout childhood)
– Also includes cases of congenital hearing loss
due to pre-, peri-, or post-natal genetic
influences, injuries or illnesses Copyright ©2006 by Pearson Education, Inc.
Justice
Upper Saddle River, New Jersey 07458
Communication Sciences and Disorders: An Introduction All rights reserved.
13.15
II. How is Pediatric Hearing
Loss Classified?
• Classified by either etiology,
manifestation and impact, or severity
A. ETIOLOGY
• For characterizing the cause of the
hearing loss:
a. Genetic or environmental cause
b. Age of onset
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c. Type of loss Copyright ©2006 by Pearson Education, Inc.
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Communication Sciences and Disorders: An Introduction All rights reserved.
13.16
a. Genetic or Environmental
Causes
• Genetic:
– Transmitted from parents to offspring
• autosomal dominant
• autosomal recessive
• Environmental:
– Exposure to noise (e.g., ventilator system in
NICU)
– Sudden exposure to noise or sudden change
in air pressure (barotrauma)
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Communication Sciences and Disorders: An Introduction All rights reserved.
13.17
b. Age of Onset
• Developmental: present at birth
– Common causes: genetic disorders, Rh
incompatibility, infection or disease, trauma,
anoxia, ototoxic drugs, prematurity
• Acquired: occurs sometime after birth
– Common causes: trauma, ototoxic drugs,
middle ear infections, infection, noise,
systemic illness, barotrauma
• Prelingual vs. postlingual
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Communication Sciences and Disorders: An Introduction All rights reserved.
13.18
c. Type of Loss
• Identifies the auditory structures that are
affected
• Conductive loss: damage to the outer or
middle ear
• Sensorineural loss: damage to the cochlea
or auditory nerve
• Mixed loss: simultaneous damage to the
conductive and sensorineural mechanisms
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Communication Sciences and Disorders: An Introduction All rights reserved.
13.19
B. Manifestation and Impact
• Classification based on the aspects of
audition that are impacted
• Loss of hearing acuity: loss of precision of
hearing at different levels of loudness
• Decrease in language comprehension
(occurs with sensorineural loss)
– more difficult to manage
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Communication Sciences and Disorders: An Introduction All rights reserved.
13.20
C. Severity
• Classification based on severity using
decibel system (dB)
• Hearing loss is represented by identifying
the threshold of hearing: where a person
just begins to hear
– Normal hearing: -10 to 15 dB
– Mild hearing loss: 26 to 40 dB
– Moderate hearing loss: 41 to 55 dB
– Severe hearing loss: 71 to 90 dB
– Profound hearing loss: 91 dB or higher Copyright ©2006 by Pearson Education, Inc.
Justice
Upper Saddle River, New Jersey 07458
Communication Sciences and Disorders: An Introduction All rights reserved.
13.21
III. Prevalent Types of Pediatric
Hearing Loss
• Conductive Hearing Loss
• Sensorineural Hearing Loss
• Mixed Hearing Loss
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Communication Sciences and Disorders: An Introduction All rights reserved.
13.22
Conductive Hearing Loss
• Attenuation or reduction of the sounds
heard in the environment
• However, exaggerates sound of one’s
voice and chewing, because of bone
conduction
• Slight to moderate loss in one or both
ears, typically not severe
• Medical or surgical intervention is usually
successful, so loss is usually temporary
Copyright ©2006 by Pearson Education, Inc.
Justice
Upper Saddle River, New Jersey 07458
Communication Sciences and Disorders: An Introduction All rights reserved.
13.23
Causes and Risk Factors
• Most common cause: middle ear infections
(otitis media)
– Angle and shortness of Eustachian tube in
children allows organisms to enter easily
– Allergens (e.g., cigarette smoke) make more
susceptible
– Interactions with other children spread
infections (e.g., child-care centers)
• Other causes: ear wax (cerumen)
blockage, foreign objects, congenital
malformations Copyright ©2006 by Pearson Education, Inc.
Justice
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Communication Sciences and Disorders: An Introduction All rights reserved.
13.24
Sensorineural Hearing Loss
• Most common type of hearing loss – slight
to profound loss of hearing in one or both
ears
• Decrease in loudness, also decrease in
speech perception and ability to
distinguish speech from background noise
• Some also experience reduced tolerance
for loud noises or ringing in the ears
(tinnitus)
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Communication Sciences and Disorders: An Introduction All rights reserved.
13.25
Causes and Risk Factors
• Usually is present at birth as a congenital
hearing loss
• Half of the causes are unknown, the other
half are caused by genetics and heredity,
infection, otitis media, prematurity,
pregnancy complications, trauma
• Risk factors: influenced by maternal
health, birth process, hereditary factors,
exposure to medications, and disease
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Communication Sciences and Disorders: An Introduction All rights reserved.
13.26
Mixed Hearing Loss
• Both permanent reduction of sound
(sensorineural) and additional temporary
loss of hearing (conductive)
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Communication Sciences and Disorders: An Introduction All rights reserved.
13.27
IV. How is Pediatric Hearing
Loss Identified?
• Identification: often begins with routine
screening, (e.g., newborn screening)
• Ongoing monitoring: understanding
hearing loss changes over time and to
measure effects of intervention
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Communication Sciences and Disorders: An Introduction All rights reserved.
