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More than three million children in the US have hearing loss.

Hearing aids can help improve hearing and speech, especially in children with sensorineural hearing loss (hearing loss in the inner ear due to damaged hair cells or a damaged hearing nerve). Sensorineural hearing loss can be caused by noise, injury, infection, certain medications, birth defects, tumors, and problems with blood circulation.

Hearing aids are electronic or battery-operated devices that can amplify and change sound. Every hearing aid has 3 parts: a microphone that picks up the sound, an amplifier that boosts the sound, and a receiver that delivers the amplified sound into the ear. Children as young as one month of age can be fitted with hearing aids.

The selection of the proper hearing aid is one of the first critical tasks that parents will have to face. Therefore, it is essential that they understand what hearing aids are and what they will and will not do for children. The hearing aid, though essential, is only an aid that takes advantage of a child’s residual hearing (the hearing that is functional). It is not a cure. It will not permit a child to hear “normally.”

A properly fitted hearing aid should be expected to do the following:

• Amplify sounds to a level that the child can hear
• Be tailored to the child’s hearing loss so that frequencies that need to be louder are amplified more than the frequencies that can be heard at softer levels
• Be designed to wear comfortably and at the same time be protected from damage
• Be powerful enough to be useful, but avoid excessive loudness that can further damage hearing (Northern & Downs, 1984).

The selection of a hearing aid should involve the thoughtful decisions of a team that is directed by an audiologist. It should include an otolaryngologist and the parents. This effort should result in the best possible selection of a hearing aid for the child.

Once the hearing aids are fitted to the child, there is still much to be done. The parent must learn, with the help of the audiologist, how to maintain and monitor the aids. Regardless of the type of hearing aid the child uses, responsibility for their care falls on the parent. The list that follows is a daily checklist for the basic care and maintenance of a child’s hearing aid:

DAILY HEARING AID CARE CHECKLIST

• Check the battery with a battery tester
• Check the volume setting
• Check the earmold for clogging, cracks, or rough spots
• Check the tubing for clogging, cracks, or rough spots
• Check case for damage
• Check microphone for clogging
• Check dials and switches for ease of movement or breakage

Use a hearing aid stethoscope to check the quality of sound.
Are the sounds /a/=”ah,” /u/=”oo,” /i/=”ee,” /f/, /s /=”sss,” and /sh/ clear?
Check for feedback (squealing). Connections may not be tight, the tubing may be cracked, or the earmold may not be fitting properly.
Look at the tubing: there should not be moisture droplets. If there are, use a hearing aid blower or twirl up a tissue very thin and use it as a wick after shaking as much of the moisture down as you can. Then use another “wick” and then from the other end of the tubing if necessary. Moisture can be the cause of cracking sounds in the aid.

AUDITORY MANAGEMENT

When it comes to dealing with hearing loss, some think that simply getting hearing aids or other listening devices is the “rehabilitation.” Aural/audiological rehabilitation or auditory management, however, is a much broader concept. It focuses on reducing difficulties related to hearing loss and listening. The overall goal is to maximize communication success in everyday environments and situations.

So, the most important task ahead of you is to help your child develop his receptive listening skills. This means that the child must develop an understanding of sound in the following progression:

• Discriminate sounds (can tell that one sound is different from another)
• Understands environmental sounds
• Understands single words and short phrases supported by lip-reading
• Understands single words and/or phrases (through listening only)
• Understands details in sentences
• Understands connected conversational speech

Along with developing his/her receptive listening skills, the child is also developing expressive skills, although these generally lag behind receptive skills. This development happens in the following progressing:

• Attempts to use voice for communication purposes
• Imitates appropriate duration, pitch, and intensity patterns of speech in structured situations
• Imitates specific sounds in syllables and words in structured situations
• Spontaneously uses simple words and phrases
• Spontaneously uses details in sentences
• Spontaneously uses connected conversational speech

In providing active auditory-based language enrichment for your child so that his/her receptive listening and expressive spoken language is enhanced, you may want to consider implementing the following suggestions:

• The quieter the room and the closer you are to the child, the better you will be heard. Remember, your child may have difficulty ‘overhearing’ conversations and hearing you from a distance. You need to be close to your child when you speak.
• Focus on listening, not just seeing. Call attention to sounds and to conversations in the room. If hearing aid, FM, or cochlear implant technology has been recommended for your child — use it during every waking hour!
• Speak with clear speech, using lots of melody.
• Read aloud to your child, daily. Even infants can be read to. Try to read at least 10 books to your baby or child each day.
• Sing and read nursery rhymes to your baby every day.
• Name objects in the environment as you encounter them during daily routines.
• Talk about and describe how things sound, look, and feel.
• Talk about where objects are located. You will use many prepositions, such as, in, on, under, behind, beside, next to, between.
• Compare how objects or actions are similar and different in size, shape, smell, color, and texture.
• Describe sequences. Talk about the steps involved in activities as you are doing the activity.
• Tell familiar stories or stories about events from your day or from your past. Keep narratives simpler for younger children, and increase complexity as your child grows.

TYPES OF HEARING AIDS

There are essentially three levels of hearing aid technology, which are analog, digitally programmable, and digital.
Analog technology has been around for many decades. Analog is considered basic technology and offers limited adjustment capability. It is the LEAST expensive and the least flexible.

Digitally programmable technology is considered “middle grade” technology. Digitally programmable units are actually analog technology, but the sound capabilities of the hearing aid are adjusted digitally by a computer in the audiologist’s office.

