"Minimal" Hearing Loss: What Does it Mean?
Newborn hearing screening is a fairly new procedure, both in Idaho and in the country as a whole. It was added to the screening tests done on newborns because even severe and profound hearing losses in infants are difficult to detect. Before newborn screening, most deaf children were not identified until they were at least a year old, and most hard-of-hearing children were two or three years old or even older. The first three years of life are critical for language development, so valuable time had already been lost for these children.
While early identification of children with a severe or profound hearing loss was the primary consideration in setting up newborn screening programs, we¹re finding that screening can also pick up children with hearing loss in only one ear, or with only a tiny loss in the "better" ear. Historically, children with these "minimal" hearing losses were only identified through school hearing tests, and often not even then. In some cases, they had been misidentified as having behavior problems or ADHD, or had already been receiving speech therapy services before anyone recognized the underlying hearing problem. The tendency has been to overlook the needs of these children.
How does a unilateral or mild loss affect hearing? Hearing only with one ear makes it extremely difficult to know where sound is coming from, and to know who in a group of people is doing the speaking. Background noise, especially noise which is coming from the "good" side, often masks important auditory information. Very mild sensorineural losses may make it difficult to hear the softer, higher frequency sounds in speech. While this may not be a huge problem for an adult, it may interfere with a child's ability to learn language in the first place. English has a number of such sounds which are grammatically important, such as the /s/ used for plurals and possessives and the /ed/ of the past tense.
A fair amount of research has been done on the problems that children with minimal hearing loss face in school. Classrooms are often noisy, difficult listening environments for a child who doesn¹t hear quite as well as his peers. In fact, some professionals point out that the typical classroom is not the best listening environment for any child, even those with perfect hearing. A real red flag is the observation that about 30% of children with unilateral hearing losses will have to repeat a grade, compared to about 3% of children with normal hearing. How many more children are passing from grade to grade, but not learning all that they could? There are things that can be done to help a child with a minimal hearing loss succeed in school, if the hearing loss has been identified and parents work with the school district and teachers.
How does this relate to the infant just diagnosed with a unilateral and/or very mild hearing loss? Is early intervention appropriate? What kind of intervention? What can parents do? Because minimal hearing losses have been historically identified much later, there is little research into their impact on the language development of preschoolers. Some clues can be had from research on children who have chronic ear infections during their early years. Otitis media often causes temporary mild to moderate hearing loss. Long periods of hearing loss during the preschool years put a child at risk for delayed language development. Most of these children seem to catch up to their peers once they stop having middle ear problems; whether some continue to have subtle language problems is a hot topic for debate. We've found some suggestions for parents of children who have chronic otitis media which may be of value to parents of children with minimal and/or unilateral losses. We've also been able to find a few very similar suggestions specifically for parents of children with unilateral losses. The ideas for language and literacy activities are useful for children with perfectly normal hearing, too, but if your child has been identified as having some kind of hearing loss, they become even more important.
Sources for further information:
Another website that has more information about unilateral hearing loss:
These books, while not all for parents of children with hearing impairments, may be a start:
Facilitating Hearing and Listening in Young Children (second edition,1999) by Carol Flexer: This book is aimed at both parents and professionals; it is a great resource for parents who wish to learn more about the auditory-verbal approach or how to maximize their child's use of hearing. You won't find any discussion of sign language, cued speech, or even speech-reading in this book. What you will find is a fair amount of coverage of issues related to minimal hearing losses, defined by the author as any hearing loss as small as 15 dB, even if in only one ear. The book is fairly expensive (about $70) but you may be able to get it through interlibrary loan.
Because babies can sign before they can talk, there is a recent movement to teach hearing babies a few signs as a means of enhancing communication and language-learning in the early years. If this strikes your fancy, there are several resources available. Two commonly available books are Sign With Your Baby by Joseph Garcia and Baby Signs: How to Talk With Your Baby Before Your Baby Can Talk by Linda Acredolo et al.
Hearing health care: Have your child's hearing re-tested on a regular basis, as suggested by your physician or audiologist. If, for any reason, you suspect an additional hearing loss, have it re-tested immediately. Some hearing losses get worse with time. Take care of residual hearing by providing ear protection when noise damage is possible (anything at 90 decibels, including noisy equipment, loud music, firearms, etc.) Watch out for ear infections, which can be a bigger problem for a child who already has a hearing loss.
Safety: A child with a unilateral loss will have problems localizing sound. Teach him to be extra careful crossing streets and to pay attention to visual cues. When bicycling, a rear-view mirror is a good idea.
Make listening easier: Decrease background noise by turning off the television and music for at least part of the day. Noisy appliances may also interfere with listening. Get close to your child, down at his level; speak clearly, without shouting or exaggerating. Favor your child's "better" ear, if one is better than the other. Repeat important words, and check for understanding. If the child misunderstands, try using different words or phrases rather than just repeating what you said. Visual clues, such as holding a jacket when announcing an outing, help a child understand what you're talking about. Use gestures and facial expression to enhance your speech.
Help you child learn language: Children learn language best from adults who talk to them and interact with them. Take time to get down on the floor with your child; talk about his toys, and respond to what he has to say. Let him "help" you with your work, and talk to him about it and answer questions. Talk to him during everyday activities such as baths and mealtimes. Take him places and talk to him about what you see and do. With preschoolers, talk about feelings and why things happen, and things that happened yesterday or are planned for tomorrow. This is just a start, there are many books written on this topic.
Promote early literacy: Read to your child early and often. At first, you may just be describing the pictures you look at together, or telling the story in simple sentences rather than actually reading straight from the book. Talk about the story as you read, ask questions such as "What do you think will happen next?" Let children draw and "write" using crayons, markers and pencils. Sing simple songs with repeated words and phrases; play sound, word and alphabet games that focus on beginning and ending sounds of words. There are books written on this subject, too.
Getting help from professionals: By now you should have been referred to the Idaho Infant Toddler Program or early intervention program in your area. These are federally mandated programs to provide intervention services for children under three years of age. Your Early Intervention Specialist can get you in touch with professionals, especially a speech/language pathologist, who can help you monitor and stimulate your child's language development. When your child reaches age three, ongoing education responsibilities transfer from early intervention to your local school district. Even if he does not qualify for special education services, he may benefit from modifications to his classroom or special equipment to make hearing easier.
At some point you may wish to contact the Outreach Program of the Idaho School for the Deaf and the Blind. There is at least one Parent School Advisor (PSA) in each region of the state, listed on the orange sheet in the Hands & Voices Parent Information packet. While your child may not qualify for the full range of services provided to children with more severe losses, the PSA in your region can serve as a resource to help you learn how to help your child. When your child starts school, the PSA can work with the school district to determine what kinds of accommodations can be made to make your child's school experience successful. Professional recommendations generally carry more weight than suggestions from parents, and the PSA will usually know more about the educational implications of hearing loss than anyone working in the school district.
Hands & Voices is a private, non-profit organization for parents of children with hearing loss. The Idaho chapter is still very new, and growing. Our children have hearing losses ranging from mild to profound, and attend many different educational programs and use a wide range of communication strategies. Our goal is to support each other and our children. As more children with minimal hearing loss are identified through newborn screening, we'd like to extend a welcome to their families. Over the years we've found that other parents, especially those just a few years further along the journey, to be among our best resources.
Lorna Irwin is the Director of Parent Consultants and Secretary of Idaho Hands & Voices.