Evaluation & Diagnosis Of Hearing Loss

It’s very important for you to know the hearing status of your baby. Most babies have their hearing screening in the hospital or birthing center. If your newborn did not pass the newborn hearing screening, you will be referred for a rescreen or a more complete hearing evaluation to determine if there is a doorway problem that is preventing information from getting to your baby’s brain. Completing each step as quickly as possible is important to your baby’s brain development for listening and spoken language (LSL) and knowledge. If your child is older and you’re concerned about their hearing, you’ll want to schedule an appointment with a pediatric audiologist for a hearing screening as soon as possible.

A COMPLETE HEARING EVALUATION

Comprehensive hearing testing, which is also called a diagnostic hearing or audiological evaluation, will confirm if your baby truly does have hearing loss. It’s recommended that infants who don’t pass their hearing screenings should have a complete hearing evaluation within the first 3 months after birth. The sooner you know your baby’s hearing status the better.

The diagnostic hearing tests will measure how much your baby can hear in each ear (how much auditory information is reaching their brain) and whether the hearing loss can be corrected by surgery or can be managed by technology, such as hearing aids. These tests are very important and you should follow up on them because in some cases, babies who don’t pass their newborn hearing screenings may pass when more in-­depth testing is provided and you will be relieved to know the status of the test results.

When you schedule the hearing evaluation, you should bring a family member with you. If your baby is diagnosed with a hearing loss, the news can be a surprise or a shock and may be an emotional time. It’s good to have a supportive family member with you when the results are shared and subsequent treatments are explained.

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PREPARING FOR YOUR BABY'S HEARING EVALUATION - Be confident when you walk into every appointment by knowing what to expect, like what kind of tests they’ll do and what kind of questions you’ll be asked.


WHO DOES THE TESTING?

Your baby’s comprehensive hearing tests should be performed by a pediatric audiologist. In the United States, a pediatric audiologist is a doctor of audiology (Au.D or Ph.D), who is legally licensed to practice audiology in the state where they live, and who has lots of knowledge and experience working with babies. They’ll test your baby’s hearing and report the results to you.

Depending on the results of the initial testing session, you may be asked to schedule more than one appointment to determine your baby’s hearing status. The process to diagnose hearing loss often requires more than one test and depending on a number of factors, your audiologist may ask you to schedule another appointment for testing.

If hearing loss is diagnosed, they’ll also:

  • Explain your baby’s hearing loss or doorway problem in terms you can understand
  • Recommend hearing technology options to get complete and clear auditory information through the ear to your baby’s brain
  • Discuss costs and services for the hearing devices
  • Customize your baby’s hearing devices so they fit well
  • Teach you how to care for the devices
  • Discuss the desired outcomes you want for your baby and immediate enrollment in appropriate early intervention to help you reach your goals for your baby
  • Monitor your baby’s hearing or doorway to get the best results

When a baby is diagnosed with hearing loss, your pediatric audiologist will most likely request to include other doctors on your team. Typically your baby is referred to a medical doctor who specializes in childhood ear and hearing problems – like an ear, nose and throat (ENT) doctor or an otologist. They’ll examine your baby to see if there is a medical solution. Your baby may be referred for other diagnostic tests, such as X-rays or MRI scans, to further define the type and source of the hearing loss – the nature of the doorway problem.

Meet the pediatric audiologist. This professional specializes in evaluating and diagnosing hearing loss in children. They manage your child's hearing and hearing technologies.


WHAT DO THE TEST RESULTS MEAN

The results of your baby’s diagnostic hearing evaluation will be reported to you by the pediatric audiologist. They’ll explain the purpose of each test and what it means for your baby’s hearing.

Depending on the age of your baby, they may be tested using behavioral audiometry. For this testing, sounds are presented to your baby and the audiologist observes your baby’s responses. You’ll be present with your baby throughout the testing and have the chance to observe the responses as well. The results of behavioral testing will be shared with you in a graph called an audiogram. The audiogram gives you a visual picture of your baby’s hearing. You’ll be able to see how your baby hears compared to normal hearing levels.

The audiogram will also show which speech sounds get through the ear to your baby’s brain at the time of testing. Speech sounds have high and low pitches and different loudness levels. To develop good speech, your baby’s brain needs to be able to hear the full range of speech sounds.

Your audiologist will be able to clearly explain what the testing does and doesn’t tell them about your baby’s hearing. They’ll also be able to show you the range of your baby’s hearing loss in each ear and identify if their hearing loss level is mild, moderate, severe, or profound, and what can be done about it.


Introducing the “Audiology Fruit and the String Bean”

Drs. Jane Madell and Carol Flexer, notable pediatric audiology thought leaders, explain how the audiogram provides a visual picture of the speech information going through the doorway to the brain.


If your baby is diagnosed with hearing loss, you’ll return often for repeated testing of your baby’s hearing. This happens so that hearing devices can be appropriately fitted and any change or drop in hearing can be detected quickly.

While all this is a lot to take in, your pediatric audiologist will be there to guide you through the results, and will recommend a plan to help your baby hear better by giving their brain access to all the sounds of speech.


TYPES OF HEARING LOSS-IDENTIFYING THE DOORWAY PROBLEM

Your baby may have hearing loss (a doorway problem) in only one ear (unilateral) or both ears (bilateral). The hearing loss is also identified according to the part of the ear that is not working and what is causing it. In many cases, the cause of your baby’s hearing loss may be unknown. Your audiologist and ENT will help determine a cause if it’s possible.

There are two basic types of hearing loss:

  • Conductive hearing loss is caused by problems in the outer or middle ear, such as an ear infection, wax buildup, or a problem with how the ear is formed. Sometimes this type of doorway problem can be corrected with medical treatment or surgery. Depending on your child’s specific hearing loss, hearing technology may still be recommended.
  • Sensorineural hearing loss means the doorway problem is in the inner ear or cochlea – the part of the ear that receives, organizes, and transfers sound through nerves to the brain. This type of hearing loss is permanent, which means that it cannot be corrected with surgery. However, hearing, listening, and spoken language are still possible with the use of technology that gets auditory information through the doorway to your baby’s brain.

Hearing loss can also range in degree from mild to profound, but with early auditory brain activation through technology (e.g. hearing aids), your child can have the ability to learn to listen and talk.