Digital technology is the most sophisticated hearing aid technology. Digital technology gives the audiologist maximum control over sound quality and sound processing characteristics. There are qualitative and quantitative indications that digital instruments outperform digitally programmable and analog hearing aids. Digitals are not perfect, but they are very good. They are also the MOST expensive.

Digitally Programmable and Digital aids use programmable settings and adjustments so that very specific, tailored fittings can be made for a child’s individual hearing loss and their varied listening environments. Standard or Analog hearing aids can usually make adjustments in only two areas — low pitch and loudness. Programmable aids, on the other hand, allow for adjustment in low and high pitch, loudness, and frequency response. Some units have multiple “memories” that can be switched (either manually or remotely) from the user’s chosen program for listening situations, such as talking on the phone. Because of their technology and flexibility, successful use of these devices generally requires some degree of sophistication on the part of the listener. Programmable aids are especially appropriate for very young children and when progressive or fluctuating losses are diagnosed or suspected. The programmable aid provides the audiologist ultimate flexibility in terms of programming for changes in hearing. While this increased flexibility improves the fitting process and patient benefit, it also translates into a higher costs for equipment.

There also are available six basic types of hearing aid styles: in the ear (ITE), behind the ear (BTE), canal aids (ITC and CIC), body aids, CROS aids, and bone anchored hearing aids (BAHA). In-the-Ear (ITE) Hearing Aids. These hearing aids come in plastic cases that fit into the outer ear. Generally used for mild to severe hearing loss, the ITE hearing aids can accommodate other technical hearing devices, such as the telecoil, a mechanism used to improve sound during telephone calls. However, their small size can make it difficult to make adjustments. In addition, ITE hearing aids can be damaged by earwax and drainage. Because of the small size, this type of hearing aid not ideal for children.

Behind-the-Ear (BTE) Hearing Aids. Behind-the-ear hearing aids, as the name implies, are worn behind the ear. This type of hearing aid, which is in a case, connects to an earmold inside the outer ear. These hearing aids are generally used for mild to severe hearing loss. However, poorly fitted BTE hearing aids can cause feedback, an annoying “whistling” sound, in the ear. Children are most often fitted with this kind of hearing aid.

Canal Hearing Aids. Canal aids fit directly in the ear canal and come in two styles: in-the-canal (ITC) hearing aids and completely-in-the-canal (CIC) hearing aids. Customized to fit the size and shape of the individual’s ear canal, canal aids are used for mild to moderate hearing loss. However, because of their small size, removal and adjustment may be more difficult. In addition, canal aids can be damaged by earwax and drainage. Children are not fitted with this kind of hearing aid.

Body-Worn Hearing Aids. Generally reserved for profound hearing loss, or if the other types of hearing aids will not accommodate, body-worn aids are attached to a belt or put in a pocket and are connected to the ear with a wire. Body hearing aids typically use analog technology.

The CROS Hearing Aid. CROS aids, which mean Contralateral Routing of Signal, are designed specifically for unilateral losses. They are not generally appropriate for small children, but rather for adults and some adolescents. These systems use one microphone, which is placed on the side of the ear with the hearing loss to receive the sound signal. The signal is then carried to the ‘good’ ear, generally by a wireless radio frequency signal. The listener then hears sounds from both sides of the head. Again, be aware that such technology is available for older children.

The Transcranial CROS Hearing Aid. Clients with unaidable sensorineural hearing loss in one ear and normal hearing in the opposite ear can present a challenge to audiologists. At least two recommendations may be available. One approach is to attempt to minimize the communication problems associated with unilateral hearing loss by recommending preferential seating or counseling the patient to place the normal ear so it faces the desired signal. Another approach to improving communication for patients with unilateral loss is with the introduction of CROS amplification to the good ear. However, the success of this system is directly related to the degree of hearing in the better ear. If the hearing in the better ear is within normal limits, the prognosis with CROS amplification is guarded.

The Bone Anchored Hearing Aid (BAHA). The BAHA is a bone-implanted device through which sound is transmitted via bone conduction. The BAHA is used for individuals with conductive and mixed hearing loss. A small titanium fixture is implanted in the bone behind the ear. The implanted component osseointegrates, or bonds to the living bone. After a healing period of about three months, the patient is fitted with the sound processor, which is attached through the skin. The processor has an on/off volume control and a multi-directional microphone. This type of hearing aid uses analog technology. The normal sound path (via air conduction) of the outer and middle ear is avoided and the sound is transmitted to the good inner ear using bone conduction. This kind of hearing aid is available only to persons 18 years and older.

HEARING AID INSURANCE

The cost of purchasing hearing aids is high and seems to be escalating! When hearing aids are purchased, most audiologists charge a “bundled” price. This means you are essentially buying everything that is needed to get the best use of the hearing aids, including:

• Hearing aid accessories
• Limited supply of batteries
• Fitting services
• Follow-up visits
• Verification measures
• Adjustments
• Repairs under the manufacturer’s warranty
• In-office repairs
• Periodic check-ups

Unfortunately, few standard health insurance policies provide coverage for hearing aids. Some insurers offer supplemental coverage specifically for hearing related procedures and devices. You will need to check with your insurer to determine what, if any, costs are covered.

Some states provide funding for the purchase of hearing aids and other assistive technology for children from birth through age two. North Carolina has this kind of funding and it is available through the Assistive Technology Funding Program administered by the NC Department of Public Health.