PROBLEMS HAVING EARWAX.

Earwax Obstruction

Another leading cause of hearing aid failure is wax blockage. The technical name for common earwax is cerumen. It’s produced by a gland in the outer ear roughly one-third of the way down the ear canal. The
product of this gland is a pasty substance, usually light brown or tan in color and bitter in taste. (Take our word on this one!) Cerumen is believed to exist in the ear canal to discourage flies and insects from entering this opening.The degree of wax generated in the canal varies greatly from one person to the other. On average, men experience more wax buildup than women. Some women, however, can produce large amounts of cerumen, as can children. For reasons not clearly understood, some individuals generate little or no wax. If you’re presently unaware of the wax condition in your ears, your physician or hearing healthcare professional can readily inform you of this after examination with an otoscope (ear light).
Hearing aid wearers must continually be on the lookout for adverse effects of earwax. When hearing aids
are inserted into the ear canals, (or earmolds in the case of BTE hearing aids), they can slide alongside or
directly into accumulated wax. The fresher the wax, the softer and more easily it can get pushed into the
sound bore (receiver) of an aid. A thin smear of earwax over the receiver (sound) tube will shut the hearing
aid down instantly.

Preventing Wax Build-up

The first defense against wax build-up is regular cleaning of your ear canals by a physician or audiologist, or
as simple as it sounds, in a shower by direct spray into the canals. The cautions here are to be careful of the
water pressure, and be certain you don’t have a hole in your eardrum, or any other condition which might
prevent such easy management of earwax.
Hearing instrument specialists are generally not trained to remove earwax, and while wax removal is within the scope of practice for audiologists, many prefer not to provide this service. In any case, you are well-advised to locate a person or office that will provide this service as needed. Attempting to control build-up of earwax by regular use of cotton swabs is not recommended. Aside from the possibility of doing physical damage to the ear canal or drum (the “don’t put anything in your ear smaller than your elbow” concept), cotton swabs will usually only serve to pack the wax deeper with each attempt. By looking into the ear, professionals can readily discern the cotton swab users, as the wax shows a nicely formed concave surface down in the ear canal.
Some hearing aid wearers with chronic wax problems may find regular use of “ear lavage” effective. Equipment along with instructions for home use are available in many hearing care offices and drug stores. Wax softeners for use prior to cleaning can also be purchased. Some people may be uncomfortable
squirting water into the ear canal. A discussion with your physician would be advisable before attempting it. The main problem with this type of treatment is the difficulty knowing when the wax is all out.
The second defense against wax blockage is utilization of some type of wax guard for your hearing aid. There are a number of commercially available products which suit this purpose.

Many manufacturers now provide such a device on their hearing aids. Directly, or under magnification,
you can look into the sound opening of the hearing aid to see if a wax guard is there. These common devices
include “spring,” “Band-Aid” or “trap-door” style guards. All such devices should be discussed with
your hearing health care provider who can explain service requirements.

Responsibility for Wax Maintenance

Whomever dispensed your hearing aids does not have the primary responsibility to keep them free of earwax.You need to develop a daily habit of inspecting the end of the hearing aid where the sound comes out and looking for wax blockage. If accumulation is noticed, this wax can be readily removed in most cases

by the hearing aid wearer with tools provided by the hearing healthcare professional. Remember, periodic
check-ups (every 3-6 months) with your hearing health care professional are recommended.After you have been fit with hearing aids, be sure your hearing healthcare professional demonstrates how to clean your hearing aids using tools which normally come with the purchase of hearing aids.

