Mrinal is eight
years old sweet girl, studying in the third grade. Mrinal has been having
hearing problem for last five years. Her
parents consulted the ear specialist and the doctor said a surgery can be done
to cure her hearing problem.
Jitendra 12 year old
boy developed hearing
loss following high fever. His family has been consulting various doctors
and everybody is saying nothing can be done. His hearing loss is of permanent
Charulata a four year old has been having
infections. She has been on medical treatment, Charulata hears well when
her ears are free from infection, and her hearing is very bad, when she gets
bad ear infection, she does not respond when called. Her parents are concerned
about her inconsistent hearing response.
loss was suspected at the age of nine months, and doctors told the family,
nothing can be done. Rehman will be a hearing impaired child, so now focus
should be on how he would speak, and how would he attend the normal school. But
his parents have not understood why it is so that Rehman’s hearing can not be
cured? Even, when his hearing loss is identified at such an early age, his
grand parents are saying that as, the child grows his hearing will improve.
We need to understand that there are certain ear
conditions those can be treated medically and there are some conditions, which
cannot be treated medically or surgically. How do we know which
ear defects are treatable and which are not?
Hearing loss may develop due to
various defects in the ear. The defect may be in the outer ear, or in the
middle ear, or in the inner ear. This
hearing loss may be of mild, moderate or severe type. If the defect is in the middle ear child may
complain about earache, ear blockage and/or he may have ear discharge. Such
conditions are treatable with medical and/or surgical intervention. These
defects may give temporary hearing loss. Once the medical intervention is done
child would be alright. Children who are more prone for upper respiratory
infections often have middle ear infections. Such children’s hearing levels
need to be monitored closely.
Hearing loss which are due to inner ear defect
are often permanent type. Depending upon the age of onset of hearing loss, it
would have adverse effects on language
development as well as scholastic performance. Such type of hearing loss may be
since birth or it may be associated with some illness.
When do we have our child’s hearing
test done? Hearing test can be done in the first few days after his birth and
anytime after that but if you suspect hearing problem then have a test done
immediately. Child’s behavior often indicates possibility of hearing loss.
How do You Suspect That Your
Child has Hearing Loss?
Our hearing mechanism is functional
right from the birth. So one month old baby, or a two year old toddler will
certainly react to various sounds in the environment. We as parents need to
observe their behavior and this behaviour may indicate that the child may have
The child of one year of age
or above has good orientation about his environment. He knows what’s happening
around him, like people are talking; mother is busy with some household job.
Though child may not speak, or understand the details of the activity, child
knows about movements, and actions. Child should respond to doorbell, telephone
ring, whistle of a pressure cooker, mixer sound or even if somebody drops an
object on the floor child should respond to such sounds.
By two year age child develops his language. Spontaneous expressive language is another
strong indicator for normal hearing sensitivity. Observe the following.
A Child with Normal Hearing Should
- Identify his body parts, such as show me your eyes, and point to your nose.
- Responds to simple instructions, such as come here, clap your hands, close your eyes.
- Say simple sentences. E.g. give milk, want more, and pick (me) up.
- Imitate adult speech, especially child tries to imitate intonation pattern
- Have vocabulary size of 10-20 words.
If the child fails to
understand simple commands, or if he uses too many gestures to communicate,
then child should be referred for detailed audiological evaluation.
Gradually a child enters a school. Child with moderately
severe to profound hearing loss can be identified by this age, as he would fail
to acquire age appropriate language. But children with mild to moderate hearing
loss are difficult to identify, and many times these defects go unnoticed up to age of five to six years of age. Let
us try to understand the subtle behaviour of older age group children.
Observations in Older Age
Following checklist may help the parents to identify
hearing-impaired child. The symptoms are:
child may speak too loudly or too softly.
may put T.V. or radio at high volume.
child may use lot of signs while speaking.
may not like to play with other children of his group, as he can not actively
participate in communication with his friends.
child may be using only few words, and may not be able to speak meaning full
may not respond if being called from the other room.
may respond inconsistently and in appropriately.
child may prefer lip reading (Speech reading) to listening. That means child
prefers to talk face to face, and likes to look at the face of the speaker very
closely while talking.
may have faulty speech, like child may say tup
for cup, old for cold. This kind of articulation errors lead to unintelligible
speech. Only his immediate family members can understand him but not all.
10) The child
may have difficulty paying attention for long time. He will not be able to do
If such symptoms occur consistently, then it is advisable to
refer this child for the formal hearing test.
There are various types of hearing
tests. Some tests are screening tests, while other tests help to study the type
and degree of a hearing loss in details.
The Hearing Tests
We have understood that
hearing loss can be one ear or in both the ears, and it can be mild or can be
profound as well. We need to have a tool to measure these hearing impairments.
There are various types of hearing test.
Hearing loss can develop at the age of ten years, fifty years, or as
young as one day of age. Some children develop hearing loss prior to their
birth.. There should be a test for every age. That’s why there are various
tests; let us try to understand the utility of some of these tests. These all
tests have a common aim to find out the hearing capacity.
Objectives of Hearing Tests
Why do we need to test one’s hearing? Can the doctor examine
the ears and draw his conclusion? The fact is physical examination of the ear only will give information of ear
canal, ear drum, this examination gives information to the doctor whether
person has normal ear drum or it has a perforation or some disease etc. Looking
at the ear does not give any information about function of the ear. There is a
need to test the sensory function of the ear and to draw a conclusion
whether hearing is normal or abnormal. If the hearing mechanism is abnormal,
then we need to know degree and type of hearing loss.
Types of Hearing Tests
There are two types of tests. These
are subjective hearing tests, and
the objective hearing tests. In
subjective hearing test the person has to take part in the test. Person has to
show whether he hears the sound or not. An adult can tell you by way of saying
‘ Yes, I heard the sound, or he may not say it, but indicate with action such
as, he would raise the finger to indicate, yes I heard the sound.’ But for
children it is very difficult to tell whether child has heard or not. Suppose
we teach him to do some activity every time he hears the sound. e.g. child will
drop a block in a bucket every time he hears the sound. That means the child
will be asked to do certain activity (task) and his actions and response patterns
will give some information to the tester. This information will facilitate the
tester to draw a conclusion about the hearing status of that child. Such test
is called Pune Tone Audiometry.
The report of the test is called Audiogram. Audiogram is a graphical
representation of hearing sensitivity of the ear. This is the most commonly
done test, and this test gives sufficient information to plan the line of
action. These actions can be medical intervention, or nonmedical (rehabilitative)
There are some occasion pure tone
test can not be done, either the child is too young to undergo the test, or
child is totally non cooperative to have a test, in such situations objective
tests are recommended.
In objective tests the
individual’s will not participate to say or to indicate whether he has heard
the sound or not. That means child’s participation will be very minimal and the
instrument will do the testing automatically. In the era of high tech
computerization these tests are very effective and provide very valuable
information about the hearing status in a short time. These tests are called as
Otoacoustic Emission Test and another test is called as Auditory evoked
Response (ABR) Test.
These tests are very reliable test
and test results can provide sufficient information to plan an action.
The test can be subjective test or
objective test, but the crust is if you suspect hearing loss in your child, have
a hearing test done.