Hearing loss can affect a child’s ability to develop communication, language, and social skills. The earlier children with hearing loss start getting services, the more likely they are to reach their full potential. If you are a parent and you suspect your child has hearing loss, trust your instincts and speak with your child’s doctor. Don’t wait!
A hearing loss can happen when any part of the ear or auditory (hearing) system is not working in the usual way. This includes the outer ear, middle ear, inner ear, hearing (acoustic) nerve, and auditory system. Hearing loss can vary greatly among people and can be due to any of a number of causes.
The outer ear is made up of:
- the part we see on the sides of our heads, known as pinna
- the ear canal
- the eardrum, sometimes called the tympanic membrane, which separates the outer and middle ear
There are four types of hearing loss:
The middle ear is made up of:
- the eardrum
- three small bones called ossicles that send the movement of the eardrum to the inner ear
The inner ear is made up of:
- the snail shaped organ for hearing known as the cochlea
- the semicircular canals that help with balance
- the nerves that go to the brain
This nerve sends sound information from the ear to the brain.
Auditory (Hearing) System
The auditory system processes sound information as it travels from the ear to the brain so that our brain pathways are part of our hearing.
- Conductive Hearing Loss
Hearing loss caused by something that stops sounds from getting through the outer or middle ear. This type of hearing loss can often be treated with medicine or surgery.
- Sensorineural Hearing Loss
Hearing loss that occurs when there is a problem in the way the inner ear or hearing nerve works.
- Mixed Hearing Loss
Hearing loss that includes both a conductive and a sensorineural hearing loss.
- Auditory Neuropathy Spectrum Disorder
Hearing loss that occurs when sound enters the ear normally, but because of damage to the inner ear or the hearing nerve, sound isn't organized in a way that the brain can understand. For more information, visit the National Institute of Deafness and Other Communication Disorders.
The degree of hearing loss can range from mild to profound:
- Mild Hearing Loss
A person with a mild hearing loss may hear some speech sounds but soft sounds are hard to hear.
- Moderate Hearing Loss
A person with a moderate hearing loss may hear almost no speech when another person is talking at a normal level.
- Severe Hearing Loss
A person with severe hearing loss will hear no speech when a person is talking at a normal level and only some loud sounds.
- Profound Hearing Loss
A person with a profound hearing loss will not hear any speech and only very loud sounds.
Hearing loss can also be described as:
- Unilateral or Bilateral
Hearing loss is in one ear (unilateral) or both ears (bilateral).
- Pre-lingual or Post-lingual
Hearing loss happened before a person learned to talk (pre-lingual) or after a person learned to talk (post-lingual)
- Symmetrical or Asymmetrical
Hearing loss is the same in both ears (symmetrical) or is different in each ear (asymmetrical).
- Progressive or Sudden
Hearing loss worsens over time (progressive) or happens quickly (sudden).
- Fluctuating or Stable
Hearing loss gets either better or worse over time (fluctuating) or stays the same over time (stable).
- Congenital or Acquired/Delayed Onset
Hearing loss is present at birth (congenital) or appears sometime later in life (acquired or delayed onset).
In order to better understand hearing loss, it helps to understand how we hear. Sounds are described in terms of their frequency or “pitch” and intensity or “loudness.”
Sound Frequency (Pitch)
Frequency is measured in hertz (Hz). A person who has hearing within the normal range can hear sounds that have frequencies between 20 and 20,000 Hz. The most important sounds we hear every day are in the 250 to 6,000 Hz range.
Speech includes a mix of low and high frequency sounds:
- Vowel sounds like a short “o” as in the word “hot,” have low frequencies (250 to 1,000 Hz) and are usually easier to hear.
- Consonants like “s,” “h,” and “f,” have higher frequencies (1,500 to 6,000 Hz) and are harder to hear. Consonants convey most of the meaning of what we say. Someone who cannot hear high-frequency sounds will have a hard time understanding speech and language.
Sound Intensity (Loudness)
Sound intensity, or loudness, is measured in decibels (dB).
- A person with hearing within the normal range can hear sounds ranging from 0 to 140 dB.
- A whisper is around 30 dB.
- Conversations are usually 45 to 60 dB.
