Hearing Level / Hearing Loss

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Children and Youth with Special Health Needs (CYSHN)

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Hearing Level / Hearing Loss

Taking Action: About First Hearing Aids

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Your Child's First Hearing Aids
Earmold Impressions
Hearing Aid Fitting
Care and Use of the Hearing Aids
Hearing Aid Follow Up
Hearing Aid Benefit
Daily Listening Checks
Keeping the Hearing Aids On
Trouble Shooting and Repairs
Periodic Hearing Evaluations
Frequently Asked Questions

YOUR CHILD'S FIRST HEARING AIDS

Most children are evaluated by an ear nose and throat (ENT) specialist before an audiologist fits them for hearing aids. Fitting the hearing aids may require several appointments, with the number and sequence of appointments depending on your child, the family, and your clinician.

You can expect your audiologist to:

Determine the benefit of a hearing aid
Take the earmold impression
Order the earmold and hearing aids
Fit the hearing aids and ensure they work well
Repair the hearing aids

Your child's audiologist will instruct you on the use and care of hearing aids and will continue to re-evaluate for any changes in hearing status. Remember, it takes time to learn everything you need to know, so ask questions. Some parent have even found it helpful take another person along to appointments as support.

EARMOLD IMPRESSIONS

The earmold for a behind the ear (BTE) hearing aid must be custom made to fit your child's ear. Here is how the process goes:

A cotton block or sponge is placed in the ear and a small amount of impression material is put in the ear canal with a syringe. (It takes just a few minutes for the earmold impression material to set up). Impressions may be taken one ear at a time or both ears at the same time, and after it is set, it is removed from the ear and sent to an earmold manufacturer. The earmolds will usually be ready in about two weeks.

The audiologist may initially fit your child with “loaner” hearing aids. These hearing aids may be used until all hearing tests have been completed, until you decide which hearing aid you will get, or until funding is approved. In Minnesota, we are fortunate to have loaner hearing aids available through the University of Minnesota Lions Infant Hearing Program.

When the earmolds and hearing aids are ready, you will be scheduled for a return appointment with the audiologist. It is at this appointment where you will learn more specific information about the hearing aids your child will wear.

HEARING AID FITTING

Every person is unique, so hearing aids are adjusted or programmed to provide the correct amount of amplification for your child. They may be pre-programmed by the audiologist before you arrive.

Example of a hearing aid. The audiologist will check the fit of the earmolds, trim tubing to the correct length, and then the earhook on the hearing aid is attached to the tubing. A battery will be placed in the device, and the working hearing aid will be placed in your child's ear.

Your audiologist will be very helpful at this appointment, and will make sure you feel comfortable placing the hearing aids. There will be time to help you practice several times before you leave the clinic.

You will learn to:

Turn the hearing aids on and off
Place the devices in your child's ears
Remove them and care for them
How to check and change the battery when it gets low (usually every 7-10 days) The hearing aid should have a tamper-proof battery door so that your child cannot take the battery out
Cleaning and storing the earmold and hearing aid

The hearing aid will also come with a hard copy manual that covers almost everything that your audiologist teaches you.

CARE AND USE OF THE HEARING AIDS

Example of a hearing aid maintenance kit (battery tester, blower, drying container and listening stethescope). Hearing aid care and use are discussed during the hearing aid fitting appointment. You may be asked to come back in a week or two to see how the hearing aids are working and to answer any questions. Many audiologists order a “hearing aid care kit” for your child along with the hearing aids. Common items in the kit include:

Battery tester
Bulb syringe to dry tubing
Wax loop for the earmold
Listening tube so you can listen to the hearing aids
Drying container

Hearing aids are very sensitive to moisture which can cause serious problems with how the aids work. This is why they should always be kept either in your child's ears or in the drying container. The container has silica crystals to absorb the moisture out of the hearing aids when they are not worn.

Your child will be wearing hearing aids continuously during all waking hours to get the most benefit from them. Some children even prefer to wear their hearing aids while they are sleeping.

HEARING AID FOLLOW UP

Hearing Aid Follow Up

You may return to the clinic several times during the first month or two, and additional testing may be completed during these visits. The audiologist may review some of the directions you were previously given and any concerns that you have can be addressed at this time.

Consistent hearing aid use will be emphasized. If you are having trouble keeping the hearing aids in your child's ears, the audiologist can give you helpful tips. One of the problems parents frequently report is “feedback” or whistling of the hearing aids.

During the first year of life, the baby’s ear canal grows very quickly. Any leakage of sound around the earmold may cause excessive feedback, so it is common to replace the earmold as often as every 30 days for the first few months.

It is normal for the hearing aid to whistle when something is very close to it. Sometimes the hearing aids whistle when the child is in a car seat while driving, so many young children do not like to wear hearing aids in the car. If you are concerned about your child getting the battery door open, the safest thing is to take them out.

If your baby accidentally swallows a battery, call the poison hotline number 1-800-222-1222.

HEARING AID BENEFIT

The audiologist will use different methods to make sure the aids are working properly. You will be with your child during testing.

With older babies, hearing thresholds can be measured while the child is wearing the hearing aids. This procedure is very similar to a typical hearing test in a sound room.

Another method used to determine if your child is receiving enough amplification is called “real ear” measures. A small probe tube with a tiny microphone is placed in your child's ear. This measures how much amplification is provided at each pitch. These tests do not hurt, however, your child may cry or become agitated during testing.

You will be asked to provide feedback about your child's listening behavior. This will help your audiologist evaluate hearing aid benefit.