13.28
The Assessment Process
• Referral
• Screening
• Comprehensive Audiological Evaluation
• Hearing Aid Evaluation
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Communication Sciences and Disorders: An Introduction All rights reserved.
13.29
Referral
• EDHI programs are present in most states,
with the goal to detect hearing loss while
the infant is still in hospital after birth
• Toddlers and preschoolers are referred if:
– show developmental delay
– have hereditary disposition for hearing loss
– develop disease or disorder that affects the
auditory mechanism
• All children are evaluated routinely in
kindergarten, and 1st-3rd grades, and 7th
and 11th grades Copyright ©2006 by Pearson Education, Inc.
Justice
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Communication Sciences and Disorders: An Introduction All rights reserved.
13.30
Screening
• Infant Screening:
– Completed at birth in the hospital
– Typically uses otoacoustic emissions or
evoked auditory potentials as test measures
• Conventional Hearing Screening:
– Require the child to respond when a soft tone
is presented and heard (behavioral testing)
– Children who fail are either re-screened in two
weeks or referred for a comprehensive
examination
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Communication Sciences and Disorders: An Introduction All rights reserved.
13.31
Comprehensive Audiological
Evaluation
• Assesses the type and degree of hearing
loss, speech discrimination, and auditory
perception
• Case history
• Interview and observation
• Otoscopic examination
• Audiometry
• Objective measures
– Immitance, otoacoustic emissions (OAEs),
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evoked auditory potentials (EAPs) Copyright ©2006 by Pearson Education, Inc.
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Communication Sciences and Disorders: An Introduction All rights reserved.
13.32
Hearing Aid Evaluation
• If family decides on this option, requires
fitting and monitoring use of hearing aids
• Probe microphone measurement:
computerized method of measuring
hearing aid function in a child’s ear
• Electroacoustic evaluation: electronic
verification of sound properties of hearing
aid (gain, output, frequency response)
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Justice
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Communication Sciences and Disorders: An Introduction All rights reserved.
13.33
Importance of Accurate Diagnosis
• Because there is typically no outward
signs of hearing loss, it is hard to identify
and consequently treat
• Failure to identify hearing loss continues
the harmful effect on the child
• However, mistaking other conditions for
hearing loss can have negative
consequences as well
Copyright ©2006 by Pearson Education, Inc.
Justice
Upper Saddle River, New Jersey 07458
Communication Sciences and Disorders: An Introduction All rights reserved.
13.34
V. How is Pediatric Hearing
Loss Treated?
• Communication Choices
• Amplification and Listening Devices
• Aural Habilitation
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Justice
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Communication Sciences and Disorders: An Introduction All rights reserved.
13.35
Communication Choices
• Parents need to choose whether to
embrace the Deaf community or the
mainstream oral community, or to consider
a combination
– 49% of children use both speech and sign
• 44% use speech only
– 6% use sign only
Copyright ©2006 by Pearson Education, Inc.
Justice
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Communication Sciences and Disorders: An Introduction All rights reserved.
13.36
Amplification and Listening
Devices
• Hearing Aids: children usually have behind-the-ear
hearing aids (BTEs)
– improved greatly in recent years due to technological
advances
• Assistive Listening Devices: improve a person’s
ability to hear in difficult listening situations (e.g.,
FM system, soundfield system)
• Cochlear Implants: provides direct electrical
stimulation to the auditory nerve, for children with
severe to profound sensorineural loss
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Communication Sciences and Disorders: An Introduction All rights reserved.
13.37
Aural Habilitation
• Individualized intervention to achieve fluent
communication in manual and/or oral
modality
• Involves activities such as tactile training,
auditory training, speech reading and visual
cues, and education and counseling
• Three principles:
– Ensure an appropriate listening environment
– Maximize audition
– Support the continuum of listening
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development Copyright ©2006 by Pearson Education, Inc.
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Communication Sciences and Disorders: An Introduction All rights reserved.
13.38
Intervention Principles: Infants,
Toddlers, and Preschoolers
1. Early Intervention
2. Parental Involvement
3. Naturalistic Environments
4. Social Interaction
5. Functional Outcomes
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Communication Sciences and Disorders: An Introduction All rights reserved.
13.39
Intervention Principles:
School-Age Children
1. Effective Means of Communication
2. Self-Advocacy
3. Literacy
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Communication Sciences and Disorders: An Introduction All rights reserved.
13.40
VI. Auditory Processing Disorder
• Neurological problem that adversely
affects an individual’s processing or
interpretation of auditory messages
• Not typically accompanied by a loss of
hearing acuity
• Cause is often unknown, but sometimes
associated with other disorders, like
dyslexia, ADD, and autism
Copyright ©2006 by Pearson Education, Inc.
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Communication Sciences and Disorders: An Introduction All rights reserved.
13.41
Assessment and Intervention
• Currently no “gold standard” for
identification, but behavioral assessment,
so not recommended for children under 7
• Common symptoms cluster into four
areas: behavioral, literacy, linguistic, and
organizational
• Treatment approaches:
– Environmental modification
– Remediation activities
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– Compensatory strategies Copyright ©2006 by Pearson Education, Inc.
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Communication Sciences and Disorders: An Introduction All rights reserved.
