Today’s post originally ran in June at Hearing & Kids, but we thought it was worth sharing with our readers at Hearing Views in case you missed it.
By Jane Madell, Ph.D.
Mild hearing loss is a misnomer. I do not know what word to substitute but mild hearing losses are not a mild problem. The data is clear. Children with mild hearing loss are at risk for academic, speech-language, and social-emotional difficulties. Newborn hearing screening does not always pick up mild hearing loss so babies with mild hearing loss may not get identified until they demonstrate delays.
Why are newborn hearing screenings missing mild hearing loss?
Newborn hearing screening. Courtesy CDC.gov
Current standard newborn hearing screening techniques are good at identifying moderate or greater hearing loss. So when the baby passes hearing screening the family is told the baby has normal hearing. Since the parents and pediatricians have been told that the baby has normal hearing, if concerns develop, it may not occur to parents or the pediatrician that hearing loss may be a factor.
What exactly is mild hearing loss?
The definition of mild hearing loss varies depending on the researcher so results indicating the effects of mild hearing loss vary. Some audiologists define mild hearing loss as hearing thresholds of 15-30 dB, others use 20-40 dB. Statistics vary from 1-3% of the newborn population to 54/1000 in the school population. What ever criteria is used results in a significant number of affected children. The topic cannot be ignored.
What are the effects of a mild hearing loss?
Mild hearing loss is an invisible acoustic filter. The speech signal is not sufficiently loud and clear. Children with mild hearing loss will have less access to speech. A child with a 30 dB hearing loss will miss 25-40% of what happens in the classroom. A child with a 35-40 dB hearing loss will miss about 50% of what happens in the classroom. Bess et al, (1998) reported that 37% of children with minimal hearing loss (mild or unilateral) failed a grade by third grade.
A child with mild hearing loss will hear speech that is spoken close to the child, but when the child is 10 feet from the person talking, it will be difficult to hear. This is not an insignificant problem.
More than 80% of what children learn they learn by overhearing things not specifically directed to them (incidental learning). If a child has, even a mild hearing loss, he will miss a lot of what is said, resulting in delayed language. Likely the delay will not be recognized for several years by which time we are talking about having to try and correct deficits rather then preventing delays.
Children with a mild hearing loss can be expected to have more problems hearing in noise then their typically hearing peers. Since the world is a noisy place it is not possible to avoid noise. If speech perception decreases in noise we expect a child to have language learning, and academic delays.
Middle ear disease?
Children with mild hearing loss can have a more significant problem from middle ear disease than children with normal hearing. Middle ear disease can decrease hearing by as much as 15-30 dB. If you have normal hearing, having a drop of 20 dB may not be a problem but if you have a hearing loss of 30 dB, an additional 20 dB drop can be devastating. Parents and physicians need to be vigilant and move quickly if a child has a mild hearing loss.
Do children with mild hearing loss need hearing aids?
Audiologists do not agree on the answer to this question. I am in the group that believes we need to do whatever we can do to assure that children hear everything around them. I will do extensive testing to see how a child is hearing, including speech perception as soon as a child can do that task. If a child is having trouble hearing soft speech that is a concern, and for me, that usually means hearing aids will be beneficial. For school, children with mild or unilateral hearing losses need FM systems to reduce the negative effects of distance and background noise.
Counseling about mild hearing loss.
The worse thing we can say to a family is “it’s only mild.” It is not a mild problem. The data is very clear that children with mild hearing losses struggle. Does this mean they will never succeed? No, of course not. But it does mean that they will have to work harder. So let’s do what we can to make things as easy as we can. Let’s use technology and provide necessary therapy and school assistance. Our goal is to have all kids with any degree of hearing loss be able to do whatever they want to do.
*Title image courtesy NCBegin.org
Take a close look at the photo of the infant being screened on the right of the page: Notice something missing, that can — and *will* — allow some profoundly deaf infants to “pass” their newborn screenings?
That’s right: The technician is using otoacoustic emission screening to test the infant in the photo and not an ABR (with wires on the scalp; and that means 100% of the infants whose deafness is from Auditory Neuropathy Spectrum Disorder (ANSD) — As many as 15% of hearing impaired infants — *will* incorrectly be passed… With consequences even more disastrous than if the child had not been screened at all.
What’s more, this we know from parents of children victimized by improper screening protocols in the 750+ member Auditory Neuropathy Spectrum Disorder group on Facebook: When Junior can’t hear, the first thing the pediatrician does is look at the newborn screening results and says “your infant’s hearing is OK” …And valuable time is lost while the mother — who knows nothing about deafness (let alone ANSD) goes in around in circles until eventually Junior gets the diagnosis missed since birth — starts googling and ends up in the ANSD group.
This happens about once per week, with frightening regularity.
Dan, you are exactly right! This is why audiologists should be overseeing all newborn screening programs and these tests should not be solely OAE screens. Cannot tell you how many times I’ve seen nurses screen a child 5+ times so they “pass”. This is not OK, and if you only have a technician doing these procedures without the knowledge base as to why does and doesn’t constitute an accurate test and passage of that test, then we are bound to make continued mistakes.
Pediatricians are not alone, this also happens in ENT offices frequently (yes, because too many are relying on OAE screenings done by techs). Let’s hope that message continues to get out there.
Composer Richard Einhorn, who suffered a sudden hearing loss in his better ear has proposed a new hearing loss classification: mild hearing loss should be renamed as “bad hearing loss”, moderate loss should be renamed “REALLY bad hearing loss” and anything beyond moderate range is in the “TERRIBLE hearing loss range”. And we all know that hearing aids are unable to deliver in situations where distance, background noise and reverberation are involved. Which means they will not hear well in church, in a theater or high school play.
It is my experience that children with mild hearing loss extra help. This means at school they need an FM system to hear well in school and at home need help with the TV. All kids need a wireless accessory like the Oticon Streamer, an iCom or the Widex TV Dex or from a hearing loop.
Ellie (now 12) uses one hearing aid for a mild hearing loss because she is deaf in the other ear has told me that when she uses a loop the sound is clear and that she can hear every single word while without the loop “I only hear the loudest sounds of the TV.” When the loop was first installed her mother emailed me with this testimonial: “My daughter is lying on my lap right now. We are watching “Cupcake Wars.” In our “pre-loop” days, she sat apart from us all, about two feet in front of the TV, so that she could hear better. It’s so much better with her on my lap!”
The hearing loop has one other benefit according to Ellie: she reports she doesn’t have to listen to the annoying sounds of her brothers! Other teens have reported they can turn off the captions when watching TV in the loop or that a loop allows them to “zone out” after a busy day at school and still hear every word when in a loop.
Take a moment to listen to the dramatic testimonial from Ellie’s mom recorded at a hearing loop meeting in Stevens Point https://www.youtube.com/watch?v=4jL4x2kkAJ0 and two hearing loop activations for children here: https://www.youtube.com/watch?v=J5OiqHyW7vw and https://www.youtube.com/watch?v=e_nUXAHT-Pg .
Wouldn’t it be great if someone would undertake a study that evaluates the speech and language development of children with and without hearing loops in the home? These kids deserve all the help they can get.
A small TV hearing loop can be installed by a handy person in an hour or two and costs less than the MFRs TV streamer or accessory, won’t put additional drain on the battery nor will it require upgrading when a new instrument of a different make is purchased. If multiple members in the family use amplification it will help them hear as well. Just be sure to turn off the loop driver when the child goes to bed as the overspill can sometimes be heard upstairs in the bedrooms!