When and How to Remove Wax

The best time to inspect hearing aids for wax is at the end of the day. At this time, any accumulated wax will still be soft and more easily removed. If you use the Band-Aid style guard, you can wipe across it gently. After a few days if you observe the cushion separating from the adhesive backing, remove it altogether and replace. If used properly, you’ll never need to clean out the receiver (loud speaker) which is the rubber
housing hole at the tip of an aid.
If your hearing aids have the wire coil in them, you may use a device known as a wax loop. This is merely
a wire looped around the end of a piece of plastic. Gently insert it into the receiver tube, turn it one full
rotation, then remove. Avoid picking or poking. Clean any debris from the loop. Nightly cleaning has the
added advantage of keeping the receiver tube open for more adequate ventilation and drying. Review this
procedure carefully and thoroughly with your hearing healthcare provider so that inadvertently you don’t
damage your hearing aids by cramming the wax loop into the wrong opening (such as the microphone port
on the face of the hearing aid) or too deeply into the receiver port which can damage the speaker diaphragm.
Additionally, a wax tool that is a little too large to fit readily into the receiver tube can push the tube itself down into the shell of the hearing aid. This will damage the aid, often causing it to squeal, resulting in needed repairs.Wax should also be removed from hearing aid vents. This is the other port in the hearing aid next to the receiver (loud speaker) port. It can be identified because vents are longer, they do not have a rubber housing through the channel, and often run the length of the earpiece or ear mold. This also means they’re not as easily cleaned. Some people have resorted to the use of wires of various gauges to ream out vents. Wire should be used with caution as it can crack the shell. Large vents are less likely to get plugged up and much easier to clean. Pipe cleaners work extremely well for large vents, such as ITE's, and light gauge fishing line for vents in CICs. Your provider will have suggestions for obtaining these and other suitable tools for cleaning.Sometimes, wax build-up becomes dry and flaky before it’s removed. When this happens, a good brushing of the hearing aid openings can be helpful in addition to use of the wire loop. When brushing, always hold the hearing aid upside down so that wax particles fall out of, rather than down into, the hearing aid. Also, keep your brush clean so that wax particles which collect in the bristles from previous brushing aren't injected inadvertently into the openings.

Your Guide to Care and Maintenance of Hearing Aids

If you are a new hearing aid user or even if you've had your hearing aids for a while you may need a guide 

to help you care for and maintain your hearing aids in top condition. Here are some of the main issues that 

you need to know and understand to get the most from your amplification.

In this post we address eight main issues:

  1) Batteries, 2) ear wax, 3) ear mold/venting issues, 4) moisture/corrosion/dirt/intermittent, 5) telephone use, 6) feedback, 7) static/noise, and 8) prevention.

If you need help with any of these you may consult the blogger at the given email.

Issues with batteries include the following: Dead and defective batteries, getting the most
out of your batteries, batteries in backwards, spent batteries, defective batteries, short battery life,
conserving battery life, safety issues with batteries.

Issues with ear wax include: earwax obstruction, preventing wax build-up, when and how to
remove wax.

Ear mold and venting issues include (comfort & sound quality): ear discomfort, causes
of ear discomfort, correcting a hearing aid fitting problem, plugged up vents.

Moisture, Corrosion, Dirt & related intermittent:Moisture problems, resolving moisture
problems, effects of moisture, dirty volume control, dirty battery, problem of oily skin.

Telephone issues: Poor telephone reception, telecoil circuit, successful use of the telecoil circuit,
other tips for improved telephone listening.

Feedback Issues: Hearing aid squeal (acoustic feedback), acceptable versus unacceptable feedback,
earwax and feedback, solving the feedback problem, feedback with new hearing aids, feedback and
telephone use.

Static and other unwanted sounds: Wind noise, background noise.

Preventive hearing aid maintenance: Spare set of hearing aids, hearing aid disuse and longevity.

Different types of Hearing Loss in Children

CAUSES OF HEARING LOSS IN CHILDREN

Otitis Media (ear Infections) | Congenital Causes | Acquired Causes

Hearing loss in children

Otitis Media                                                           

What is otitis media?

Otitis media is an inflammation in the middle ear (the area behind the eardrum) that is usually associated with the buildup of fluid. The fluid may or may not be infected.

Symptoms, severity, frequency, and length of the condition vary. At one extreme is a single short period of thin, clear, non infected fluid without any pain or fever but with a slight decrease in hearing ability. At the other extreme are repeated bouts with infection, thick "glue-like" fluid and possible complications such as permanent hearing loss.

Fluctuating conductive hearing loss nearly always occurs with all types of otitis media. In fact it is the most common cause of hearing loss in young children.

How common is otitis media?

Otitis media is the most frequently diagnosed disease in infants and young children (1). Seventy-five percent of children experience at least one episode of otitis media by their third birthday. Almost one-half of these children will have three or more ear infections during their first 3 years of life (2). Health costs for otitis media in the United States have been reported to be $3 billion to $5 billion per year (3).

Why is otitis media so common in children?

The eustachian tube, a passage between the middle ear and the back of the throat, is smaller and more nearly horizontal in children than in adults. Therefore, it can be more easily blocked by conditions such as large adenoids and infections. Until the Eustachian tube changes in size and angle as the child grows, children are more susceptible to otitis media.

How can otitis media cause a hearing loss?

Three tiny bones in the middle ear carry sound vibrations from the eardrum to the inner ear. When fluid is present, the vibrations are not transmitted efficiently and sound energy is lost. The result may be mild or even moderate hearing loss. Therefore, speech sounds are muffled or inaudible.

