Unilateral Conductive Hearing Loss

There are many types of hearing loss. One way that the types are divided is by which part of the ear is not working. A conductive hearing loss occurs when the middle ear (canal, eardrum, stapes, malleus, incus) is not functioning properly. The sound cannot travel through to the cochlea. Oftentimes, this is temporary and caused by fluid in the ear. Sometimes it is permanent due to abnormal structure in the ear.

The other type of hearing loss is a sensorineural hearing loss. The most common cause of this is a non-functioning cochlea. The cochlea is the part of the ear that converts the sound into electrical energy and sends it on through to the brain.

A friend of mine recently gave birth to a beautiful baby boy. He did not pass his newborn hearing screening and has been recently diagnosed with a severe unilateral (one-sided) conductive hearing loss. She called me to find out what she can do for him. Being a speech-language pathologist herself, she understands the need for auditory input to facilitate proper language development. She began to second-guess herself when the audiologist told her that children with hearing loss in one ear do very well and often don't need amplification.

This post is meant to put a start to breaking down that myth.

Children with hearing loss in one ear will obviously do better than children with hearing loss in both ears. But they will also obviously do worse than children with normal hearing. It is common sense.

Still, there are professionals out there who are uneducated in this matter. There are many who still believe that if a child has hearing in one ear then they can learn language normally and function well in the classroom. This is generally not true.

Children with unilateral hearing loss are at ten times more risk for academic failure than are children with normal hearing in both ears (Bess, Dodd-Murphy, & Parker, 1998; Tharpe, 2006). Also, they have demonstrated greater difficulty identifying speech in noise, localizing sound sources, and other important classroom skills. They have more difficulty discerning speech, even when it is spoken into the good ear (Cole, Flexer, Children with Hearing Loss, 2007).

This article is just one example of many studies that have recently been done showing these negative effects. As parents and professionals who are armed with this knowledge, we need to be advocates for these children by raising awareness and spreading research such as this.

Now. If your child has a unilateral hearing loss, you don't have to "wait and see" as my friend's audiologist told her, to see if it causes problems. "Waiting and seeing" often produces children with delays who spend much of their lives trying to catch up. Here are some options for you:

1) Talk with a good audiologist who will help you determine the cause and severity of your child's loss. Then you can determine what options are best.

3) Because many of these options are not as successful as in older children, just know which ear is your child's better ear and speak into that ear when possible. Speak closely to your child as much as possible. Little to no research has been done on the benefits of fitting newborn infants with unilateral hearing loss with amplification.

2) Make sure that your child's teacher uses an FM system.

3) Place your child at the front of the classroom.

4) You can also look into candidacy for a BAHA (bone-anchored hearing aid). This type of hearing aid bypasses the middle ear and sends the signal directly to the cochlea. It is recommended for children 5 and older.

5) The CROS system is an option for older children as well.

Some people might tell you that they had negative experiences with the BAHA and other methods of amplification for unilateral conductive losses. It is my opinion that you should be informed of all the possible risks and options so that you can make an informed decision.

Good luck!

Birth to 1 Milestones

Children start learning language basics even before they are born! Even in the womb, babies hear voices and become used to their mother's voice. As soon as they are born they respond to their mother's voices by increased sucking or being comforted. Then throughout the first year, they learn the foundations for language. Here are some milestones to watch for in your baby:

Birth to 3 Months:

- smiles reflexively

- coos

- tracks sound with eyes

- quiets when picked up

- startles to loud sounds

4-6 Months

- raises arms in response to "Come here" or other phrases

- Looks at appropriate family members when named

- Begins to growl, squeal, yell, make raspberries, and babble

7-9 Months

- can recognize common objects when their name is said (Where's your ball?)

- plays pat-a-cake-, peek-a-boo,

- uncovers hidden toy

- understands "no"

10-12 Months

- understands up to 10 words

- uses first true word (uses the same sounds consistently for the same object/person)

- turns head when name is said

- points to or vocalizes when they want something

Don't panic if your child hasn't reached one or two of these milestones. Take a day or two and try to work on something specifically. Sometimes a child just needs a little direction and they'll pick it up quickly. If they are a few months behind on several of these milestones then you might want to get an evaluation.

