QUESTIONS ABOUT AMPLIFICATION
FOR CHILDREN
WHEN SHOULD MY CHILD GET A HEARING AID?
Most newborns have their hearing tested at birth and can be fitted with hearing aids within a few weeks. Research tells us that fitting a hearing aid as soon as possible helps to minimize the effect of the hearing loss on language development. Ideally an infant will be fit before 3 months of age and no later than six months of age.
WHAT IS A HEARING AID?
A hearing aid is a device for the ear, which makes sounds louder in the range of a particular hearing loss. The goal is to provide the ability to hear speech and environmental sounds at a comfortable level.
WHO DECIDES WHICH HEARING AID IS BEST?
Parents and the child's audiologist should come to a careful decision regarding amplification after consideration of the infant or child's individual needs, including the characteristics of the hearing loss, available technology as well as financial resources. Hearing aids are prescribed to assure the best possible fit with the information available. As more specific information about the hearing loss is obtained, the hearing aids will be adjusted. The audiologist will perform tests with the hearing aids on your child to further confirm the fitting benefit. The child's physician will provide a medical clearance statement to permit the fitting of hearing aids on a child in compliance with the FDA (Food & Drug Administration) requirements.
WHAT STYLES OF HEARING AIDS ARE AVAILABLE FOR CHILDREN?
Hearing aid styles differ by how they are worn on the ear.
 BEHIND-THE-EAR (BTE): Hearing aids are positioned behind the ear and coupled to the ear with a custom fitted earmold. BTE hearing aids are utilized for infants and young children due to the following features:
- BTE earmolds are made from soft materials, which are more comfortable and less easily broken, for physically active children.
- Earmolds can be replaced as the child's ears grow. It is not necessary to recase or replace the hearing aid itself
- BTE hearing aids are often more reliable and less easily damaged.
- BTE hearing aids are easily connected to a FM system or assistive listening device.
- BTE hearing aids and earmolds are available in colors and with accessories designed specifically for children.
IN-THE-EAR (ITE): Other completely in-the-ear hearing aid styles may be available to older children and adults.
HOW DOES A HEARING AID WORK? Sounds are picked up by a microphone and carried to a signal processor (amplifier) where they are made louder and shaped to match the hearing loss characteristics such as frequency (pitch) and intensity (loudness). The sound is then sent through the receiver and delivered by the earmold into the ear.
Earmold: Custom made, seals the ear to prevent sound leakage which then causes feedback (whistling)
Tubing: Soft, flexible; connects the earmold to the hearing aid; securely attached to the earmold and detachable from the earhook; replaceable if torn, cracked or too short.
Earhook: Curved, hard plastic; supports the hearing aid on top of the ear; protects the receiver and channels sound to the earmold. May have a filter to further shape the sound for the hearing loss.
Receiver: Sound speaker inside the hearing aid that opens into the earhook.
Microphone: Collects sound for amplification through a small opening in the hearing aid case.
Internal Adjustment Controls or Computer Cable Connector Port : Accessed by the audiologist to modify the hearing aid sound response.
Switch: Usually 0 = Off; T = Telephone or FM System, M = Microphone
Volume Control: Usually a numbered wheel that changes the loudness of the sound. Typically the smaller the number the lower the volume. Some hearing aids may not need this control.
Battery Door: Holds the battery which is changed regularly; opening the door will turn off the hearing aid; batteries are toxic if swallowed and tamper resistant doors are recommended for children.
WHAT TYPES OF HEARING AID CIRCUITRY ARE AVAILABLE?
Conventional or Standard Hearing Aid Circuits use a traditional analog signal processor; the audiologist modifies the hearing aid response by adjusting controls in the hearing aid case.
- Analog Signal Processing: These circuits have an internal microchip for more precise sound adjustment than is possible with a manual adjustor. Programmable Hearing Aid Circuits may have channels that split the sounds into parts for the amplification to be tailored to specific hearing loss characteristics. They may have memories to store different hearing aid responses for varied listening environments such as home, classroom and playground. They may use a remote control for on/off and to change listening memories. The audiologist uses a computer to make fine tuning adjustments in how the hearing aid processes sound. This can be easily adjusted over time.
- Digital Signal Processing: These circuits use an internal microprocessor to convert the sound to numbers according to a mathematical formula called an algorithm. The algorithm is sensitive to changes in speech and environmental noises and modifies the signal before it is delivered to the ear.
