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Chapter 13
Pediatric Hearing Loss

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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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 in evidence-based practice?

What is an auditory processing disorder, and how is it identified and treated?

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Introduction

Deafness is a much worse misfortune [than blindness] for it means that loss of the most vital stimulus – the sound of the voice that brings language, sets thoughts astir, and keeps us in the intellectual company of man. Helen Keller, 1933

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Case 13.1: Lauryn

Lauryn has a behind-the-ear hearing aid in her left ear but has not been fitted for one for her right ear. This is due to structural abnormalities of her right ear. She has been receiving speech-language and hearing intervention but is not developing listening and language skills on par with her peers. Options for her include:
Surgically implantable bone-anchored hearing appliance
Implantable middle-ear hearing aid
Cochlear implant

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Brainstorm and Discussion

If you were an interventionists working with Lauryn and her parents, would you endorse a decision for repair? Why or why not?

What challenges face children who are raised in the Deaf community?

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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What Is Pediatric Hearing Loss?

Hearing loss
Refers to a condition in which a child or adolescent is unable to detect or distinguish the range of sounds normally available to the human ear.
Auditory processing disorders (APD)
Hearing loss resulting from damage to the processing centers of the brain.

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Definition

Location of damage to the hearing structures.
Outer
Middle
Inner
Because we have two ears, hearing loss varies in whether it affects one or both ears.
Bilateral
Unilateral
The extent to which hearing acuity is impacted.
Congenial hearing loss
Acquired hearing loss

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Terminology

Hearing loss
Hearing impairment
Hearing disorder
Deafness
Hard of hearing
Deaf
deaf
Deaf Community

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Prevalence and Incidence

The reported prevalence of hearing loss among children varies significantly, depending on the criteria used to identify the loss.
The term “educationally significant” refers to a hearing loss that is serious enough to impact a child’s ability to perform well educationally.
Impact
Integration into the Community
The Deaf Community
Communication Development

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Impact

Hearing loss not identified early and addressed with an appropriate communication approach can have far reaching affects
Ability to develop relationships
Ability to succeed academically
Ability to be involved with extracurricular activities
Parental response is key

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Integration into the Community

Parents must decide
Communication mode
How child will communicate; speech or sign language
Orientation
Member of oral or Deaf community

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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The Deaf Community

Identity is centered on shared attitudes and a common language
It is a social community based on a shared set of beliefs
A common belief is that deafness is an attribute and not a deficiency

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Communication Development

Most states have infant hearing screening in place
For those not identified early or provided an effective means of communication, difficulties exist in:
Vocabulary
Grammar
Communicative intent and interaction style
Speech intelligibility
Academic achievement

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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How is Pediatric Hearing Loss Classified?

Etiology

Typically classified according to its etiology, its manifestation and impact, and its severity.
Genetic or Environmental Cause
Age of Onset
Type of Loss

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Genetic or Environmental Cause

Genetic and environmental factors that can result in hearing loss are numerous, although in many cases the specific cause is unknown.
Autosomal dominant hearing loss
Autosomal recessive hearing loss

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Age of Onset

The age of onset for hearing loss is typically differentiated into developmental or acquired.
Developmental
Present at birth
Acquired
Occurs sometime after birth
Prelingual
Loss occurring before language is acquired
Postlingual
Loss occurring after language is acquired

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Type of Loss

Type of loss identifies the auditory structures that are affected.
Conductive hearing loss
Sensorineural hearing loss
Mixed hearing loss
In classifying the hearing loss of a given individual, experts consider all these sources of information--cause of loss, age of onset, and type of loss.

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Manifestation

Classified according to the aspects of audition that are impacted.
Some children with hearing loss experience loss of hearing acuity.
More problematic than a loss in acuity is a decrease in auditory comprehension.

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Severity

Hearing loss is also classified according to its severity, using the decibel (dB) system.
Decibels
Standard unit of sound intensity.
Represents the differences in loudness available to human hearing, from the threshold of sound at 0 dB (the drop of a pin) to the threshold of pain between 120 dB and 140 dB (a fire alarm close to your ear).
Threshold
Audiogram

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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What Are the Defining Characteristics of Prevalent Types of Pediatric Hearing Loss?

3 Types of Hearing Loss
Conductive
Sensorineural
Mixed

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Conductive Hearing Loss

Defining characteristics

When sound is not conducted efficiently through the outer or middle ear, the result is an attenuating, or reduction, of the sound heard.
Bone conduction

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Causes and Risk Factors

Causes
Malformation of the outer and middle ear
Underdeveloped or missing ossicles
Wax build up
Otitis media
Risk factors
Biological
Environmental

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Sensorineural Hearing Loss

Defining characteristics
Most common type of hearing loss
Results from damage to the cochlea or the auditory nerve that travels from the cochlea to the brain
Decrease in overall loudness, speech perception and ability to distinguish speech from background noise

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Causes and Risk Factors

Most often, sensorineural hearing loss is congenital.
Most influential factors
Maternal health during pregnancy
Birth process
Child’s health at birth
Hereditary factors
Exposure to ototoxic medications
Disease
Leading causes
Genetics and heredity
Pregnancy related
Postnatal disease or injury

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Mixed Hearing Loss

When both conductive and sensorineural loss exist.
Typically includes a permanent reduction of sound as well as additional temporary loss of hearing from the conductive component.