Generally, this type of hearing loss is conductive and is temporary. However when otitis media occurs over and over again, damage to the eardrum, the bones of the ear, or even the hearing nerve can occur and cause a permanent, sensorineural hearing loss.

Can hearing loss due to otitis media cause speech and language problems?

Children learn speech and language from listening to other people talk. The first few years of life are especially critical for this development.

If a hearing loss exists, a child does not get the full benefit of language learning experiences.

Otitis media without infection presents a special problem because symptoms of pain and fever are usually not present. Therefore, weeks and even months can go by before parents suspect a problem. During this time, the child may miss out on some of the information that can influence speech and language development.

How can I tell if my child might have otitis media?

Even if there is no pain or fever, there are other signs you can look for that may indicate chronic or recurring fluid in the ear:

§                         Inattentiveness

§                         Wanting the television or radio louder than usual

§                         Misunderstanding directions

§                         Listlessness

§                         Unexplained irritability

§                         Pulling or scratching at the ears

What should I do if I think that otitis media is causing a hearing, speech, or language problem?

A physician should handle the medical treatment. Ear infections require immediate attention, most likely from a pediatrician or otolaryngologist (ear doctor). If your child has frequently recurring infections and/or chronic fluid in the middle ear, two additional specialists should be consulted: an audiologist and a speech-language pathologist.

An audiologist's evaluation will assess the severity of any hearing impairment, even in a very young or uncooperative child, and will indicate if a middle ear disorder is present.

A speech-language pathologist measures your child's specific speech and language skills and can recommend and/or provide remedial programs when they are needed.

Will my physician refer my child for these special evaluations?

As a parent, you are the best person to look for signs that suggest poor hearing. The American Academy of Pediatrics recognizes this when it states, "Any child whose parent expresses concern about whether the child hears should be considered for referral for behavioral audiometry without delay".

Parents should not be afraid to let their instincts guide them in requesting or independently arranging for further evaluation whenever they are concerned about their children' s health or development.

Congenital Causes

The term congenital hearing loss implies that the hearing loss is present at birth. It can include hereditary hearing loss or hearing loss due to other factors present either in utero (prenatal) or at the time of birth.

Genetic factors are thought to cause more than 50% of all incidents of congenital hearing loss in children (4). Genetic hearing loss may be autosomal dominant, autosomal recessive, or X-linked (related to the sex chromosome).

In autosomal dominant hearing loss , one parent who carries the dominant gene for hearing loss and typically has a hearing loss passes it on to the child. In this case there is at least a 50% probability that the child will also have a hearing loss. The probability is higher if both parents have the dominant gene (and typically both have a hearing loss) or if both grandparents on one side of the family have hearing loss due to genetic causes. Because at least one parent usually has a hearing loss, there is prior expectation that the child may have a hearing loss.

In autosomal recessive hearing loss , both parents who typically have normal hearing, carry a recessive gene. In this case the probability of the child having a hearing loss is 25%. Because both parents usually have normal hearing, and because no other family members have hearing loss, there is no prior expectation that the child may have a hearing loss.

In X-linked hearing loss, the mother carries the recessive trait for hearing loss on the sex chromosome and passes it on to males, but not to females.

There are some genetic syndromes,in which, hearing loss is one of the known characteristics. Some examples are Down syndrome (abnormality on a gene), Usher syndrome (autosomal recessive), Treacher Collins syndrome (autosomal dominant), Crouzon syndrome (autosomal dominant), and Alport syndrome (X-linked).

Other causes of congenital hearing loss that are not hereditary in nature include prenatal infections, illnesses, toxins consumed by the mother during pregnancy or other conditions occurring at the time of birth or shortly thereafter. These conditions typically cause sensorineural hearing loss ranging from mild to profound in degree. Examples include:

§                         Intrauterine infections including rubella (German measles), cytomegalovirus, and herpes simplex virus

§                         Complications associated with the Rh factor in the blood

§                         Prematurity

§                         Maternal diabetes

§                         Toxemia during pregnancy

§                         Lack of oxygen (anoxia)

Acquired Causes

Acquired hearing loss is a hearing loss, which appears after birth, at any time in one's life, perhaps as a result of a disease, a condition, or an injury. The following are examples of conditions that can cause acquired hearing loss in children are:

§                         Ear infections (otitis media) (link to specific section above)

§                         Ototoxic (damaging to the auditory system) drugs

§                         Meningitis

§                         Measles

§                         Encephalitis

§                         Chicken pox

§                         Influenza

§                         Mumps

§                         Head injury

§                         Noise exposure

HEARING LOSS

                         Hearing Loss

Hearing loss has been called an "invisible" disability.

