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03 March 2021

Diagnosing and assessing hearing loss in children.

More than 500 children are born with moderate to profound hearing impairment in Australia every year and 3% of children aged 0 to 14 experience a long-term hearing disorder.[1] In addition, at any given time 25% of school aged children suffer from middle ear infections and fluctuating hearing loss.

In recognition of World Hearing Day this week, today we speak with audiologist Dr Tegan Keogh about how to identify if your child has a hearing issue and what happens next. Dr Keogh shares her thoughts about the importance of early intervention and information about some of the treatments available.

Babies and hearing.

Screening of newborn babies usually takes place at the hospital within several days after being born. The health care system in each state performs the free test and offers follow up referral, investigation and care if required.

Better Health Victoria offers a guide on things to look out for to ensure a baby’s hearing is progressing as expected:

  • Newborn to age 8 weeks: startles or widens eyes at loud noises, is woken or stirs from sleep by noise
  • 8 weeks to 4 months: looks toward direction of sound, shows signs of listening
  • 6-12 months: turns head towards known voices or sounds, starts to babble
  • 12-18 months: can identify favourite toys, imitates words and sounds
  • 18-24 months: able to say single words, understands basic directions.[2]

Hearing loss in preschool and school aged children.

For toddlers and older children, signs of hearing loss vary. Dr Tegan Keogh from Hear Check, a Sunshine Coast audiology practice, and the President of Independent Audiologists Australia says that by age three, a child should be speaking in small sentences that are understandable by others.

Dr Keogh says unclear speech is often the first sign of a hearing issue. Other signs there may be a hearing problem include:

  • Mouth breathing
  • Frequent colds and flus or allergies
  • Child turns the volume up on television, music or games
  • Frequently misunderstands questions or instructions
  • Snoring, night waking or difficulty going to sleep
  • Irritable behaviour
  • Eating only soft foods
  • Saying “what?” or “huh” and appearing like they are ignoring you.

“While your child might be hearing you, they may be missing some pitches to be able to hear you perfectly and for the normal development of speech, language and literacy,” Dr Keogh explains.

“We see many children who have been diagnosed with ADHD and/or autism spectrum disorder (ASD) who also have significant, fixable hearing issues. The pathway changes incredibly as they start to get the help they need.”

The importance of early intervention.

Research shows that “early diagnosis and early intervention do make a difference”.[3] Hearing loss that goes untreated can lead to learning difficulties and prevent your child from reaching their full potential.

“There is a critical period for the learning of language, which is 0-3years. So, testing your child around 2.5 years is highly recommended, especially if they are not speaking in two word utterances. For example, ‘my doll’, ‘drink please’ or ‘where’s my book’? Picking up hearing issues in this bracket can mean that a child develops normal or near normal speech in time for school entry,” said Dr Keogh.

Additional testing during childhood can also identify impacts on hearing that may be a result of middle ear infections.

“Research tells us that often the impact of middle ear infections is underestimated by parents, teachers and health professionals,” says Dr Keogh. “Many children have silent infections, with no obvious clinical signs. That’s why the list of symptoms is really important to note. A child won’t be able to tell you they have a blocked ear until they are about 8 years of age,” Dr Keogh explained.

It is common for non-verbal children suspected of having ASD to experience moderate hearing loss that is completely fixable. For this reason, it’s important to include an audiology assessment as part of the ASD diagnosis process.

Diagnosis and treatment for hearing loss in children.

Given that hearing affects speech, language and motor skills, ruling out hearing issues is an important initial step, ideally before speech pathology and occupational therapy.

An audiologist will look in a child’s ears, test their middle ear function with a quick test called tympanometry, then they’ll play listening games with your child while they wear headphones. Dr Keogh recommends testing headphones on your child before the appointment so they are familiar with the experience.

Specially calibrated speakers in sound-proofed booths can also be used to gauge a child’s ability to hear more globally and adequately.

The next steps depend on the diagnosis and may include:

  • Referral to an ear, nose and throat (ENT) specialist for hearing issues that are medically treatable
  • Fitting hearing aids or devices and/or the use of assistive technology for permanent hearing loss
  • Ear-level remote microphone technology to enhance functional listening and receptive language for children with ASD
  • Further monitoring for fluctuating hearing loss (which is treatable).

Dr Teagan Keogh in a Hear Check testing booth
Image: Dr Teagan Keogh in a Hear Check testing booth

The NDIS and hearing supports for children.

The NDIS early childhood early intervention (ECEI) approach is designed to identify the type and level of early intervention support a child needs to achieve their best outcomes. This can include hearing supports. The first step is to get an assessment completed by an audiologist.

“If you’re unsure, book an appointment with a local audiologist who specialises in working with children. You don’t need a referral. If your child has a speech or language issue, then you could also ask your GP if you’re eligible for a chronic health management care plan for audiology. Audiology and hearing supports can also be funded under the NDIS in many instances,” Dr Keogh said.

If your child is diagnosed with a permanent hearing loss, your audiologist may refer you to Hearing Australia, an organisation that can help you apply to access the NDIS. Alternatively you can visit a local NDIS ECEI partner office. Your local audiologist can also help you by providing wrap-around services and devices which are outside the scope of Hearing Australia, but which are funded by NDIS.

Once your child has access and becomes an NDIS participant, they will get an NDIS Plan that includes a reasonable and necessary level of funding for early intervention supports. This funding can be used for early intervention providers such as audiologists.

Many audiologists emphasise the importance of following your intuition when it comes to hearing loss. If you feel something is not quite right, it is best to organise a hearing assessment.

Helpful resources.

You can find Hear Check and hundreds of other providers in the Leap in! Provider Network Directory. Special thanks to Dr Tegan Keogh for sharing her expertise with us. 

 

References:
[1] Australian Government, Vision and Hearing Disorders, 2016, accessed 1 March 2021
[2] Better Health Victoria, Hearing problems in children, accessed 1 March 2021
[3] Education Victoria, Hearing loss facts, accessed 1 March 2021

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