- Sounds that are louder than 90 dB can be uncomfortable to hear.
- A loud rock concert might be as loud as 110 dB.
- Sounds that are 120 dB or louder can be painful and can result in temporary or permanent hearing loss.
Different groups and organizations use decibels to define the degree of hearing loss differently. Click on the following links to see some examples:
American Speech-Language-Hearing Association
Alexander Graham Bell Association for the Deaf and Hard of Hearing
Boys Town National Research Hospital
The signs and symptoms of hearing loss are different for each child. If you think that a child might have hearing loss, ask the child’s doctor for a hearing screening as soon as possible. Don’t wait!
Even if a child has passed a hearing screening before, it is important to look out for the following signs.
Signs in Babies
- Does not startle at loud noises.
- Does not turn to the source of a sound from birth to 3 or 4 months of age.
- Does not say single words, such as “dada” or “mama” by 1 year of age.
- Turns head when he or she sees you but not if you only call out his or her name. This sometimes is mistaken for not paying attention or just ignoring, but could be the result of a partial or complete hearing loss.
- Seems to hear some sounds but not others.
Signs in Children
- Speech is delayed.
- Speech is not clear.
- Does not follow directions. This sometimes is mistaken for not paying attention or just ignoring, but could be the result of a partial or complete hearing loss.
- Often says, “Huh?”
- Turns the TV volume up too high.
Babies and children should reach milestones in how they play, learn, communicate and act. A delay in any of these milestones could be a sign of hearing loss or other developmental problem. Milestones that children should reach from 3 months to 5 years of age.
Screening and Diagnosis back to top
Hearing screening can tell if a child might have hearing loss. Hearing screening is easy and is not painful. In fact, babies are often asleep while being screened. It takes a very short time — usually only a few minutes.
All babies should have a hearing screening no later than 1 month of age. Most babies have their hearing screened while still in the hospital. If a baby does not pass a hearing screening, it's very important to get a full hearing test as soon as possible, but no later than 3 months of age.
Children should have their hearing tested before they enter school or any time there is a concern about the child’s hearing. Children who do not pass the hearing screening need to get a full hearing test as soon as possible.
- If you think a child might have hearing loss, ask the doctor for a hearing screening as soon as possible.
- Children who are at risk for acquired, progressive, or delayed-onset hearing loss should have at least one hearing test by 2 to 2 ½ years of age. Hearing loss that gets worse over time is known as acquired or progressive hearing loss. Hearing loss that develops after the baby is born is called delayed-onset hearing loss. Find out if a child may be at risk for hearing loss.
Full Hearing Test
All children who do not pass a hearing screening should have a full hearing test. This test is also called an audiology evaluation. An audiologist, who is an expert trained to test hearing, will do the full hearing test. In addition, the audiologist will also ask questions about overall health and hearing loss in the family.
There are many kinds of tests an audiologist can do to find out if a person has a hearing loss, how much of a hearing loss there is, and what type it is. The hearing tests are easy and not painful.
Some of the tests the audiologist might use include:
- Auditory Brainstem Response (ABR) is a test that checks the brain's response to sound. Because this test does not rely on behavior, the person being tested can be sound asleep during the test.
- Otoacoustic Emissions (OAE) is a test that checks the inner ear response to sound. Because this test does not rely on behavior, the person being tested can be sound asleep during the test.
- Behavioral Audiometry Evaluation tests the function of all parts of the ear. The person being tested must be awake and cooperative during this test.
With the parents’ permission, the audiologist will share the results with the child’s primary care doctor and other experts, such as:
- An ear, nose and throat doctor, also called an otolaryngologist
- An eye doctor, also called an ophthalmologist
- A professional trained in genetics, also called a clinical geneticist or a genetics counselor
For more information about hearing tests, visit the American Speech-Language-Hearing Association.
