It is amazing to know that even the unborn child in the womb perceives sounds from the outside world; the unborn child reacts to sound as early as the 24th week of pregnancy. However, the auditory paths mature completely only after birth; furthermore, this maturation process is fostered by acoustic stimuli.
By the sixth month, the second stage of the babble phase usually begins. Children start to be aware of their own voices and thus experiment with speech. If a child does not begin to play with sounds and to produce syllables at this age, there might be a hearing impairment. Even with a mild hearing loss, a child may quickly lose interest in experimenting with different sounds.
Hearing and perceiving acoustic signals is necessary for a child’s speech and hearing development. During the first babbling phase of speech acquisition, all children throughout the world exhibit roughly the same phonetic speech patterns. At the age of four to six months, the child’s sense of hearing really begins to influence further speech development.
Not only speech acquisition, but also a child’s intellectual and personal development is closely linked to hearing and its development. The parent’s voice is a source of security and closeness to the infant. Even before the child learns to talk, he or she can differentiate between praise, approval or admonition in the melody of a parent’s voice. Much of what an infant knows of the world, he/she learns through hearing.
Hearing is necessary for speech and language development. Children’s speech development and clarity; behavior; mental and personal development are closely linked to hearing. Hearing problems in children can develop before, during birth or after birth, affecting younger and older children. If you have any doubt about your child’s hearing or if your child’s hearing was never tested, it’s best to get it tested as soon as possible.
There are indicators, which are referred to as risk factors, which also require parents to have their baby’s hearing reassessed at various intervals in their development. These risk factors may be related to baby’s birth weight, prematurity, and health status during and after birth.
Middle ear fluid is the most common childhood complaint. It can result in temporary or fluctuating hearing loss, which can in turn affect a child’s learning, language and behavior. Audiologists can assist doctors to detect middle ear fluid and decide on appropriate management based on routine monitoring.
Children like adults can acquire a permanent hearing loss at any stage in their life from different causes. The earlier the hearing loss is detected and managed the less is its damaging effect language and learning.
The causes of infantile hearing impairment are diverse. Congenital hearing loss is hearing loss acquired from or before birth and can include:
Risk factors, which can cause hearing loss during or after birth:
Other possible reasons that may result in hearing loss include:
Middle ear fluid is the most common childhood complaint. It can result in temporary or fluctuating hearing loss, which can in turn affect a child’s learning, language and behavior.
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Symptoms of hearing loss in infants may be harder to pick:
If you have doubts about any of the above, there is a chance that your infant may have a hearing loss. Organize an appointment to discuss your concern with our audiologists.
Symptoms of hearing loss in younger children / toddlers:
If you have doubts about any of the above, there is a chance that your toddler may have a hearing loss. Arrange an appointment to have your toddler ‘s hearing assessed.
Symptoms of hearing loss in older children:
If you have doubts about any of the above, there is a chance that your child may have a hearing loss. Arrange an appointment to have your child’s hearing assessed.
Depending on the child’s developmental age and maturity, different test techniques are used to assess and measure hearing ability. The aim is to plot the softest levels (in decibels) heard for various pitches (frequencies) on a graph. This is called an audiogram. To have hearing within normal limits, sounds should be heard at or softer than 20dB.
If your baby was born in Australia, his or her hearing would have been screened at birth using special no invasive equipment which can indicate a pass or fail status. The result would be then recorded in the blue discharge book.
All babies need to be screened at birth to eliminate significant hearing loss that can impair their development of speech and language. If your baby was not screened at birth; failed the screening test; or risk factors putting them at risk of hearing loss are present at birth, then every effort should be made to have your baby tested or retested as soon as possible.
Techniques to test babies before 6 months of age are usually objective in nature and doesn’t require baby to actively respond to sound. When using objective techniques, it is best if baby is asleep or well settled for the test to progress successfully. In some cases pediatric audiologists may use special equipment called noisemakers such as bells and chimes to observe babies responses and behavior to various frequencies. Responses observed are not expected to be head turns at this stage. Responses may be as subtle as a raised eyelid; awakening; cessation of sucking dummy or bottle; a frown; cessation of babble; or a startle in response to a loud stimulus. If you have any concerns about your baby’s responses at this stage, do not defer until they are older but arrange an appointment to talk to our pediatric audiologist about the way in which your baby responds to sound.
The technique used to test children’s hearing will vary based on the child’s development ability. From the age of 6 months, if baby has established head turning ability, a puppet show is used at our clinic to assess the child’s hearing ability. This technique is referred to as Visual Reinforcement Orientation Audiometry (VROA). Our pediatric audiologist will train the child to respond consistently to a sound in the room by introducing the sound simultaneously with a puppet behind a lit up screen. Following few goes, the child will associate and learn that every time the sound is on, the puppet will show. The puppet now becomes the child’s reward. Every time the child turns towards the sound presented the audiologist will reward the child by lighting up the puppet. This technique is very successful and upon completion, the audiologist will determine if the child has sufficient hearing for speech and language development in at least one ear. Sometimes, depending on child’s development and cooperativeness, this technique can be used with headphones thus testing both ears and acquiring separate ear information.
From a developmental age of two to three years onwards, children are able to participate more actively in the test situations. Play audiometry, turns the hearing test into a game. The child might be asked to build a block or to complete a puzzle piece by piece every time they hear a sound. Sounds of different frequencies usually from 250Hz- 8KHz will be presented. The child is encouraged to listen to very soft sounds. An audiogram or a graph of the softest sound the child can hear will be obtained if the child is able to respond consistently and reliably. Depending on the age, size and reaction of the child towards headphones, the test sounds may be displayed via loudspeakers or headphones. If a loudspeaker is used, the test procedure is shorter as both ears are tested at the same time, but also less exact, as the result does not allow a differentiation of the hearing ability between the ears or establishing if hearing is completely in the normal range.
Depending on child’s maturity and development ability, Play audiometry can be used or Pure Tone Audiometry where the child is asked to push a button every time they are presented with a sound via the headphones. Sounds of different frequencies usually from 250Hz- 8KHz will be presented in each ear separately to try to establish if hearing is within normal limits.
Speech testing can also be used to establish how is sound being processed by the child. Various speech materials is available to test auditory processing depends on the child’s age. The child is presented with single words or sentences and asked to repeat what they hear or point to the pictures.
Tympanometry is a non-invasive method of testing the status of the middle ear. Children are at high risk of middle ear dysfunction, which can impede the levels clarity of sound. A device is used to seal the outer ear canal for few seconds and measure the vibration created by the eardrum. This test helps to diagnose children who have persistent middle ear fluid requiring grommets and or treatment.