By Dr. JJ
Our last blog focused on osseointegrated (OI) hearing aids. The purpose of this blog is to summarize details about the three primary options for hearing technology available to children with hearing loss in the United States.
Why Hearing Technology?
First, let’s talk about why some people choose hearing technology for children in the first place. Nearly 1-3 out of 1000 infants born in the United States have permanently elevated hearing thresholds at birth and cannot hear soft sounds. This means that sounds perceived as whispers to you and me need to be increased in loudness to shouting level to be perceived as whispers to infants who are hard-of-hearing.
We’ve previously talked about communication options for children who are deaf or hard-of-hearing, and one of those options discussed is listening and spoken language; meaning, children’s families choose to have their child’s access to sounds improved through technology so that they can develop spoken language abilities and communication with speech. Some families may choose other communication modalities and still choose to have their children fit with hearing technology simply to enhance the child’s access to sounds in the environment.
Technology Options for Hearing Loss in Children
So, what are the options for hearing technology in children? The mostly commonly known and understood are traditional hearing aids.
Traditional Hearing Aids
The word “traditional” in traditional hearing aids is just reference to the kind of hearing aids that (traditionally) sit behind the ear. In children, these hearing aids are commonly coupled to tubing and earmolds which sit in the child’s ear, as pictured below. You may hear them referenced by audiologists as BTE hearing aids, which stands for behind-the-ear. BTE means that all the technology related to the hearing aid is housed within the body of the hearing aid that sits behind the ear (e.g., speakers, microphones, amplifiers, Bluetooth).
Some children wear what are called receiver-in-the-canal, or RIC, hearing aids. These hearing aids look similar; however, the speakers of the hearing aids are actually placed in the ear canal through a thin wire that’s coupled to the body of the hearing aid.
Any child with elevated hearing levels (commonly understood as hearing loss) ranging from mild to severe may be candidates for traditional hearing aids. Even if your child is experiencing profound hearing levels, many health insurances require a period (usually 6 months) during which your child is consistently using traditional hearing aids prior to the health insurance approving a cochlear implant procedure (described below). Children can be fit with traditional hearing aids as soon as they receive their diagnosis of hearing loss (the youngest infant I’ve fit was three weeks old . . . nothing cuter, in my opinion).
Osseointegrated Hearing Aids
As mentioned, Dr. Lindsey talked about this technology in our last blog. In brief, osseointegrated (OI) hearing aids are designed specifically for those individuals who have a permanent or fluctuating conductive or mixed hearing loss. These hearing aids are particularly common among children with craniofacial differences and have differently formed ears that do not have the physical space for traditional hearing aids. Recently, Med-El ® came out with BoneBridge™ and Cochlear Americas® came out with Osia™, which are a surgically implanted OI hearing aids. Not everyone is a candidate for these technology options, but you can find out more about them by clicking on the links provided.
Like traditional hearing aids, non-surgical OI hearing aids can be fit in infancy. Not all pediatric audiologists are familiar and comfortable working with OI technology, so be sure to find one who is!
Cochlear Implants
Cochlear implants are the most powerful (in terms of sound) hearing technology option. Essentially, the cochlear implant comes in two parts:
- the internal implant, which consists of an electrode array that is surgically inserted into the cochlea (the sensory organ of hearing), and
- The external processor that sits behind the ear and is coupled to a transmitting coil by way of magnet on the back of the head.
Cochlear implants require both audiologic and medical criteria for candidacy. For audiology, the hearing levels need to fall into the severe to profound hearing range. Children may also be candidates for cochlear implants if they have an auditory neuropathy disorder. In either case, the child needs to demonstrate that traditional hearing aids do not provide the benefit needed to access quality sound. For certain age groups, there are test batteries that must be completed to show this limited benefit from traditional hearing aids. Obviously, for infants, we are not able to measure many functional outcomes, but we can use parent report and some elements of aided testing that show hearing aids are not the right option for children.
For medical candidacy, children must be able to endure the cochlear implant procedure safely, and this is something you will determine with your surgeon and the child’s medical team. Further, medical candidacy includes use of imaging to ensure that the appropriate anatomical structures are in place that would allow for cochlear implantation (e.g., is there an auditory nerve, is there a cochlear, how is the cochlea shaped/formed?).
Unlike hearing aids, cochlear implants are not an immediately available option in infancy. In the United States, there are three main cochlear implant manufacturers who have FDA approval for use of their products. They are Cochlear Americas®, Med-El®, and Advanced Bionics®. Recently, Cochlear Americas® received FDA approval for implanting infants as young as 9 months old. Otherwise, children currently need to wait until a minimum of 12 months of age to receive their cochlear implants.
Choices, Choices
Choosing technology can be a challenging experience. Over 90% of children who are born deaf or hard-of-hearing are born to parents who are hearing and never anticipated needing to make these kinds of decisions. Remember to give yourself grace. Sometimes, pediatric audiologists make you feel like you need to make your decision right now, this minute. However, while time without sound is an important factor in delayed spoken language development, neuroplasticity in children is an amazing thing. I think it is important that parents feel comfortable and confident in their decisions, which may even lead to better outcomes because of higher commitment to consistent technology use.
Are you concerned your child needs intervention for hearing? Call today!