DAILY LISTENING CHECKS

Location of the volume control on a behind the ear hearing aid. It is important to know how to check your child's hearing aids to see if they are working properly. You may have a hearing aid care kit which includes a listening tube or stethoscope. The idea is for you to connect the hearing aid to your listening tube and turn it on to see if it sounds as it should. Use of a listening stethoscope allows you to actively listen to your child's hearing aids on a daily basis so you will know for sure that the hearing aids are working correctly.

A good way to listen to your child's hearing aid is to use the “Ling Sounds”. The six Ling Sounds contain all of the sounds from low pitch to high pitch. If you can hear all of these sounds clearly through the hearing aid, then it is working properly. As they get older, it is possible to do this test while the child is wearing the hearing aids.

When you say the following six Ling Sounds your child will learn to clap or repeat the sound.

Say OO as in moo, the child responds OO, or claps
Say AH as in pop, the child responds AH, or claps
Say EE as in me, the child responds EE, or claps
Say SH as in “shhh”, the child responds SH, or claps
Say SSS as in so, the child responds SSS, or claps
Say M as in mom, the child responds M, or claps

Watch to make sure your child is not lip reading!

KEEPING THE HEARING AIDS ON

For some parents, keeping the hearing aids in the ears is a HUGE challenge! Most children pull the hearing aids out because the sound is different from what they are used to not because the hearing aids hurt or are not fitting properly. There are a number of things that you might want to try:

Pediatric Ear Hooks -
Most audiologists will fit the BTE hearing aids with a pediatric “ear
hook” that helps the hearing aid fit over the ear better. It has a
tighter curve than a regular ear hook.

Toupee Tape -
Tape that is used to keep toupees in place (double sided tape) can be obtained at most wig shops. A small piece of this tape may be placed on the inside of the hearing aid to secure it to the head.
Huggie Aids -
These are plastic rings that are secured to the hearing aid and can be placed around the ear to help with retention. There are also headbands that can be worn around the hearing aids to hold them in place.
Critter Clips -
The cute critter is clipped to the collar or at the back of the neck and has a cord that attaches to each hearing aid. It prevents the hearing aids from getting lost if they are taken out.

TROUBLE SHOOTING AND REPAIRS

If you notice that your child's hearing aid does not sound like it should, there are several steps you can take to figure out the problem.

Check the battery or replace it.

Remove the earmold tubing from the earhook. Listen to the hearing aid and see if it works. If it does, the problem is in the earmold or tubing. If it still doesn't work, the problem is in the hearing aid.
Soak the earmold and tube in soapy water and blow out the tubing using the bulb syringe. Make sure the tubing is completely dry before putting it back together.
Put the hearing aid in the drying container for a day. If it still doesn't work, it may have to be sent for repair. Contact your audiologist for repair services and the possibility of a loaner.

Hearing aids are very sensitive electronic devices. Even the humidity in the air is enough to cause hearing aid problems over time. It is not uncommon for hearing aids to be repaired two or three times a year. Taking care of the hearing aids properly can help reduce the number of times that the hearing aid has to be repaired.

PERIODIC HEARING EVALUATIONS

Hearing can change over time and should be monitored regularly. The ear canal also changes over time, so earmolds need to be checked periodically to make sure they fit properly. The ear canal of an infant changes rapidly over the first year. Earmolds may need to be changed from six to eight times during the first year:

Babies younger than one year:	every 1-3 months
Infants from one to two years:	every 3-6 months
Toddlers and young children:	every 6-12 months

FREQUENTLY ASKED QUESTIONS

There is so much information when your child first gets hearing aids that it can be overwhelming. These are some questions most parent have:

Which hearing aid make/model is best?
Providing auditory stimulation at the earliest possible time is very important. Your audiologist is familiar with the “features” that a hearing aid should have for your child's type, degree, and shape of hearing loss. Your audiologist will be able to discuss the options that meet your child's needs.

Does my child need one or two hearing aids?
If your child has a hearing loss in both ears, two hearing aids are needed. If your child has a loss of hearing in one ear, only one hearing aid may be needed. Being able to hear from both sides is important to determine where sound is coming from or localization, hearing across distance, and hearing in background noise. Limiting hearing aid use to one ear if there is a loss in both ears limits your child's ability to hear the best that they can. It also deprives the brain of the stimulation it needs to develop properly.

What is feedback and what can I do about it?
Feedback is the whistling sound that the hearing aids make which is caused by “leakage” of the amplified sound. Feedback can also result from:

Too much wax in the ear canal
Objects too close to the hearing aid's microphone
Earmolds that are too small
A hearing aid that is not seated in the ear properly

Occassional feedback is expected when you hug your child, but let your audiologist know if you are concerned about feedback.

What does it mean to “program” a hearing aid?
Hearing aids can be adjusted by using a small screwdriver or by connecting it to a computer. Hearing aids are “programmed’ when they are adjusted for your child's specific amplification need.

How can I make sure my child has consistent hearing aid use?
Your goal is fulltime hearing aid use.

Start each day with a listening check
Put the hearing aids in your child's ears upon waking
Keep the devices in your child's ears throughout the day

It may be helpful to keep a calendar of daily hearing aid use to share with your audiologist.

Is there a support group for parents of children identified as deaf or hard of hearing?
Getting to know other parents who have children identified as deaf or hard of hearing in your community can be very important. They have the experience and insight that can be a valuable resource. Some communities have organizations that you can join to make these connections. If you are working with the state parent/infant program or with the state early intervention services, they may be able to help. Sometimes, professionals working with your child can help you make these connections. There are also many support groups and information resources available on the Internet. Many organizations have Internet discussion boards, chat rooms, email, and list serves designed for parents, siblings, and others.

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Information on this web site was obtained from the Infant Hearing Guide developed in a cooperative project between the University of Arkansas for Medical Science, Arkansas Children's Hospital and the University of Arkansas RRTC and we would like to acknowledge their work.

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