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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How Is Pediatric Hearing Loss Identified?

Assessment for hearing loss in pediatric population requires a multi-tiered approach.
The Assessment Process
Referral
Screening
Comprehensive audiological evaluation
Evaluation of assistive technology
The Importance of an Accurate Diagnosis

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Referral

Programs, whose purpose is early diagnosis of hearing impairment, are present in most states.
Their goal is to detect hearing loss at birth, while the infant is still in the hospital.
These toddlers and preschoolers should be referred:
Exhibit developmental delays in communication
Have a hereditary predisposition to hearing loss
Develop diseases or disorders that impact the auditory mechanism
School-age children are routinely screened.

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Screening

Screening generally falls into two categories, depending on the child’s age.
Infant screening
Also called newborn hearing screening
Completed at birth
Involve specialized testing
Conventional hearing screening
Behavioral testing

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Comprehensive Audiological Evaluation

Assesses the following:
Type and degree of hearing loss
Speech discrimination and auditory perception abilities in quiet and noisy conditions
Any other concerns
Major tools for evaluation
Case history and interview
Other interview and observation
Otoscopic examination
Audiometry
Objective measures

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Evaluation of Assistive Technology

Audiologist works with the child and family to determine the most appropriate avenue for habilitation.
Assistive technology
Hearing aids
Assistive listening devices
Cochlear implants

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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The Importance of Accurate Diagnosis

Hearing loss is an invisible disorder; there is typically no outward physical sign that a problem exists.
Reasons for missing hearing loss
Problems in under- and over-identification

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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How Is Pediatric Hearing Loss Treated in Evidence-based Practice?

Communication Choices
Amplification and Listening Devices
Aural Habilitation
Fads and Fallacies
Overview of Effective Treatment Approaches

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Communication Choices

The overarching goal of all interventions for pediatric hearing loss is the development of healthy, socially and emotionally balanced individuals who are able to integrate fully into society and lead productive lives.
Parental orientation in choice

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Amplification and Listening Devices

Many child with mild to severe hearing loss are fitted with amplification devices.
Hearing aids
Assistive listening devices
Cochlear implants

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Aural Habilitation

Definition
Treatment strategies designed to achieve fluent communication in the manual or oral modality
Goals
Ensuring an appropriate listening environment
Maximizing audition
Supporting listening development

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Fads and Fallacies

Importance of peer-reviewed, data-based studies with rigorous scientific standards for efficacy and safety
Auditory enhancement training (AIT)

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Overview of Effective Treatment Approaches

Infants, Toddlers, and Preschoolers

Early Intervention
Parental Involvement
Naturalistic Environments
Social Interaction
Functional Outcomes

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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School-Age Children

Intervention Principles
An Effective Means of Communication
Self-Advocacy
Literacy

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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What Is Auditory Processing Disorder, And How Is It Identified and Treated?

A type of hearing loss that adversely affects an individual’s processing, or interpretation, of auditory messages
Problems occur in one or more of the following aspects of auditory processing:
Sound localization and lateralization with both ears
Auditory discrimination
Recognition of patterns of sound
Differentiation of the temporal aspects of sound
Auditory performance when the message is incomplete or when competing acoustic signals are present

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Defining Characteristics

Difficulty interpreting and processing auditory information, even though hearing acuity is intact
Common indicators of APD include:
Behaves as if a hearing loss is present although it is not
Shows problems following complex, multi-step directions
Exhibits difficulties with reading and spelling performance
Reveals degraded listening and audition in noisy environments or with competing auditory stimuli
Appears to seek out visual cues from the environment
Has a history of fluctuating hearing loss, including middle-ear infections
Has difficulty staying on task, finishing assignments and working independently

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Causes and Risk Factors

No specific cause is unknown
Associated with other disorders
Dyslexia
Attention-deficit disorder
Autism spectrum disorder
Specific language impairment
Developmental delay

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Assessment

No gold standard for identifying the presence of an auditory processing disorder
The assessment tasks examine
Sensitivity to the temporal ordering of sounds
Ability to listen to sounds when they are degraded or have other sounds competing
Ability to listen to different stimuli in both ears simultaneously

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Treatment Approaches

Currently, treatment for APD focuses on reducing the symptoms of the disorder.
The most common symptoms cluster into four areas of concern:
Behaviors
Literacy
Linguistic ability
Organization