ive your child the gift of hearingA parents guide to hearing health

Early hearing is criticalHearing loss and deafness is a silent and debilitating disability which affects over 278 million people world wide.

Children learn to talk by hearing the language around them. In fact, by the time a child says their first word, they’ll have been listening to you talk for about a year.

So the longer a child goes without being able to hear sounds and words, the more difficult it is for them to learn spoken language. The brain’s flexibility to learn spoken language through listening diminishes over time. That’s why permanent hearing loss requires early diagnosis and intervention, if a child is going to have the best chance of learning to communicate.

“Just two weeks after Chevonne

was switched on, she answered the telephone. Chevonne couldn’t even

hear the phone ringing before, let alone be able to speak on it.”

Mother of Chevonne Adams

Babies learn from the time they are born. The typical pathway to spoken language is through listening which is why a permanent hearing loss requires early diagnosis and intervention in order to give a child the best chance to develop spoken language.

In many parts of the world newborn screening for deafness is recommended as best practice ensuring that parents can take the crucial steps in treating their children early.

The earlier a child is diagnosed and fitted with an appropriate hearing device, the better their chance of catching up to their hearing peers in listening and spoken language. Clinical studies show that children born with a severe hearing impairment who receive a cochlear implant before the age of 2 are more likely to attend mainstream school than those who receive their cochlear implant later in life.

They are also more likely to develop clearer speech, develop socially and emotionally like hearing children their age and be able to work when they’re older. Research confirms that children have the opportunity to experience a better quality of life than those who need a cochlear implant and don’t receive one.

Taking steps to identify and manage your child’s hearing loss as early as possible, will maximise their chances for hearing success 1, 2, 3, 4, 5, 6.

Group 1Child implanted before 18 months

Group 2Child implanted between19-30 months

Group 3Child implanted between31-40 months

Group 4Child implanted between41-48 months 0

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Comparison of child language development of cochlear implanted children at various ages to hearing children 6

The earlier a child is implanted, the more likely they are to develop language like hearing of children their age.

It is important to monitor your baby’s speech and language development as well as responses to sound.

The following checklist provides a guide to hearing and language milestones.

If you are concerned about your child’s hearing or speech and language development please arrange to have your child’s hearing tested. Your doctor can arrange for a referral to an appropriate location for testing your child’s hearing.

Hearing checklist

Birth to 3 months

Reacts to loud sounds

Quiets to familiar voices or sounds

Makes cooing noises

Responds to speech by looking at speaker’s face

3-6 months

Turns eyes or head toward sounds

Starts to make speech-like sounds

Laughs and makes noises to indicate pleasure and displeasure

6-9 months

Babbles, ‘dada’ ‘mama’ ‘baba’

Shouts/vocalises to get attention

Will often respond to ‘no’ and own name

Responds to singing and music

9- 12 months

Imitates speech sounds of others

Understands simple words, eg ‘ball’, ‘dog’, ‘daddy’

Turns head to soft sounds

First words emerge

12- 18 months

Appears to understand some new words each week

Follows simple spoken instructions, eg ‘get the ball’

Points to people, body parts or toys when asked

Continually learns new words to say although may be unclear

18-24 months

Listens to simple stories or songs

Combines two or more words in short phrases eg ‘more food’

Hearing loss can be categorised according to which part of the auditory or hearing system is damaged. There are 3 basic types of hearing conditions.

Sensorineural hearing lossSensorineural hearing loss is often referred to as nerve deafness. It occurs when there is damage to the inner ear (cochlear) or the nerve pathways from the inner ear to the brain. A sensorineural hearing loss is permanent and it can occur in both ears or just one.

Conductive hearing lossConductive hearing loss occurs when sound does not travel effectively through the outer ear canal to the eardrum and the tiny bones, or ossicles, of the middle ear. A conductive hearing loss may occur in both ears or just one and may often be helped by medical or surgical treatment.

Mixed hearing lossThis is a hearing loss where there is a problem with both the conductive pathway (outer and middle ear) and the inner ear (cochlea) or auditory nerve. Mixed hearing loss can occur in one or both ears.

About hearing lossSeveral methods can be used to test a child’s hearing, depending on the child’s age, development, or health status.

Deafness can be detected in children as early as a few hours after birth with modern non-invasive diagnostic tests.

What will the hearing test tell me about my baby’s hearing?Newborn screening will not give a diagnosis of a permanent hearing loss. It will let you know if your baby should be referred to a hearing specialist for further diagnostic testing to confirm a hearing loss.

The audiogramFurther diagnostic testing produces an audiogram which is a graphical representation of a person’s hearing loss. It illustrates the usable hearing and the amount of hearing loss for each ear.

An audiologist will present sounds one frequency at a time when testing a person’s hearing. They then plot the softest tone at which the person can hear each frequency on the audiogram. The closer the marks are to the top of the graph, the softer the sound that can be heard.

The most important pitches for speech are shown on the audiogram in the shaded area known as the ‘speech banana’.

The hearing test

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Unlike hearing aids, which simply make sounds louder, a cochlear implant stimulates the hearing nerves directly.