Why?

• You can't tell someone is deaf just by looking at him.
• Hearing loss often doesn't cause physical pain.

But hearing loss can greatly affect your child's life.

Here are some facts on hearing loss:

• About 1 out of 1,000 baby born is born with a hearing loss.
• You can start having hearing loss any time during your life.
• In this country, about 10 million children younger than 18 have a permanent hearing loss.
• Many more people develop hearing loss later in life.

Signs of Hearing Loss
As a parent, you'll probably be the first to notice if something's wrong. 
Check to see if your baby might have a problem.

Types of Hearing Loss

Sensorineural hearing loss? Progressive hearing loss? What do all these words mean? In this section we explain the different kinds of hearing loss.

Causes of Hearing Loss
Learn what the common causes of deafness are.

Genetics of Hearing Loss
Like blue eyes and freckles, deafness can be passed down through the family. Read this section to find out how genetics may affect your children's hearing.

Can My Child Hear?
From newborn hearing screening to OAEs, we tell you about the different ways to test hearing.

Signs of Hearing Loss

As your child grows, does something seem wrong with his/her hearing?   

Does she:

• Sleep soundly even when you talk loudly near her?
• Not babble anymore (after 9 months)?

Signs of normal hearing
If you think your child has a hearing loss, talk to your doctor. Also, read this timeline of normal things most hearing babies do. 

Just remember, all children are different. They may not do all of these things on time:

From birth to 3 months:

• React to loud noises
• Wake up at loud sounds
• Be soothed by the sound of your voice
• Start making sounds in the back of her throat, like going "goo"

From 3 to 6 months:

• React to the sound of your voice
• Start turning he/her head or eyes towards sounds
• Like playing with toys that make noise
• Stop to listen to voices
• Smile when someone talks to him/her
• Cry in different ways when she needs different things - such as if he/she's hungry, or needs to be changed.

From 6 to 12 months:

• Answer to his/her name
• Make many different baby talk sounds
• Start to understand simple words, like "mama," "dada," and "wave bye-bye"
• Turn his/her head to familiar sounds, like a telephone ringing
• React to changes in your tone of voice

By 12 months:

• Copy sounds that he/she hears
• Answer simple questions like, "Where's the ball?"
• Recognize his/her name
• Understand what "no" means

From 12 to 18 months:

• Give you a toy when you ask him/her
• Point to parts of the body when you ask him/her
• Put sounds together
• Use a few simple words, like "mama," "more," and "no."
• Follow simple directions that you tell him/her

By 18 months:

• Understand about 50 words

By 2 years:

• Understand yes and no questions
• Use words that you often use at home or school
• Make simple sentences
• Follow simple orders without being shown what to do

By 2 ½ years:

• Use about 270 words
• Say or sing short rhymes and songs
• Check out interesting sounds, or tell others about them

By 3 years:

• Make simple sentences of 3 to 4 words
• Use about 1,000 words
• Be able to tell a story
• Know his/her name and the names of people in her family
• Sing songs

Types of Hearing Loss

There are different kinds of hearing loss.

• Conductive hearing loss is when sound can't reach your inner ears.

• Sensorineural hearing loss is when the cochlea or the auditory nerve isn't working.
• Mixed hearing loss is when there is both conductive and sensorineural hearing loss.

Another way of talking about different types of hearing loss is by how a person hears.

• Unilateral hearing loss is when hearing loss is only in one ear.
• Progressive hearing loss is when the hearing loss gets worse over time.
• Fluctuating hearing loss is when the hearing loss changes. It may sometimes be worse and sometimes better.

Some other types of hearing loss don't fit any of these groups.

• Auditory neuropathy is when the cochlea works but there is something wrong with the auditory nerve. This hearing loss can be very confusing.
• Central Auditory Processing Disorder (CAPD) is when there's something wrong with how your child's brain interprets the signals it gets from the ear.

Conductive Hearing Loss

Conductive (kun-DUK-tiv) hearing loss is when sound can't reach your inner ear.

What causes conductive hearing loss?

• Ear infections
• Ear infections can make fluid build up in the middle ear.
• Something growing inside the ear canal.
• Earwax pressing on the eardrum.

How it affects your child's hearing

• This may make sounds seem quieter.
• Your child might not be able to hear quiet sounds.

