Rehabilitation

Oticon_BabyOnce a permanent hearing loss is identified, our team will work quickly to obtain hearing instruments for your child.  We know that hearing loss can disrupt language development, as learning spoken language depends on the ability to hear speech.

The primary goal of hearing instruments is to ensure speech is audible to the child. During the hearing aid evaluation, (known as a Hearing Aid Consult), we discuss the amplification options available for your child. During the fitting of the hearing aid(s), we will program the device(s) according to your child’s needs and hearing loss, and we will teach you (and your child) how to use and care for the hearing aid(s). At the follow-up visit, we will test your child’s hearing with their hearing aids on (if appropriate).

Styles of Hearing Aids

For most hearing losses, hearing aids are recommended to help maximize the amount of auditory information a patient receives. Hearing aids come in a variety of sizes and colors, as well as with differing degrees of technology. When selecting different types of amplification the audiologist will keep several variables in mind:

  • Your child’s age and needs
  • The degree and type of the child’s hearing loss
  • The durability of the hearing aid
  • The service from the manufacturer
  • The hearing aid’s ability to connect to other devices that are used in school

The audiologist will recommend which type of hearing aid is best for you or your child’s type of hearing loss. They will then work with your family to make sure that  your child is getting the most out of their hearing aid.

Behind-the-Ear (BTE)/Receiver-in-the-Canal (RIC)

This style of hearing aid fits behind the ear and is anchored in the ear canal with a variety of types of earpieces.  These styles of instruments are particularly suitable for children as they can often allow for connection to other devices in the classroom.

In-the-Ear (ITE)/In-the-Canal (ITC)/Completely-in-the-Canal (CIC)

These styles of hearing aids all have in common that the hard plastic, custom shell is designed to fit completely in the ear canal. They vary in size with an ITE filling the entire ear and a CIC fitting further into the ear canal. These styles are not recommended for young children due to the growth which renders the hearing aid loose in the ear, requiring remaking of the hearing aid, as well as the small size of the aid being a choke hazard.

Bone Conduction Hearing Aids/Bone Anchored Hearing Aids

These styles of hearing aids are used for children that have a hearing loss in the outer or middle ear which cannot be medically treated and/or surgically corrected at the current time. These can also be used with children with single-sided deafness. Bone conduction devices provide sound through a small vibrator that is attached to the head via a wearable headband or surgically implanted attachment.

Cochlear Implants

Some children, due to the severe or profound nature of their hearing loss, may be candidates for cochlear implants.  This is a device that is surgically implanted into the inner ear, and with the help of an external speech processor, sends sound information directly to the auditory nerve.

It is important to realize that none of these devices are cures for hearing loss. They cannot return hearing to normal. This is because they do not fix the problem that caused the hearing loss; they can only compensate for it. It is very important that other strategies are used along with amplification.

Prior to obtaining a hearing aid, two things are required:

  • A medical clearance from an ear, nose and throat (ENT) physician obtained within the last six months of the fitting of the hearing aid(s)
  • A hearing test performed within the last six months of the fitting of the hearing aid(s)

Once devices have been selected, your child will be scheduled for a hearing aid fitting and follow-up appointments. Your audiologist might use one of several methods for fitting and evaluating the hearing instruments. Ultimately, the goal is to insure that your child is able to hear conversational speech at a level that is comfortable for them.

The fitting and verification methods could include:

  • Probe Microphone Assessment
    For probe microphone testing, a small, soft tube is placed in the child’s ear next to the earmold or earbud. The probe microphone measures the amount of sound coming out of the hearing aid while it is on the ear. Adjustments can be made to the hearing aid while it is in place in the ear. This is particularly important as children have much smaller ears than adults. We know that ear size impacts the functioning of a hearing aid, so it important to take measures on each child’s ear to make sure hearing aids are set correctly.
  • Real-Ear-Coupler-Difference Measures (RECD)
    It can be difficult to test babies and young children using regular probe microphone tests as babies may not keep the probe tube in their ear or sit quietly enough for the time needed to perform the required measures. In these cases, a RECD can be obtained instead. The audiologist makes a quick measure in the child’s ears, and then does all of the subsequent adjustments with the hearing aid inside a test box.  The hearing aid can be adjusted for the child, and the child does not have to keep anything in their ear for more than a few seconds.
  • Behavioral Testing
    The child can be assessed in the sound booth to determine the softest sound that the child can hear with their hearing aids. This information can then be compared to testing obtained without the hearing aid or to the average level of conversational speech to determine if the hearing aid is providing sufficient amplification.

