Speech and language delays and sometimes behavioral problems are the first indicators of a possible hearing problem. Pediatric audiologists diagnose hearing disorders and coordinate with early intervention professionals, school personnel, family members and physicians to provide comprehensive hearing care for their young clients.
What is pediatric audiology?
Pediatric audiology is specialized hearing healthcare offered to infants and young children who are experiencing hearing problems or sound recognition issues. The audiology process begins with a diagnostic hearing evaluation which is used to determine the type of hearing disorder and then the initiation of habilitation services which involve providing treatment options and intervention for the hearing loss.
What is a pediatric audiologist?
A pediatric audiologist is a specialist within the medical field of Audiology who works with pediatric patients who have hearing and speech deficits. They are skilled audiologists with a doctoral degree who use varying forms of diagnostic testing to identify hearing problems and then determine a method of intervention. A pediatric audiologist is tasked with making referrals to other professionals within the community to assist the family in making informed choices regarding their child and to integrate medical records received from varying sources to optimize the infant or child’s hearing skills.
What conditions do pediatric audiologists treat?
The conditions treated by pediatric audiologists include all types and degrees of hearing loss. The types of hearing losses include: conductive, sensorineural, and central hearing losses. Hearing losses can vary in degree anywhere from mild hearing loss to profound loss.
What services do pediatric audiologists offer?
The services offered by a pediatric audiologist vary according to the condition and symptoms of the patient. The audiologist will conduct a diagnostic hearing evaluation in order to determine the type and degree of hearing deficit. These tests can include behavioral tests or electrophysiological tests and are specifically designed for infants and children. Electrophysiological testing includes: Auditory Brainstem Response (ABR), Brainstem Auditory Evoked Response (BAER), Distortion Product Otoacoustic Emissions (DPOAE’s), and Auditory Steady State Response (ASSR) testing. Behavioral assessments are conducted in the Soundbooth and may include: Visual Response Audiometry (VRA), Behavioral Observation Audiometry (BOA) and Play Audiometry testing.
After the examination and identification of the hearing loss, our Audiologists will discuss with you as the caregiver the best method of intervention and treatment for your child. Hearing aids or an FM/DM auditory training system may be recommended. Children aged birth to three are referred for additional therapeutic services through the Colorado Home Intervention Program (CHIP) and school aged children are given access to therapy services through the school district.
What can I expect at a pediatric audiology appointment?
Your child will be scheduled for a diagnostic hearing evaluation. If they are between the ages of birth to 7 months they will be scheduled for electrophysiological testing which is called Auditory Brainstem Response (ABR) or Brainstem Auditory Evoked Response (BAER) testing. The ABR/BAER testing takes approximately 90 minutes and your child will be in a natural sleep state for this test. Other possible electrophysiological tests performed that day may include Otoacoustic Emissions (DPOAE’s) and Auditory Steady State Response (ASSR) testing. Your child may also be asked to return to the clinic on another day to either complete the initial testing or to repeat certain tests to confirm any hearing loss identified. If your child is 8 months or older they will be scheduled for behavioral testing in a Soundbooth. This testing will either involve the use of soundfield speakers or inserts/headphones in their ears in order to present varying tones and speech sounds for them to identify. Other tests that may be completed include immittance measures to test for ear infections or middle ear fluid and acoustic reflexes to test the reaction of the middle ear musculature and nerve reflex.
Warning Signs of Possible Hearing Loss:
- Speaks loudly
- Attention problems
- Only responds when face-to-face
- Has a delayed reaction when spoken to
- Has no response when called upon
- Has trouble following directions
- Becomes frustrated when trying to communicate
- Pulls on their ears
- Problems sleeping at night (may indicate an ear infection)
- Delayed speech and language
When should I have my child tested?