Can it be fixed?
Yes. This kind of hearing loss can usually be fixed with:

• Medicine to treat ear infections
• An operation

Sensorineural Hearing Loss

Sensorineural (sen-sor-ee-NEW-ral) hearing loss is when the cochlea or the auditory nerve isn't working.

What causes sensorineural hearing loss?

• Side effects of medicine
• Infections
• High fevers
• Genetics (passed through the family)

How it affects your child's hearing

• The hearing loss is permanent
• The hearing loss might get worse
• Your child may not be able to hear quiet sounds.
• Your child may not be able to tell the difference between sounds.
• This would make it hard for your child to understand what people say.

Can it be fixed?
Probably not. Sensorineural hearing loss is usually permanent. 
The cochlea or auditory nerve could be damaged. 
Or they may never have grown right in the first place.

Unilateral Hearing Loss

If you think your child is having trouble hearing, take him to an audiologist to get his hearing tested. It may be a unilateral hearing loss. Then get help early. With early help, your child will succeed.

What is unilateral hearing loss?               
Unilateral (yoo-nih-LAT-er-al) hearing loss affects only 1 ear. People with unilateral hearing loss can hear normally in 1 ear, but have trouble hearing out of the other ear. The amount of hearing loss is different for different people. It can be mild, moderate, severe, or profound.

What causes unilateral hearing loss
There is more than one possible cause?

Some children are born with a unilateral hearing loss. For them, the hearing loss is passed down in the family, or genetic. Or it might be because of problems with the pregnancy or when the child was born.

Some people get a unilateral hearing loss later on in life. The cause is usually an illness (like meningitis or mumps) or a bad ear infection. It could also be caused by loud noise, like loud music or jackhammers.

Signs of unilateral hearing loss
People with unilateral hearing loss can hear well in most situations. This is because 1 ear is normal. But sometimes there are problems. If your child has unilateral hearing loss, he might have trouble:

• Figuring out where sounds are coming from. This is called localization.
• Understanding what people say when there is other noise at the same time. Like other people talking, buzzing from lights, or TV or music.
• This is worse when the "good ear" is close to the other noise
• Paying attention in class
• Following directions in class
• Learning new things

If your child has trouble with some of these things, he might have a unilateral hearing loss. Take him to an audiologist as soon as possible for a hearing test. Also, take him to an otolaryngologist.

How to help your child
If your child has unilateral hearing loss, the good news is that there are simple things you can do to help him.

Hearing aids
Sometimes a hearing aid worn on the ear with hearing loss can help. It depends on the amount and kind of hearing loss. Ask your child's audiologist about a hearing aid. The audiologist will figure out if it would help your child.

FM system
An FM system can help your child hear well in noisy places, like the classroom or a restaurant. A child might wear a hearing aid and use an FM system, too.

In the classroom

Most children with unilateral hearing loss do very well in school. But they might need extra help. Get your child the help he needs as soon as possible. That way, he will not fall behind in school. Children with unilateral hearing loss that do not get help sometimes fall behind or even fail a grade. But children that do get help can succeed in school as much as hearing children. Here are some simple things you can do to help your child do well in school:

• Make sure his teachers know about the hearing loss.
• Your child's teachers should let him sit wherever he can hear the best.
• Have your child sit no more than 5 or 6 feet away.
• Ask the teacher to make sure your child's "good ear" is close to the teacher. This will help him hear the lessons and directions.

• Have your child sit as far as possible from noisy places.

• Like the hall, the playground and the street.

• Have your child sit away from things like air conditioners, pencil sharpeners, and heaters.

• Quiet noises might bother your child, even if they wouldn't bother someone with normal hearing. This could make it harder for your child to learn.

• Ask the school to get rid of things that stop sound from traveling well in the classroom.
• Like tennis balls under desks, or carpeting on the floor.

• Ask the teachers to teach your child with things he can see.
  Your child may learn better that way.
• Teachers can write key vocabulary words on the blackboard.
• Teachers can also use things like overhead projectors and videos to help your child learn better.
• Ask the teachers to make sure that your child understands the lessons and directions before moving on to something else.

• Ask the teacher for lessons before class.
  Sometimes your child can read ahead in the lesson book. That way, he will understand more when the teacher talks about the lesson in class.

Outside the classroom

• Teach your child to be extra-careful in dangerous situations.
  He might have trouble figuring out where sounds are coming from.
• Teach him to look carefully both ways before crossing the street.
• Put rear-view mirrors on his bike. Teach him to look out for cars driving behind him.
• Protect your child's "good ear."
• Use earplugs to protect your child's hearing from very loud noises (like lawnmowers, power tools, and loud music).
• Take your child to the doctor to have his hearing tested often. The doctor will tell you how often to do this.
• Ear infections can hurt your child's hearing. If your child gets an ear infection, take him to the doctor right away. The doctor can give your child medicine to treat the ear infection before it hurts his hearing.

