Hearing loss in babies

Q: Hello doctors! I have a 10-month-old son. When he was 3 days young, he went through the newborn hearing test. Result showed that he failed the test. The audiologist told us not to worry, there might be fluid in his nose and ears as he was born borderline premature at exactly 37 weeks through an emergency c-section.

We went again to get him tested. Did OAE, ABR, and tympanometry. OAE and ABR shows that he has mild to moderate bilateral hearing loss while tympanometry shows that he doesn’t have middle ear problem. we went to another hospital to get second opinion and the result is the same as the first hospital. We recommended to get hearing aids for our son so that he can hear better and learn to speak like other babies.

Naturally, my husband and i freaked out and were in shock and sad. Over time, we accept it. Met the audiologists and we’ll get the hearing aid in two weeks. We hope our baby can hear well and will be able to talk normally with the hearing aids.

After doing our research online, we could not find support group or website for deaf chlidren in Malaysia or for parents with hearing problem kids. Most websites or organization are for/by/about deaf people mostly adults who communicate mainly through sign language. We couldn’t help but feel alone in this as there’s lack of information.

Here’s some of our pregnancy, family history and facts to paint a clear picture on our situation:

1) I was infected with viral fever when 8 weeks pregnant.

2) my husband and i are first cousins

3) there is no history of born-with-it hearing loss in both our family..

I have a few questions for you guys. i know some of these questions might sound stupid to you, but i’d like to know your opinion based on your experience, so here goes..

1) will there still be a delay in speech if my son wears the hearing aids as early as 10 months?

2) will he need to learn sign language?

3) psychologically, will he have problems when he’s in school in terms of acceptance by friends/feeling insecure/etc?

4) do you know any organization/support group/or even parents who are dealing with kids with hearing loss? it’d help a lot to learn from other’s experience.

5) how common is hearing loss among babies in Malaysia?

6) what do you think is the cause of the hearing loss? will it happen to our next children?

Thanks doctor, for taking the time to read my lengthy email. I’m not looking for diagnosis as we’ve been through tests and audiologists. I’m just gathering some advice and knowledge and hoping to know if there are people you know with the same experience as us.

Again, thanks for your time. i hope to hear from you soon 🙂  

(Worried mom)

A:  Dear Worried Mum,

Thanks for your email. From the details you gave, it seems your child has hearing loss in both ears, due to a problem with either the auditory nerve or the inner ear. This is called sensorineural hearing loss.

As a paediatrician, I don’t have direct experience in performing hearing assessments and planning for hearing aids or speech therapy. I have tried to answer your questions to the best of my knowledge, but if you need further details I would suggest talking to an experienced audiologist or speech therapist.

1.  As the hearing loss is mild to moderate, hearing aids should help to improve his hearing and allow him to develop his speech better. Input from a speech therapist would be very useful to optimise his speech development. At 10 months, it is too early to know if he will have any speech delay, but hearing aids and speech therapy would certainly help to optimise his speech development and minimise any speech and language problems. The earlier he starts using hearing aids and speech therapy, the better the outcome. We normally need to follow up until he is at least 4-5 years old, to look out for any speech problems.

Children who have more profound hearing loss, or no improvement with hearing aids, may require a device called a cochlear implant. This is a special hearing aid that is surgically placed in the inner ear. Your audiologist or ENT Specialist will probably advise you about this, if needed. Whatever device is used, close follow-up with an audiologist and speech therapist is ESSENTIAL to optimise his speech development.

2. Since he has mild to moderate hearing loss, he would probably be able to hear well enough to develop speech, with the help of hearing aids. Speech development should start as early as possible, to stimulate the parts of the brain involved in speech and language and give him the best chance to develop effective speech.

     Even children with profound deafness can now develop speech, with the help of cochlear implants. However, sign language skills can be developed at ANY time, even by children or adults with normal hearing. Many children with hearing impairment choose to develop sign language skills as a second language, when they grow up. Babies can learn sign language very early (even before they start speaking!). In summary, he probably won’t NEED to learn sign language, but he CAN learn it as a second language, if you want.

3. Children who are born with hearing impairment often learn to cope very well with their disability, and adapt. Some hearing aids are very small, and not easily seen. This may help the child to avoid stigma or seeming ‘different’ from other children. If he has significant hearing problems, you’ll need to inform his teachers, so he can be placed near the front of the classroom.

4. As far as I know, most of the support groups in Malaysia work with people who have more profound deafness, and use sign language.  YMCA KL (http://www.ymcakl.com/PMY/PMY_programmes.htm), and St Nicholas School in Penang are among the active centres for people who use sign language. Some of the speech departments in medical universities (eg HUKM) may have support groups for children who use speech. The important thing is: which group is closest and most convenient for you?

Your local audiologist, speech therapist or ENT Specialist should be able to advise you about nearby support groups, and put you in touch with parents who have kids with hearing loss.

5. About 1 or 2 in 1000 children are born with hearing loss sufficient to require hearing aids. A further 2 or 3 per 1000 will develop severe hearing loss later on. The main risk factors for hearing problems in babies are:
   1. Family history of sensorineural hearing loss
   2. Infection during pregnancy associated with hearing loss
   3. Abnormalities of the skull or face
   4. Birth weight under 1500 grams
   5. Severe neonatal jaundice requiring exchange transfusion
   6. Medicines that damage the ears
   7. Bacterial meningitis
   8. Very low Apgar score at birth (3 or less at 5 minutes )

6. Inherited causes of sensorineural hearing loss include various very rare syndromes, such as Waardenbrug syndrome, Pendred’s syndrome, Alport’s syndrome and Jervell-Lange-Nielsen syndrome. Some of them are associated with kidney problems, visual problems, thyroid disorders and abnormal heart rhythms. Therefore, every child with hearing problems should have a careful examination by an experienced otologist  / ENT Specialist.  Sometimes, the doctor may recommend screening for infections, checking thyroid function, kidney function, and ECG, certain genetic tests, or a brain scan, depending on the examination findings.

Children can also get hearing problems following maternal infections during pregnancy, such as rubella, toxoplasmosis, cytomegalovirus and syphilis. Certain antibiotics and medicines, meningitis, and severe jaundice in young babies, can also cause hearing problems.

Unfortunately, even after extensive investigation, many children will still not have a specific cause found for their hearing loss. As you and your husband are first cousins, there is a risk of inherited hearing problems. I would suggest discussing with your paediatrician or ENT Specialist about the possible cause of your child’s hearing loss, whether any further investigations would be helpful, and the potential risk in future pregnancy.

Below are some links to websites that explain a bit more about hearing loss in babies and children. These are quite good.

http://www.patient.co.uk/doctor/Childhood-Deafness.htm

http://www.hear-the-world.com/en/hearing-and-hearing-loss/special-topics/children/hearing-loss-in-babies-and-children.html

Hope this helps answer some of your questions. It’s great that you’re getting the hearing aids soon and working closely with the audiologist and speech therapist. Their input will be essential in helping your son achieve the best possible speech development. All the best!

Yours sincerely,

Dr Pravin Vasanthan