WHICH IS BETTER, CONVENTIONAL OR PROGRAMMABLE HEARING AIDS?
Conventional analog hearing aids are being phased out due to improved technology and increased affordability of programmable hearing aids. Programmable hearing aids may offer better sound quality and provide more flexibility as the child's hearing levels are better defined or when there is a change in hearing levels.
WHAT OTHER TYPES OF HEARING AIDS MIGHT BE NECESSARY:
Bone Conduction Hearing Aids: Some children with a conductive hearing loss, and/or malformed or missing outer ears may use bone conduction hearing aids. This is a specially adapted version of a behind-the-ear style of hearing aid which are held in place by a headband.
Transpositional Hearing Aids or Vibro-Tactile Hearing Aids: These are specialized hearing devices that may be necessary for some children with profound deafness who do not benefit from traditional types of hearing aids.
WHAT OTHER DEVICES MIGHT BE OPTIONS FOR MY CHILD?
There are other accessories and or alternatives to hearing aids, which you and your audiologist may consider for your child. Some of these are as follows:
Cochlear Implant (CI): A cochlear implant is an electronic device that is surgically implanted in the cochlea of the inner ear. It transmits auditory information directly to the brain, by-passing damaged or absent auditory nerves. Technically, it synthesizes hearing of all sounds, but the wearer requires training to attach meaning to the sounds. This is called auditory "habilitation", or "re-habilitation". Typically, cochlear implant users have severe to profound hearing losses and do not get much benefit from hearing aids. Successful CI users gain useful hearing and improved communication abilities. The FDA has approved CIs for adults and children who are profoundly deaf at age 12 months, and for those with severe hearing loss at age 24 months.
FM System: These devices may be connected to the hearing aid to improve the ability to hear voices from a distance or in background noise. All hearing aids are limited in their ability to differentiate individual speakers. A FM system consists of a microphone worn by the speaker and wireless sound transmission to a receiver (either an electronic box or an ear-level connector) worn by the child. The most common application is with classroom teachers, however there are significant advantages for use with very young children and their parents.
Telephone Amplifier: This type of assistive listening device makes the telephone signal louder and may be used with or without a hearing aid.
Closed Captioning: This assistive device is either attached to a television or built in to a television to provide written text of the spoken words.
Finally, ALL hearing aids have limitations. Hearing aids cannot cure a hearing loss, they cannot amplify all frequencies across the frequency range, they cannot make sounds more clear if the inner ear (cochlea) is damaged and distorting these sounds and they cannot completely separate speech from background noise. Hearing aids will enhance your child's life and development when a close working relationship exists between the parents, their child, the audiologist and the intervention team
OTHER QUESTIONS YOU MIGHT WANT TO ASK AN AUDIOLOGIST:
- Is the loss permanent?
- Does my child need more testing?
- How often should my child's hearing be tested?
- Can you tell if my child' hearing loss will get worse or change?
- Do both ears have the same hearing loss?
- How will the hearing loss affect my child's speech and language development?
- What could have caused my child's hearing loss?
- Would you suggest genetic counseling for our family?
- May I have copy of the hearing test results?
- How much do hearing aids cost?
- Can I get help to pay for the hearing aids?
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- Can you help me contact a program that can lend me hearing aids?
- What will my child hear with the hearing aids?
- How often will my child need new hearing aids or parts?
- What are the parts of a hearing aid that may need to be replaced?
- With my child's hearing loss, should I consider a cochlear implant?
- Where can I go for more information?
- Can you give me resources of people who will have different perspectives on our decision making process? (i.e. other professionals/other parents/deaf and hard of hearing adults)
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More information/Resources about Cochlear Implants
Navigating a forest of Information
http://clerccenter2.gallaudet.edu/KidsWorldDeafNet/e-docs/CI/CI-K.pdf
Risk of Meningitis
http://www.fda.gov/cdrh/safety/cochlear.html
http://www.nlm.nih.gov/medlineplus/tutorials/meningitis/htm/index.htm
Cochlear Implant Myths & Realities
http://www.listen-up.org/ci/ci-myths.htm
NAD Cochlear Implant Position Paper
http://www.nad.org/site/pp.asp?c=foinkqmbf&b=138140
Cochlear Implant online discussion group
http://groups.yahoo.com/group/CIHear/
FAQ's about Cochlear Implants
http://thelisteningcenter.com
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