The external sound processor captures sounds and converts them into digital signals.

These signals are sent to the internal implant, via the coil.

The implant converts the signals to electrical impulses and sends them along an electrode array in the cochlea.

The hearing nerve delivers the signal to the brain, sound is heard.

How does a cochlear implant work?

What options are available if your baby/child is diagnosed with a hearing loss?Continue to talk and sing to your baby and assume they can hear you. Talk to your baby as you feed, change and play. Singing children’s songs and rhymes will be fun for both you and your baby.

If your child has a hearing loss your options include:

Hearing Aids Cochlear implant Bone conduction system

Could your child benefit from a cochlear implant?

Cochlear Implants

Was he born with severe to profound hearing loss, or was your child born with normal hearing and has progressive hearing loss?

Does she fail to respond to your voice or loud sounds, or to look at someone who’s speaking?

Does he only react to very loud sounds? Is she not imitating speech sounds like other children? Is he missing the normal speech and language

development milestones? Has she lost hearing since first learning to speak? Does he rely on lip reading a lot of the time? Does she find the effort of concentrating to hear

and understand her teachers exhausting?

If you answered yes to some of these questions, your child may benefit from a cochlear implant.

“In spite of the problems and criticisms, I just had to go on. A cochlear implant was their only hope of ever hearing.”

That was Professor Graeme Clark’s way of thinking – never give up on finding a way to help the profoundly deaf hear.

It was his deaf father’s struggles that ignited this determination. Professor Clark grew up seeing the hardship of living in silence – including the frustration, anguish and resulting isolation. He also witnessed his father’s desire for a greater connection to others, and was determined to make it possible.

In the mid-1960s, while working as a research professor at the University of Melbourne in Australia, Professor Clark came upon a scientific paper. It described how a profoundly deaf person received hearing sensations through electrical stimulation. The seed was planted, and he began researching the possibility of an electronic, implantable hearing device: a cochlear implant.

In 1978, the first cochlear implant surgery took place. Professor Clark’s determination had paid off – the surgery was a success.

From the beginnings of Professor Graeme Clark’s work in the 1960’s through our research today, Cochlear continues to push the scientific boundaries and forge the development of technology in our field of expertise – implantable hearing solutions. For more than 25 years Cochlear has been reconnecting people to their families, friends and communities with more than 200,000 people using Cochlear’s technology, 7 out of 10 parents select Cochlear when choosing a cochlear implant.

Hearing with Cochlear: The Cochlear story

Rod Saunders, left (first multichannel cochlear implant recipient) and Graeme Clark, right (inventor of the Cochlear Nucleus System) 1978

Next StepsIf your hearing health professional recommends a cochlear implant for your child.

Your hearing health professional will recommend if your child already wears a hearing aid, that they wear it during all waking hours as any hearing stimulation is beneficial to aid outcomes after cochlear implantation.

Enroll in a habilitation program before surgery to focus on the development of spoken language through listening.

Discuss the benefits of bilateral hearing (having two cochlear implants) with your clinic.

Cochlear implant surgery is a routine medical procedure which is considered to be very safe.

Discuss with your clinic the cost and available funding options for the cochlear implant.

Your child’s sound processor will be switched on 2-4 weeks after surgery, and programmed to meet their unique hearing needs.

Your hearing health professional will continue to fine tune your child’s implant. The improvements in your child’s hearing will depend on a lot of factors including their hearing before, and habilitation after, the implantation. The team at your hearing clinic will guide you through the preparation, implantation and habilitation process, and help you ensure the best results for your child.

Cochlear and the elliptical logo are trademarks of Cochlear Limited. © Cochlear Limited 2010.

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References1 Drinkwater, T. The Benefits of Cochlear Implantation in Young Children. Cochlear White

Paper, March 2004.

2 Habib MG, Waltzman SB, Tajudeen B, Svirsky MA, Int J Pediatr Otorhinolaryngol. 2010 May 14. Speech production intelligibility of early implanted pediatric cochlear implant users.

3 Hogan A, et al (1998) Employment and Economic Outcomes for deafenedadults with cochlear Implants, presented to Audiological Society ofAustralia, 1998

4 Yoshinago-Itano, C (2003), Ment. Retard Dev. Disabil. Res Rev. 2003: 9 (4), Early Intervention after universal hearing screening: impact on outcomes

5 Summerfield AQ, Marshall DH, Stacey PC, Fortnum HM. Quality of life outcomes in a large scale comparison of children with permanent hearing impairment with and without cochlear implants: preliminary analyses. In Measuring the Immeasurable? Proceedings of a conference on quality of life in deaf children. Hughes Associates, Oxford. 2003

6 Hammes D, Novak M, Rotz LA et al. Maximising spoken language development in infants and children with hearing loss. Effects of early implantation on speech and language outcomes. Carle Clinic and foundation. Urbana Illinois.

For more information

Call 1800 620 929 (Australia) 0800 444 819 (New Zealand)

Email customerservice@cochlear.com

Web www.cochlear.com/au