Unilateral Hearing Loss

This article is just one example of many studies that have recently been done to show the effects of hearing loss in one ear. There are many professionals out there who still believe that if a child has hearing in one ear then they can learn language normally and function well in the classroom. Please be aware that this is not true. Bilateral hearing (hearing in both ears) gives children a major advantage in learning language and developing good speech patterns. As parents and professionals who are armed with this knowledge, we need to be advocates for these children by raising awareness and spreading research such as this.

Spoken Language for Kids with Hearing Loss: An Option

For your information, I will be posting lots of articles and research regarding hearing loss and cochlear implants. I was fortunate enough to be able to focus much of my time in graduate school in a program aimed at training students how to facilitate listening and spoken language in young children with hearing loss. It is my strong belief that parents have a right to be presented with all options for their children who are born deaf. One of these options is the spoken language route. Auditory-Verbal Therapy is a type of therapy that helps a child who is born deaf use amplification (hearing aids or cochlear implants) to learn to listen and use spoken language. It is truly an amazing option that, with new research and technology, is more available and successful than in the past.

While attending graduate school, I had an opportunity to go to Connecticut and visit CREC Soundbridge which is a school focusing on teaching children with hearing loss how to listen and use spoken language.  I walked in to a classroom full of 4 and 5 year olds.  They were all wearing cochlear implants (some wore 2), and were all therefore born deaf.  Yet they all came up to me and bombarded me with questions, "Who are you? What's your name? Want to play with me?"  It was incredible.   No sign language, all listening and talking.  Crazy cool. 

The program I referred to earlier is called "The Graduate Studies Program in Auditory Learning and Spoken Language". It is located at Utah State University. Check out their website for more information.

Communication Disorder: Know the Warning Signs

The following information was adapted from a brochure published by ASHA (American Speech-Language and Hearing Association) , 2010.

Your child may have an underlying problem in communication if he or she...

Began talking later than expected

Is harder to understand than other kids their age

Is performing below expectations in the classroom

Is having difficulty learning to read

Cannot seem to express his/her thoughts and ideas, uses lots of "filler words" such as "stuff" and "things". Also may be very vague or unclear when explaining something.

Has problems understanding others and following directions

Doesn't pick up on social cues

Has problems taking tests

Says "huh" a lot and needs things repeated often

Does not respond consistently to sounds

If any or some of these ring true for you, and your motherly instinct is telling you something is off, go get your child evaluated. It will put your mind at ease to know what professionals think. If there is a problem, then you can start taking care of it with support from others.

How to Find a Speech Therapist

As stated in the blog description to the right of this page, no website or advice, even when received from a professional speech-language pathologist, can compensate for the REAL DEAL. If you have concerns, you need to get your child evaluated by a speech-language pathologist. This post will give you a little bit of background on how to find one.

The first thing you should know is that school districts are responsible for finding children with disabilities within their boundaries. So typically the best way to go is through your school district.

You will go about contacting your school district differently, depending on your child's age. If they are currently in school, talk to your child's teacher and possibly your child's principal to learn about the process. It's different for every school.

If your child is not in school yet, you will probably need to contact Early Intervention, sometimes referred to as Birth to Three. Click here for the website for Davis School District in Utah. For any other area, it usually works well to Google "Early Intervention/Birth to Three, (your county and state)" Or you can just look up the main number for the district and they will probably direct your call appropriately. Or you can try this link. It lists coordinators by state. I don't know when it was last updated.

If your child qualifies for speech then services are usually free. Sometimes Birth to Three services have fees for direct services, and that varies by state also. Most evaluations are free of charge.

If you don't want to go through the school district, you can find a speech therapist in your area by doing a little bit of research (again Google works wonders) or you can try this website.

Good luck! Post your questions and let me know if this information was helpful!