When your child was born they should have received a hearing screening as part of a newborn general well baby check at the hospital. If your child was born at home or in an alternate setting then the delivering practitioner will arrange for this screening to be completed a week or two after delivery at an alternative site. If your child did not receive this initial screening then this can be completed through this clinic or you can contact your primary care doctor for a referral for this test. If your child failed the initial screening then it is critical for you to schedule your child for a follow-up diagnostic evaluation. The early identification and treatment of hearing loss has been proven to enhance the normal development of speech and language skills. Further, if your child’s hearing loss is identified within the first three years of life they will have an advantage in their speech and language development over children identified at a later age. Learning language begins very early in life which includes identifying common environmental sounds and discriminating speech sounds. A child with a hearing loss is not able to hear sounds the same way a normal hearing child does. This deficit can delay their acquisition of speech and create sound localization problems. How much of an effect on their speech and language development varies depending upon the type and degree of hearing loss and whether the loss is in one ear or both ears.
How important are hearing aids?
Research has shown that identifying hearing loss early in life and the use of hearing aids can significantly improve language growth in infants and small children. A child’s brain and optimal developmental period is from birth to age 3 years. Learning obviously does occur after that time but it is not as accelerated. Typically the earlier the infant or child begins using hearing aids the easier it is for them to hear and integrate speech sounds into their daily lives. Infants and children with significant or profound hearing losses sometimes need additional visual or hands-on assistance which may include the use of sign language or cochlear implants (a specialized inner ear implanted hearing device).
The development of social skills takes time and practice. Hearing loss and decreased language skills can reduce or impair the development of these skills. It is important for you to continue talking to your child even if they have hearing loss. With the use of hearing aids and visual cues from your face and mouth you can convey a lot of important speech information. Having your child interact with their peers is also a great way to expose them to both language and social situations. Children are very forgiving and often teach each other during play the best ways to communicate to each other. You may feel very protective of your child but you may not be doing them a favor by keeping them isolated. Realistic expectations regarding social skills for their age can be discussed with your child’s physician, audiologist, school personnel and speech and language therapist. Allowing your child to engage in varying activities and hobbies at school, sports and clubs is a great way to expose them to a variety of language situations.
What are FM/DM systems and how can they help my child?
An FM (frequency modulation) or DM (digital modulation) personal auditory system is an assistive listening device (ALD) that works either in conjunction with your child’s hearing aids or separately. FM/DM systems are used in environments with background noise or large spaces to assist the child’s hearing for a specific speaker or small group. The speaker (such as a parent, teacher or therapist) wears a microphone attached to a small power pack and the child has small receivers either attached to their hearing aids or they wear a wire loop around their neck attached to a small receiver. The speaker’s voice is heard directly in their ears with less distracting noise and more clarity which provides the child with an improved speech sample with which to base their developing language skills upon. The use of an FM/DM system provides a consistent signal independent of the distance the speaker is to the listener. It is therefore very effective in playgrounds, at assemblies, during group activities and whenever there is extraneous noise in the environment. An FM/DM system may be recommended for your child depending upon their degree and type of hearing loss, their speech and language skills, their social development skills and their educational environment. It is typically recommended that your child become accustomed to their hearing aids prior to using an FM/DM system. Some classrooms are equipped with sound field systems which have speakers located in important areas of the classroom for instruction with the teacher wearing a wireless microphone. These systems are set up and monitored by the school district audiologist and school personnel.
When your child is wearing an FM system they may:
- Respond to voice quicker
- Attend better even at a distance
- Follow directions better in groups
- Show less fatigue
- Be more interactive
- Have less frustration
How do I know my child is hearing what they need to?
The last piece to fitting and programming hearing aids is validating their settings within real world environments. This is accomplished by observation, speech testing within the classroom or home environment and questionnaires given to caregivers, therapists and educators to assess their hearing abilities. When your child is comfortably using their hearing aids, their ability to hear in varying environments will be evaluated by individuals providing in-home or educational services. Any concerns are communicated to your child’s audiologist. Validation is an ongoing process that occurs throughout your child’s life as they grow and become involved in different environments.