Treatments and Intervention Services back to top
Child signing the word mother to an adultNo single treatment or intervention is the answer for every person or family. Good treatment plans will include close monitoring, follow-ups and any changes needed along the way. There are many different types of communication options for people with hearing loss and for their families. Some of these options include:
- Learning other ways to communicate, such as sign language
- Technology to help with communication, such as hearing aids and cochlear implants
- Medicine and surgery to correct some types of hearing loss
- Family support services
Many people who are deaf or hard-of-hearing have some hearing. The amount of hearing a deaf or hard-of-hearing person has is called "residual hearing". Technology does not "cure" hearing loss, but may help a child with hearing loss to make the most of their residual hearing. For those parents who choose to have their child use technology, there are many options, including:
- Hearing aids
- Cochlear implants
- Bone-anchored hearing aids
- Other assistive devices
Hearing aids make sounds louder. They can be worn by people of any age, including infants. Babies with hearing loss may understand sounds better using hearing aids. This may give them the chance to learn speech skills at a young age.
There are many styles of hearing aids. They can help many types of hearing losses. A young child is usually fitted with behind-the-ear style hearing aids because they are better suited to growing ears.
A cochlear implant may help many children with severe to profound hearing loss — even very young children. It gives that child a way to hear when a hearing aid is not enough. Unlike a hearing aid, cochlear implants do not make sounds louder. A cochlear implant sends sound signals directly to the hearing nerve.
A cochlear implant has two main sections — the parts that are placed inside the ear during surgery, and the parts that are worn outside the ear after surgery. The parts outside the ear send sounds to the parts inside the ear.
CDC and the Food and Drug Administration (FDA) carried out studies in 2002 and 2004 to learn more about a possible link between cochlear implants and bacterial meningitis in children with cochlear implants.
- 2002 Study of the Risk of Bacterial Meningitis in Children with Cochlear Implants
Many people have received cochlear implants to help them hear and communicate. CDC and the Food and Drug Administration (FDA) carried out a study in 2002 to learn more about a possible link between cochlear implants and bacterial meningitis in children with cochlear implants. This study had two purposes: (1) to find out how many children who had cochlear implants got bacterial meningitis afterwards, and (2) to find out if there are factors that might make it more likely that someone would get meningitis after getting a cochlear implant. The study found that bacterial meningitis occurred more often in children with all types of cochlear implants than in children of the same age group in the general population. It also found that children with an implant with a positioner (a piece used in some implant models) were much more likely to get bacterial meningitis than children with other types of cochlear implants. The implant with a positioner was voluntarily taken off the market by the manufacturer in July 2002.
- 2004 Study of the Risk of Bacterial Meningitis in Children with Cochlear Implants
After the 2002 study was completed, the FDA continued to receive reports of bacterial meningitis in children with cochlear implants. Because of these new reports, CDC and the FDA updated the 2002 study by looking at reports that were received up to 2 years after the 2002 study ended. The purpose of this updated study was to find out if children with cochlear implants continued to be more likely to get bacterial meningitis than children of the same age group in the general population even after they had their implant in place for more than 2 years. The study found that even two years after implant surgery, children with cochlear implants with a positioner were at greater risk of developing bacterial meningitis than children in the general US population.
Recommendations from the CDC and FDA based on this study include:
- Children should be up-to-date on vaccines at least 2 weeks before having a cochlear implant if they are not already up-to-date on these vaccinations.
- Parents of children who have already received an implant should check with their child’s doctor to ensure that their child is up-to-date on all vaccinations.
- Doctors and other health care providers should review vaccination records of their patients who are cochlear implant recipients or candidates to ensure that they have received the recommended vaccinations based on the age-appropriate schedules for high risk people.
- Parents of children with cochlear implants should be watchful for possible signs and symptoms of meningitis and seek prompt attention for any bacterial infection their child might have. Any questions parents have about their child’s health should be discussed with the child’s doctor.
- Parents of children with cochlear implants should also be watchful for signs and symptoms of an ear infection, which can include ear pain, fever, and decreased appetite. Parents should seek prompt medical attention for these signs and symptoms.
- Parents should talk about the risks and benefits of cochlear implants with their child’s doctor and should discuss whether their child has certain medical conditions that might make him or her more likely to get meningitis.
Bone-Anchored Hearing Aids
This type of hearing aid can be considered when a child has either a conductive, mixed or unilateral hearing loss and is specifically suitable for children who cannot otherwise wear 'in the ear' or 'behind the ear' hearing aids.
- Conductive: Hearing loss caused by something that stops sounds from getting through the outer or middle ear. This type of hearing loss can often be treated with medicine or surgery.