Hearing Assistive Technology: FM Systems

Being able to understand in the classroom is a critical component for learning. In a typical classroom, the degree of background noise and reverberation are high enough to affect speech understanding, attention, and academic achievement. In addition, most teachers will turn to the board or move around a classroom, causing the loudness of the voice to vary. Assistive-Device

For children with normal hearing, these everyday classroom noises and events do not create a problem.  For hearing impaired children, even with appropriately fit amplification, the speech signal is not loud enough or clear enough to allow for maximum understanding. Even children with minimal hearing loss, fluctuating hearing loss or unilateral hearing loss struggle with background noise interference and variations in the loudness of the teacher’s voice. A hearing assistive technology is often used to help increase a child’s access to sound, particularly in a noisy and reverberant setting such as a classroom environment or a restaurant. There are several types of hearing assistive devices. The two most commonly used are the personal and classroom FM systems which are described below.

Personal FM

For a PERSONAL FM, the person speaking wears or holds a transmitter microphone, or the transmitter is placed in the middle of a group (picking up speech from all around). Using harmless radio waves, the FM system sends the speech signal to the listener, who wears a tiny FM receiver behind the ear or a neckloop with the transmitter attached to it (the transmitter communicates with the hearing aid wirelessly via the neckloop).

Classroom Sound Field System

Another FM option is a CLASSROOM SOUND FIELD SYSTEM. With this system, the speaker still wears or holds a transmitter microphone, or the transmitter is placed in the middle of a group. Speakers in the classroom amplify the speech to a level louder than the background noise, and all children in the room enjoy the benefit.

Studies have shown that FM systems have the best results when implementation is made early in the amplification-fitting or cochlear implant process. Consideration for connectivity of a hearing assistive technology is included in the selection process for hearing aids or cochlear implants. These devices maximize children’s hearing capabilities, which can help facilitate improved language development and academic achievement.

Other Assistive Technology

Noise Protection/Musician’s Molds

Studies have shown that for 12.5 percent of 6-19 year olds and 16.8 percent of 12-19 year olds in the United States, their hearing thresholds have become worse due to noise exposure (exposure to loud sounds). We often overlook the dangers of noise and music in school-aged children and teenagers. Noise protection and musician’s earplugs are created using a custom impression of the ear. The molds are then fit to the child/teenager’s ear three weeks later. These types of mold allow the child to enjoy the noisy activity (concerts, sport event, etc) without damaging their hearing.

Swim Molds

When children have a hole in their eardrum or open tympanostomy tubes, they often are instructed by their physician to not allow water to get into the ear. A custom swim mold requires an impression to be taken of the ear, mailed to a manufacturer of swim molds and then fit to the child’s ear approximately three weeks later.

Telephone Solutions

Most hearing aids now have telephone solutions to allow for better connection to the phone. Many options exist for louder ring tones or volume controls.

Television Solutions

Television solutions to be used both with and without hearing aids are readily available using infrared, Bluetooth and FM technology. These devices direct sound right to the ear, allowing for reliable transition of information and eliminating bothersome background noise. These systems allow a child to listen to the TV at a comfortable listening level without disturbing others in the room.

Alerting Devices

Depending on the severity of the hearing loss, some children may not be able to hear important warning signals, even when appropriately amplified. Alerting systems help a hearing impaired child be aware of important events such as doorbells ringing, knocks at the door, telephone ringing, smoke/fire alarms and alarm clocks. Alerting devices supplement the use of hearing aids by providing visual/vibrotactile stimulation to sound.

Induction Loop System

An audio frequency induction loop is a wire that circles a room and is connected to a sound system that transmits the audio signal to hearing aids via a t-coil. It can be found in many public buildings, including banks, post offices, churches and theaters. For more information, click here.