Pediatric Hearing Loss

Specialized hearing testing, diagnosis and treatment for children

Hearing and speech are an important part of learning and developing social skills as a child. Early diagnosis and management of hearing loss can help prevent delays in speech or language and optimize social and academic development. The C.S. Mott Children’s Hospital Audiology Clinic provides comprehensive care for children with hearing issues, from birth through age 21. We offer a full range of  testing, diagnosis and treatment of hearing disorders, in conjunction with our team of pediatric otolaryngologists (ENTs) and otologists.

What is hearing loss?

Hearing loss affects two in 100 children under the age of 18 to some degree. There are two main types of hearing loss: sensorineural hearing loss and conductive hearing loss. Sensorineural hearing loss is caused by a loss of function within the inner ear or with the connection to the brain.  It can be present at birth (congenital) or acquired, due to genetic causes, or less commonly due to loud noise exposure, trauma, infection or damage from medications that can be harmful to the ears. Conductive hearing loss is caused by a problem in the outer or middle ear in which the sound waves are not sent to the inner ear correctly.  Conductive hearing loss is the most common type of pediatric hearing loss and is usually acquired, although it can be congenital.  Causes of conductive hearing loss: 

  • ear infections (otitis media) or fluid behind the ear drums
  • perforation of the ear drum
  • excessive wax
  • foreign bodies in the ear canal
  • tumors (rare)

Signs and symptoms of hearing loss

While they don’t necessarily mean your child has a hearing loss, there are several signs that may indicate your child is having some level of difficulty hearing:

  • child doesn’t startle at loud noises
  • child turns up the volume of the TV or radio excessively high
  • lack of response when name is called
  • difficulties articulating words
  • delayed speech/language
  • difficulties in school
  • repeated earaches, ear pain or head noises
  • difficulty understanding what people are saying, or consistently inappropriate responses to questions

Your primary care provider can help you determine if your child’s symptoms should be evaluated by a hearing specialist.

Diagnosing hearing loss

Early diagnosis of hearing loss is vital to allow for intervention and appropriate support to avoid developmental, social, and academic delays.  Accurate diagnosis is especially important to ensure that your child receives appropriate treatment for his or her own unique needs and type of hearing loss. Our audiology team specializes exclusively in diagnosing hearing loss in children.  The diagnostic process takes place in our state-of-the-art Audiology Clinic, and often includes one or more of the following elements:

  • Newborn hearing screening measures your child's physical response to quiet sounds.  The most common newborn hearing tests are the otoacoustic emissions (OAE) test and the auditory brain stem response (ABR) test. Both tests are painless, take only a few minutes, and give good results.  Because we screen newborns seven days a week at the Von Voigtlander Women’s Hospital Birth Center, located within C.S. Mott Children’s Hospital, we have a 99% in-house screening rate for all babies born at U-M.
  • Behavioral hearing assessments determine the softest sounds that a child can hear, also referred to as their hearing thresholds.  Sounds are presented via air conduction (soundfield, headphones or insert earphones) and bone conduction by placing a device that sends vibrations to the skull).  There are three main types of behavioral hearing tests:
    • Behavioral observation audiometry, often used for infants, involves watching behaviors such as sucking, eye widening and startles in response to sound.
    • Visual reinforcement audiometry, often used for children 5 months to 2 years old, involves having the child sit on the caregiver's lap while the clinician teaches the child to respond to sounds with a head turn. The child is reinforced with a light-up animated puppet or video.
    • Conditioned play audiometry, often used with children 2 ½ years of age and older, uses games to teach a child to respond to sound.
  • Tympanometry assesses how well the eardrum is functioning. A tympanogram is obtained by placing a small rubber ear tip in the ear. Eardrum movement is measured in response to air pressure changes.   This information can be used to help diagnose problems with the eardrum and middle ear space. Abnormal tympanograms can help diagnose problems such as fluid in the middle ear, a hole in the eardrum, or problems with the small bones in the middle ear space that can result in hearing loss.
  • Acoustic reflexes are tests that check the function of a small reflexive muscle in the middle ear space called the stapedial reflex. Much like with tympanometry, a small rubber tip is placed in the ear and a loud sound is presented to the ear. This provides information about the nerve pathway along the reflex arc.
  • Otoacoustic Emission (OAE) testing assesses the function of the hair cells in the inner ear. To measure OAEs, sounds are presented through an earphone and a response (emission) from the inner ear is recorded. These emissions can be used to predict the presence of a normal (or no more than mild) hearing loss. OAEs are a helpful tool that can be used to screen newborn hearing or complement behavioral testing, and they are also used as a way to diagnose hearing disorders in older children who are not developmentally ready for behavioral testing.
  • Auditory Brainstem Response (ABR) testing is usually done while a child is sleeping. Electrodes are placed on the forehead and near each ear. Different sounds are played through earphones and the child's brainwaves are recorded in response to the sounds played. This test is often used to aid in appropriately fitting a hearing aid for an infant who is not yet capable of behavioral testing. It is also helpful in other populations who are not developmentally able to have their hearing tested conventionally. ABR tests are done in our audiology clinic, as well as under anesthesia in the operating room.
  • Genetic testing is available for children with sensorineural hearing loss of early onset and unknown cause.  Genetic testing can provide an accurate understanding of the cause of the patient’s hearing loss, and provide guidance regarding treatment and long-term medical management, particularly with young infants. Genetic testing is arranged through referral to the Pediatric Genetics Clinic or through your pediatric otolaryngologist.

