Hearing loss is a condition in which an individual's ability to hear sound diminishes. This loss can be of a permanent or temporary nature. While permanent hearing loss is mostly due to a problem in the inner part of the ear (called cochlea), the temporary hearing loss can result due to any problem in the sound pathway to the inner ear and many times can be treated by medical intervention. Today, let us have a look at hearing loss in children in detail. 

Main causes of hearing loss in children. Hearing loss can occur due to several reasons. A child may be born with a congenital hearing loss due to some genetic factors, infections such as rubella in pregnant mothers, or associated with a syndrome. It can also occur in newborns who acquire neonatal jaundice soon after birth.

Symptoms to find out if my child is suffering from hearing loss. In case of children, the best approach to detect hearing loss at the earliest stage is to have neonatal hearing screening while the newborn is still in the hospital (through use of oto acoustic emissions instrument). Most of the hospitals run neonatal hearing screening programs, which are accessible to all parents of newborns. The process takes only a few minutes and is very reliable. In case of a failure in screening test, the newborn is referred for a detailed evaluation which is done through auditory brainstem responses test (ABR). Symptoms of hearing loss in very young children may range from a child's low response to parents' call, delayed speech and language development (example, the child may not utter a single word like mama-papa at the age of one year), or lack of head turning towards the environmental sounds.

Who tests for hearing loss? An audiologist is a hearing specialist who performs specialized diagnoses of hearing difficulties and rehabilitation of speech and hearing. All types of hearing assessments such as audiometry, tympanometry, oto acoustic emissions (OAEs) and auditory brainstem response test (ABR) are usually performed at hearing care clinics. The audiologist  not only assesses hearing, but also furthers the rehabilitation process and selects appropriate hearing solutions. Testing hearing in children may involve a lot of play activities to keep the child interested while the audiologists observe the responses and obtain a detailed information of type and degree of the child's hearing loss.

Types of hearing loss. Hearing loss can be broadly classified in 3 types.

1. Conductive (due to a problem in the outer and middle ear), sensorineural (due to a problem in inner ear or cochlea) and mixed (both conductive and sensorineural components).
2. Conductive hearing loss may result due to an obstruction (such as a foreign body in the ear canal), or perforation of the eardrum, and infections of outer and middle ear. The hearing loss of this type is mostly treatable through medical treatment.
3. Sensorineural hearing loss is usually permanent in nature due to a problem in the cochlea and its connecting nerves. This hearing loss can be treated by use of amplification through use of hearing aids. In certain cases when the degree of hearing loss is more and no benefit from hearing aid is obtained, the child may be considered a potential candidate for a cochlear implant.

Degrees of hearing loss and its effects. A child with even a mild hearing loss will miss on soft speech or whispering, environmental sounds such as birds chirping, sounds of tap dripping etc. A moderate degree of hearing loss can cause difficulties in hearing conversations in places with noise such as schools and social gatherings. The child may want to keep the TV/radio levels louder than usual. A child with severe extent of hearing loss may only hear conversations spoken at loud levels and will miss most of speech unless he/she learns how to lip read. A child with a profound degree of hearing loss may only occasionally hear loud environmental sounds such thunder, plane landing sounds or truck horn sounds.

Effect of hearing loss on a child’s development. Normal hearing is essential for the normal development of speech and language as it's only when the child hears that he/she learns to speak. Any deficiency in hearing may result in either delayed or inadequate speech development. It also affects the social, emotional, educational and psychological development of the child. The child may not mingle with his/her peers, may miss important lessons in the classroom, and may not communicate efficiently.

How the rehabilitation procedures work. Rehabilitation of hearing loss can be done through use of devices such as hearing aids, assistive listening devices such as FM/phone clip/mini microphone or surgical implantable devices such as cochlear implants, bone-anchored hearing aids or middle ear implants. A hearing aid is an external device, which does not require any surgery. There has been a lot of development in hearing aid technology with some virtually invisible designs and they produce clear, amplified sounds which overcomes the hearing problem. The child may also need auditory training that involves some therapy sessions to make him familiar with sounds, both speech and environmental, along with the hearing aid use.

What can you do as a parent? As a parent, you play a vital role in your child's future. You can suspect hearing loss with your observations of your child's behaviour. Look out for problems in paying attention in school/home,  problems in hearing or low response when you speak to him/her from behind, loud or very low speech, unclear speech, or lack of response to sounds like utensil sounds, bells, table tapping, hissing or other sounds made by you to catch his attention like dropping a ball.

If you observe any of these behaviors, then explain your observations to the audiologist in detail. If hearing loss is established, immediate and appropriate rehabilitation should be done as it may significantly affect the child's development. The audiologist will also advise if the child requires any additional therapeutic management such as speech therapy and auditory training.

Remember, early identification and rehabilitation of hearing loss is the chance to normal life.

This post was complied with expert inputs from Manuj Agarwal, Audiology Trainer at Amplifon India.

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