Progressive Hearing Loss

What is progressive hearing loss?
A progressive hearing loss (pro-GRE-siv) is a hearing loss that gets worse over time. The change in hearing can happen over a few weeks, months, or even years. It can start as a mild loss and later become a moderate or severe hearing loss.

Or a child can have normal hearing as an infant and begin lose her hearing when she is 2 or 3 years old. This is called delayed onset hearing loss. Delayed onset hearing loss can happen when a child is born with a virus that no one finds out about until later. Other problems at birth can also caused a delayed onset hearing loss.

Everyone was so upset when they found out
Relatives and teachers were also noticeably alarmed or overly concerned. That's when I realized, 'Uh-oh, something's wrong with me. The way people are reacting to it, it must be really bad.' I was ashamed of what was happening to me.

Causes of progressive hearing loss
There is more than one cause. But you may not know what it is.

• Genetic

• Most progressive hearing losses are inherited. This means it was passed down through the family Doctors know about some genes that might cause progressive hearing loss. But they are still looking for other genes.

• Illness

• Hearing losses that happen because of diseases like meningitis are more likely to get worse over time.

• Hearing loss from medicine

• Some medicines used when a child is very sick can cause a hearing loss. Or they can cause a child with hearing loss to lose more hearing. The hearing loss can keep getting worse even after the child stops taking the medicine.

• Hearing loss from loud noises

• In adults, loud noises can cause progressive hearing loss. This kind of hearing loss is usually very slow. Loud noise does not usually cause progressive hearing loss in children.

• Middle Ear Problems

• If there is a middle ear infection, the hearing loss may get worse for a short time, but then get better (see fluctuating hearing loss). A leak of fluid from the inner ear to the middle ear can also cause progressive hearing loss. But this is rare.

How can I tell if my child has a progressive hearing loss?

1) Try to find out the cause of your child's hearing loss.

This helps because some kinds of hearing loss are more likely to get worse. Children who have unilateral hearing loss may be more likely to have progressive hearing loss. Some genetic problems cause progressive hearing loss.

2) Watch your child.

Once you know how much your child hears, you may be able to tell if she isn't hearing as well. Here are some signs that her hearing is changing:

• She seems to be saying "what?" a lot more.
• She doesn't seem to hear the dog barking anymore.
• She turns up the volume of the television.
• She suddenly doesn't want to wear her hearing aids. But before, she didn't seem to mind.
• She seems dizzy or has trouble keeping her balance. Sometimes children who are losing their hearing get dizzy.
• She may start to have problems in school because she isn't hearing as well as she was.

3) Take your child to an audiologist for a hearing test if you think there may be a change in hearing.

4) Call your doctor if there is a sudden change in hearing.

Some problems must be treated right away. Sometimes a doctor will ask you to go to the emergency room if he or she can't see you in the office right away. Losing your hearing suddenly is called sudden hearing loss.

Get help if your child has a progressive hearing loss

A progressive hearing loss can be confusing and scary. If your child's hearing loss is changing slowly, she may not even notice but may start to have more problems in school or with friends.

• Talk to your child about her fears. She may not want to accept that she is losing her hearing. Older children and teens can get depressed when they learn they are losing their hearing. A therapist may help your child talk about how she feels.
• Make sure her hearing aids are strong enough. You may have to get new hearing aids as her hearing loss changes.
• Keep track of how things are going in school. She may need new help at school. 
• Some children lose so much of their hearing that they become candidates. Talk to your audiologist about it.
• If your child has a progressive hearing loss, it can be hard on the rest of the family too. You may feel just as scared and confused as your child. Talking to other parents may help. Or you may want to talk to a therapist about how you feel.

Progressive Hearing Loss FAQ

Q. How can I find out about progressive hearing loss if it is hard to give my child a hearing test?

A. This is a very important question. Very young children or children with learning almost always have audiograms that change over time because it is hard to get a good test result. Ask the audiologist or doctor to go over all the hearing tests to see what your child's best hearing is.

Even if your child doesn't do well in the test room, an audiologist will usually try a behavioral hearing test if you are worried about a change in hearing. And there are other tests that don't require your child's cooperation that may help in finding a real change in hearing. These are otoacoustic emissions testing,tympanometry and acoustic reflex threshold measurement. Another hearing test used is the Auditory Brainstem Response (ABR). The doctor might have to give your child medicine to make her sleepy before the ABR.