- Mixed: Hearing loss that includes both a conductive and a sensorineural hearing loss.
- Unilateral: Hearing loss is in one ear.
Other Assistive Devices
Besides hearing aids, there are other devices that help people with hearing loss. Following are some examples of other assistive devices:
An FM system is a kind of device that helps with hearing loss. FM stands for frequency modulation. It is the same type of signal used for radios. FM systems send sound from a microphone used by someone speaking to a person wearing the receiver. This system is sometimes used with hearing aids. An extra piece is attached to the hearing aid that works with the FM system.
Many television programs, videos, and DVDs are captioned. Television sets made after 1993 are made to show the captioning. You don't have to buy anything special. Captions show the soundtrack of a program on the bottom of the television screen.
There are many other devices available for children with hearing loss. Some of these include:
- Text messaging
- Telephone amplifiers
- Flashing and vibrating alarms
- Audio loop systems
- Infrared listening devices
- Portable sound amplifiers
- TTY (Text Telephone or teletypewriter)
Medications or surgery may also help make the most of a person’s hearing. This is especially true for a conductive hearing loss, or one that involves a part of the outer or middle ear that is not working in the usual way.
One type of conductive hearing loss can be caused by a chronic ear infection. A chronic ear infection is a build-up of fluid behind the eardrum in the middle ear space. Most ear infections are managed with medication or careful monitoring. Infections that don't go away with medication can be treated with a simple surgery that involves putting a tiny tube into the eardrum to drain the fluid out.
Another type of conductive hearing loss is caused by a part of the outer or middle ear that did not form correctly while the baby was growing in the mother's womb. There are several parts of the outer and middle ear that need to work together to send sound to the inner ear. If any of these parts did not form correctly, there might be a hearing loss in that ear. This problem may be improved and perhaps even corrected with surgery. An ear, nose, and throat doctor (otolaryngologist) is the health care professional who usually takes care of this problem.
Placing a cochlear implant or bone-anchored hearing aid are also types of surgery.
Without extra help, children with hearing loss have problems learning language. These children can then be at risk for other delays. Families who have children with hearing loss often need to learn special skills to help their children learn language. These skills can be used together with hearing aids, cochlear implants, and other devices that help children hear.
For many parents, their child’s hearing loss is unexpected. Parents sometimes need time and support to adapt to the child’s hearing loss.
Parents of children with recently identified hearing loss can seek different kinds of support. Support is anything that helps a family and may include advice, information, having the chance to get to know other parents that have a child with hearing loss, locating a deaf mentor, finding childcare or transportation, giving parents time for personal relaxation or just a supportive listener.
Causes and Risk Factors back to top
Hearing loss can happen any time during life – from before birth to adulthood.
Following are some of the things that can increase the chance that a child will have hearing loss:
- A genetic cause: 50% to 60% of hearing loss in babies is due to genetic causes. Some babies with a genetic cause for their hearing loss might have family members who also have a hearing loss. About 30% of babies with genetic hearing loss have a “syndrome.” This means they have other conditions in addition to the hearing loss, such as Down syndrome or Usher syndrome.
- 25% or more of hearing loss in babies is due to maternal infections during pregnancy, complications after birth, and head trauma. For example, the child:
- Was exposed to infection, such as cytomegalovirus (CMV) infection, before birth
- Spent 5 days or more in a hospital neonatal intensive care unit (NICU) or had complications while in the NICU
- Needed a special procedure like a blood transfusion to treat bad jaundice
- Has head, face or ears shaped or formed in a different way than usual
- Has a condition like a neurological disorder that may be associated with hearing loss
- Had an infection around the brain and spinal cord called meningitis
- Received a bad injury to the head that required a hospital stay
- For about 25% of babies born with hearing loss, the cause is unknown.
Hearing loss can affect a child’s ability to develop speech, language, and social skills. The earlier children with hearing loss start getting services, the more likely they are to reach their full potential. If you are a parent and you suspect your child has hearing loss, trust your instincts and speak with your child’s doctor.
Services for children with hearing loss are available through a local early intervention agency or public school. To find the contact for your state, call the National Dissemination Center for Children with Disabilities (NICHCY) at 1-800-695-0285. Or visit the website: