By: Dr. JJ Whicker
This week’s blog is a bit more technical, but it’s answering a question we get asked a lot as pediatric audiologists: how often should I have my child’s hearing tested?
The answer to this question is going to depend on the following:
- Is there a family history of childhood hearing loss?
- Is there a history of chronic ear infections?
- Has hearing loss already been established?
- Is there a speech-language delay?
- Does your child have congenital cytomegalovirus?
Let’s break each of these down.
Family History of Childhood Hearing Loss
Frequently monitoring hearing acuity in children closely related to individuals who were deaf or hard-of-hearing in childhood is important. Childhood hearing loss is often linked to a genetic disorder in which hearing loss becomes manifest in different time frames.
Classic examples are hearing losses caused from Connexin 26 or enlarged vestibular aqueducts syndrome. Some children with these genetic disorders pass their newborn hearing screen and develop late-onset hearing loss. Or perhaps they have slightly elevated hearing thresholds at birth that progress to a more severe degree as they grow.
Because young children are not good at reporting to their parents when they experience changes in their hearing, we recommend testing every 3 months for at least the first year of life to ensure a solid baseline of typical hearing sensitivity.
After that first year is up, if parents feel comfortable gauging changes in their child’s listening behaviors, then moving to hearing assessments every six months until preschool is a solid action plan.
This may seem extreme; however, hearing can be finicky, and changes can occur at any time. For children who are learning to communicate using spoken language, we want to catch these changes as soon as they occur so that intervention can be timely, and children don’t lose out on quality access to spoken language.
History of Chronic Ear Infections
Ear infections in young children are really common . . . and in some children, they become so frequent that they require surgical intervention to help ventilate the middle ear space. Often this surgical procedure is called “getting tubes”.
For this population of children, fluctuating hearing loss is a risk. Fluctuating hearing loss just means the child’s hearing sensitivity may frequently change from typical to elevated and back to typical at different rates. Even if the child’s hearing always returns to “normal”, it’s important to note how often hearing is changing and to what degree (e.g., mild, moderate, severe, etc).
In some cases, providing temporary amplification options is necessary to help children make it through their days (and even weeks) of decreased hearing sensitivity. Thus, again for young children who are not yet able to report changes in their hearing to parents, I recommend testing every 3 months, and every 6 months for preschool/school-age children with tubes.
Known Hearing Loss
If a child already has a diagnosed hearing loss, monitoring is crucial. There is no real way of knowing if a hearing loss is going to remain stable or progress. We can guess based on etiology; for example, children with hearing loss caused by Usher’s syndrome may likely experience a progressive hearing loss.
In the end, however, we can’t ever be sure. For this reason, known hearing loss is justification for frequent hearing assessments in children to catch changes and provide appropriate program changes to hearing aids.
Again, this is especially important for children learning to communicate using spoken language. Audibility – access to clear sound – is imperative. We don’t want a child with initial mild hearing loss to be using the same hearing aid programming if their hearing progresses to a moderate hearing loss.
Speech-language Delay
If your child has a speech-language delay, ruling out hearing loss as a contributing factor is essential. In almost all cases, before your child gets a speech-language assessment, the good pediatrician or speech-language pathologist will refer for a hearing assessment.
Spoken language development and hearing go together. If there are differences in hearing sensitivity, it is likely the child will show delayed language ability.
Congenital Cytomegalovirus (cCMV)
Last but not least, cCMV. Many children with cCMV show typical hearing sensitivity at birth; however, that can change. And it can change fast. I would argue that hearing related to cCMV needs to be most aggressively monitored.
Here in Utah, the recommendation from the department of health is testing every three months for the first three years of life! And there’s good reason why. I have seen patients with cCMV show typical hearing sensitivity in one appointment, then profoundly elevated hearing levels in the next.
There are promising antiviral drugs aimed at restoring some of that hearing, but they aren’t guaranteed, and early and efficient intervention is optimal for successful outcomes.
In all cases, federal and state mandates (in the United States) require routine hearing screens through public schools. If you have a serious concern about your child’s hearing acuity, you can request a hearing screen or exam through your school district. Take advantage of that!
Of course, you are always welcome to reach out to us. We are here to support you! (801) 996-7510.
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