Q. My child passed the infant hearing screening at the hospital when she was born, but she is not talking yet. Sometimes I worry about her hearing. Could she have hearing loss?

A. Yes. Occasionally a hearing screening test at the hospital may be wrong, and a hearing loss can be missed. But sometimes a child can pass a screening, and get a hearing loss later. This is delayed onset hearing loss, a type of progressive hearing loss. This might be caused by having CMV when the child is born.

Q. How often should my child have her hearing tested?

A. After you know about the hearing loss, take her to get a hearing test at least every 6 months. The doctors and audiologists want to see whether her hearing is staying the same or changing, especially in the beginning.

Q. Can a progressive hearing loss be prevented?

A. It depends on the cause. Medical causes, like middle ear problems, can sometimes be treated. But sometimes treatment doesn't help, and the hearing gets worse anyway.

Q. How can I help my child when I am afraid of finding out there is a progressive hearing loss?

A. When you help your child to hear her best, you are helping her! If she does have a progressive loss, you can make sure her hearing aids continue to help her as much as possible. You can also tell her family, friends and teachers what to do to help her understand better. It is not easy to look out for something that might get worse. But you need to look out to help your child do the best she can do!

Fluctuating Hearing Loss

If you think your child's hearing is changing, get his hearing tested. Then get help early.

Fluctuating hearing loss can be confusing to parents. It can happen to children with normal hearing, and to children with hearing loss.

What is fluctuating hearing loss?

A fluctuating hearing loss (FLUK-chew-ate-ing) changes over time. It can get worse and better. It's different from progressive, where the hearing loss gets worse suddenly, or over time.

Fluctuating hearing loss can cause conductive, sensorineural or mixed hearing loss. Sometimes fluctuating loss can become a permanent hearing loss that gets worse over time. Take your child to an audiologist and a doctor to see if you can do something about the fluctuating hearing loss.

Causes of fluctuating hearing loss

If you think your child has a fluctuating hearing loss, get him tested to find out what's causing it. If you find out the cause, you may be able to do something about it.

Middle and Outer Ear Problems

• Infections often cause fluctuating hearing loss. Your child's hearing can get worse during an infection when there's liquid in the ear. But it should get better once the ear infection clears up.
• Earwax can block your child's ear canal. This can cause a hearing loss. Earwax can be a problem for children who wear earmolds and hearing aids. When earwax blocks your child's ear canal, his hearing aid may a high-pitched noise whistling noise called feedback.

Disease

Different diseases can affect hearing in different ways:

• Meniere's Disease causes fluctuations in hearing. But this doesn't happen a lot in children.
• Autoimmune inner ear illness can make hearing worse. But with treatment it may get better.
• Meningitis can cause hearing loss in 1 out of 10 children. But sometimes the hearing loss gets better after several months.

Auditory Neuropathy

Sometimes children with auditory neuropathy have fluctuating hearing loss. Doctors think that damaged auditory nerves cause auditory neuropathy. But because we don't know exactly what causes auditory neuropathy, we don't know why it causes changes in hearing.

Enlarged Vestibular Aqueduct

A vestibular aqueduct is the channel that connects a child's inner ear to his brain. This problem means that a child's vestibular aqueduct is bigger than it should be.

If your child has this problem, he could have a progressive or fluctuating hearing loss. He should also be careful not to hit his head (this could cause more damage).

Loud Noises

Loud noises can cause a small hearing loss and ringing in the ears for several hours. Then hearing gets better. But this short-term hearing loss can get worse over many years. This doesn't happen a lot to children, but protect your child against loud noises anyway.

Signs of fluctuating hearing loss

It can be hard to tell if your child has fluctuating hearing loss. This is true especially if your child is very young, like a baby or toddler. But here are some signs of a fluctuating hearing loss:

If a child has normal hearing

As a baby, he might:

• Not show interest in music
• Not become quiet when his mother speaks

If your baby starts acting only a little bit differently, you might not notice anything.

It's easier to tell if an older child with normal hearing has a fluctuating hearing loss. He might:

• Not pay as much attention as before
• Get distracted more easily
• Not understand directions correctly

If a child has a hearing loss

If you already know that your child has a hearing loss, it may be easier to tell if he starts acting differently to sounds you know he should hear. As a baby, he might:

• Not want to wear his hearing aid
• Act like his hearing aid battery isn't working anymore

An older child can tell you when his hearing changes.

Auditory Neuropathy

Auditory neuropathy (AN) (AW-dih-tor-ee new-RAH-puh-thee) is a type of hearing loss that can look very confusing.

• Your child might seem to hear sometimes and not hear at other times.
• She may hear when it's quiet, but not hear when there is other noise.
• She may pass certain types of hearing tests but fail others.

What is auditory neuropathy?

Auditory neuropathy is a type of hearing loss where the cochlea seems to work. But there is something wrong with how the auditory nerve works.

Children with A have different amounts of hearing loss.

• It can range from mild to profound.
• It is usually in both ears, but the amount of hearing loss might be different in each ear. Sometimes, the hearing loss is in just 1 ear. This is called a unilateral hearing loss.
• It can stay the same.
• It can get worse over time. This is called progressive hearing loss.
• It can be worse some days than others. This is called fluctuating hearing loss.
• Sometimes the hearing loss gets better. If your child's hearing loss is going to get better, it will usually happen before she turns 2.

Auditory neuropathy may also be called Auditory Dys-synchrony (dis-SINK-runny). So sometimes it will be called AN/AD.

How to find out if your child has auditory neuropathy?

If your child has trouble hearing, take her to the doctor or audiologist to get her hearing tested. Try to find someone who knows about AN, and has worked with other children with it. The doctor or audiologist may need to do many tests to find out if your child has AN. This is because one test may show that your child has normal hearing. But another test may show that your child is deaf.

Two of the tests that are usually done test different parts of your child's hearing system.

• ABR (auditory brainstem response) tests the auditory nerve. This nerve sends sounds to the brain. If your child has AN she will probably have a poor ABR.
• OAE (otoacoustic emissions) test whether the cochlea is working. Children with AN usually have normal OAEs. But sometimes they lose their OAEs over time.

Neither the ABR nor the OAE test hearing itself. They are only looking at different parts of the hearing system to see if they are working. It's like checking different parts of your car, but not really testing to see if it drives!

Your audiologist may want to do other tests to find out what the problem is. The tests will show more about where there might be a problem.

• Tympanometry tests whether the eardrum is working.
• Middle ear muscle reflexes test how well the sound is passing through the outer ear to the middle ear. These are usually absent in people with AN.
• Pure tone audiometry tests how well your child responds to different tones. This test sometimes looks normal even if your child has AN. This is because the test is done with single tones and in a quiet room. Children with AN can sometimes hear when it's quiet, but can't hear when there is other noise.
• Speech audiometry tests how well your child hears speech sounds. Children with AN usually have more trouble understanding speech than you would expect from the other hearing tests. But since speech audiometry is done in a quiet room, it can still look like your child hears better than she does in a noisier place.

What causes auditory neuropathy?

Doctors do not know what causes auditory neuropathy. There is probably more than just 1 cause. Some of the things that may increase the chance of having auditory neuropathy are:

• Problems at birth or premature birth. These babies may not get enough oxygen in their brains. Or they may have jaundice, where the baby's skin is yellow. Some doctors think these problems may cause auditory neuropathy.
• Having a sister or brother with auditory neuropathy. Sometimes it runs in families. So if you have one child with auditory neuropathy, have the doctor test your other children, too.

 

How You Can Help Your Child?

Your child with auditory neuropathy may need different help from children with other kinds of hearing loss. She may also need different kinds of help, as she gets older. This is because her hearing loss may change.

Help your child learn language

Like all children with hearing loss, children with AN need to learn language. Children with auditory neuropathy often learn language best when they use their sight to help them. If it is important to you that your child can communicate with hearing people, you might want her to learn an English-based sign language or cued speech. 

Use technology to help your child communicate

Technology can also help children with Auditory Neuropathy communicate:

• Hearing aids do not usually help people with auditory neuropathy. That is because hearing aids make the sounds louder but not clearer.
• FM and Sound Field systems help some children understand what other people are saying.
• Cochlear implants help some children with auditory neuropathy learn to hear and speak. 

Help your child cope with AN

Auditory neuropathy can be confusing and frustrating for both you and your child. Just think how you would feel if you could hear sometimes and not hear other times. Or if people think you can hear them but you can't understand what they are saying.

Talk to your child about how she feels. Let her tell you when she is upset. You may be able to think of things she can do that will help.

Talk to other parents of children with AN or to adults with AN. You can ask questions and get support from other parents.

When your child has AN plus other conditions

Some children with AN have other conditions too, like cerebral palsy (CP). The same things that caused the AN, like being born too early, may have also caused other conditions. If your child has other conditions plus AN, your doctor may also send you for other medical tests.