Treatment and management of hearing loss

Thanks to modern treatment techniques, almost all types of hearing loss can be helped by our team of pediatric hearing specialists.  We offer a full range of treatment and management options to meet each child’s individual needs for their type of hearing loss as well as their age and developmental status.  No single treatment or intervention is the answer for every child, so it is important to choose a center that offers the full range of treatments by a team that specializes in children with hearing loss.

  • Hearing aids make sounds louder. They can be worn by people of any age, including infants. Young children are usually fitted with behind-the-ear style hearing aids because they are better suited to growing ears.  We offer special expertise in evaluating children for hearing aids, in addition to special child-specific fitting and adjustment techniques to make the hearing aids as comfortable and precise as possible for your child. We offer a variety of technologies from different companies, and also maintain a donor bank of loaner hearing aids thanks to generous donations from our supporters.
  • FM systems send sounds to the ears to help a child hear better.  They work especially well in noisy situations, such as classrooms. The speaker, a teacher, for example, speaks into a microphone, from which a transmitter sends sounds to a receiver built into the child’s hearing aid or worn around the neck  We will work with your family to determine if an FM system may be right for your child, and assist in finding and fitting a system to meet your child’s needs.
  • Surgery to correct a structural deformity is an option for some children with chronic ear disease or to restore conductive hearing loss caused by tumors or problems with the Eustachian tube.  Our pediatric otolaryngologists (ENTs) and otologists offer a wide range of surgical options for children with complicated hearing disorders, with special expertise in minimally invasive surgical techniques.  All procedures are performed at C.S. Mott Children’s Hospital in the dedicated pediatric operating room by a specialized surgical team that works exclusively with children.
  • Cochlear implants can be an appropriate option for children who are not candidates for other surgical options or hearing aids.  Whereas hearing aids amplify sound from the outside, cochlear implants transform sound into electrical energy with stimulates the hearing nerve.
  • Bone conduction aids, also known as Bone Anchored Hearing Aids (BAHA), or osseointegrated hearing aids, combine a sound processor with a small titanium fixture implanted behind the ear. This unique system allows sound to be conducted through the bone rather than through the middle ear.  A child can be fit with a bone conduction device on a headband until it is determined that the child is ready to have the device implanted surgically.
  • Speech therapy from our certified speech-language pathologists ensures that your child will receive habilitation services from a professional who specializes in language impairments due to hearing loss. The speech-language pathologist serves as an important member of the team, making sure that your child is meeting their developmental milestones. 
  • Support and resources are an essential part of making sure families have what they need for their child to be successful.  Our Sound Support program  provides support and guidance to families, in addition to providing helpful referrals and recommendations to peer groups, local educational services, and facilitating support in the classroom.

Take the next step:

Schedule an appointment online or by calling us at 734-936-5730