Ear Center: Family Resource Packet
Information to Guide You and Your Child Through Their Hearing Journey
Amy M. Daughton, M.Ed., CCC-A
Navigate this page:
Early Intervention for Ages 0-3
Intervention Services Available in North Carolina
Explanation of Hearing loss
Types of Hearing Loss
Severity of Hearing Loss
Causes of Hearing Loss
Effects of Hearing Loss
Familiar Sounds Audiogram
Hearing Assistance Options
Assistive Listening Devices
Funding Available for Services and Assistance
Other Services Available
Professional Help/Healthcare Team
Local Resources for Common Referrals
Family Support Groups
Web Site References
NC State Board of Education
Your child has just been diagnosed with a hearing loss. This knowledge can be overwhelming. This packet contains helpful information to guide you in future decisions that will assist your child and your family during this process. Information regarding your child's specific type of hearing loss, the effect this can have on speech development, early intervention, services available and references for you to utilize, now and in the future, are all contained within this packet. If you or your family has any questions regarding the information presented in this packet, please contact your audiologist at The Ear Center of Greensboro, P.A. Your audiologist has knowledge and skills in pediatric audiology and is here to help and assist you in this journey. Lastly, please note on page 19 which is a place for you to take notes regarding the information that you'll read and additional information that is provided by your child's healthcare team.
EARLY IDENTIFICATION: Early identification of children is critical. As you will learn in this packet, hearing plays a critical role in the acquisition of speech and language development as well as in the achievement of other developmental milestones. Research has shown that the enactment of universal hearing screenings has helped to catch/identify more children that would otherwise have been missed. States have now enacted an Early Hearing Detection and Intervention (EHDI) program to assist in establishing early identification testing so that infants with hearing loss are identified.
EARLY INTERVENTION: Early intervention allows children to receive follow up screenings and services as needed. The goal of early intervention is to assist in preventing long term problems and to ensure that the children identified are receiving follow up care and the assistance that they may need. Beginning habilitation as soon as a hearing loss is confirmed ensures that your child will have the opportunity to be exposed to more abundant language which will enable he/she to achieve maximal language skills. Studies have shown that the positive effects of early identification and early intervention are seen in those children who are identified early. Their expressive and receptive language scores are significantly better than those that are identified later in life. Helping your child function at, or close to that of his/her peers is crucial for both educational and personal development. Thanks to federal funding states across the US, including North Carolina, are able to participate in early intervention services for infants to ensure that they are identified with hearing loss early, receive amplification (hearing aid(s), ALD's, FM's, etc.) and are, therefore, able to achieve success in speech and language development.
When your child is identified with hearing loss at age 0-3, he/she will have what is called an Individualized Family Service Plan (IFSP). Traditionally, this begins after a child has failed their newborn hearing screening. The Greensboro division of EHDI will begin this for you. If your child is identified later in life, as soon as they are diagnosed with a hearing loss by a professional, they will direct you to human services to begin the IFSP. This is similar to an Individualized Education Plan (IEP) that your child may receive once they begin school. (Refer to pg. 15, regarding further information on educational assistance and the rules and laws governing those.)
Your child's IFSP is a legal binding document that will stipulate the goals and objectives for your child along with who will work on these goals and objectives in order to close the gap in learning. Not only will this document spell out who is assisting your child but it will advise on how often the professionals will assist him/her and what the expected success date to achieve the goals that have been established. Every year your child's IFSP has to be re-evaluated to determine if your child will need to continue current services, if changes to services need to be made, or even if your child is ready to be exited from the program. Once your child is ready to begin school, they may either have an IEP or a 504 plan as needed.
In the state of North Carolina, there are several services available. Below is a listing of these services and contact information.
North Carolina Early Hearing Detection and Intervention (EHDI) Program:
This organization is responsible for implementing newborn hearing screenings, ensuring that these children who fail these screenings receive follow up services and are provided with intervention as needed:
North Carolina Early Intervention Program for Children Who are Deaf or Hard of Hearing, Office of Education Services
- Eastern 252-237-2450
- Central 336-824-3659
- Western 828-432-5352
The Early Intervention Program for Children who are Deaf or Hard of Hearing provides services to children who are deaf, hard of hearing, or deaf/blind, ages birth to three, and their families. Concentrating on language and communication skill development, itinerant professionals provide family-centered intervention in home and daycare settings. At age three, the program works to establish a smooth transition to the local education agency.
BEGINNINGS (NC Chapter) for Parents of Children Who are Deaf or Hard of Hearing
BEGINNINGS of North Carolina is a non-profit agency providing an impartial approach to meeting the diverse needs of families with children who are deaf or hard of hearing and the professionals who serve them.
North Carolina Early Intervention Services
The Infant-Toddler Program is a variety of agencies working together to provide early intervention services for children ages birth to three who have special needs and their families. Early intervention services help young children grow and develop and support their families in caring for them.
Project E.A.R's mission is to enable children with cochlear implants to maximize their listening skills and spoken and written language through training and coordination among service providers in each child's community.
Center for Acquisition of Spoken language through Listening Enrichment (CASTLE)
- Durham 919-419-1428
- Wilmington 910-686-4304
The mission of the Center for Acquisition of Spoken language Through Listening Enrichment (CASTLE) is two-fold. CASTLE is dedicated to providing quality auditory-oral early intervention and preschool services to children who are deaf or hard of hearing and their families. CASTLE teaches, encourages, empowers, and supports the parents as the primary teachers of their young children, in order to promote healthy parent/caregiver bonding and to maximize the amount of time a child spends in a language-rich environment.
Let Them Hear Foundation Advocacy Program
The Let Them Hear Foundation Advocacy Program received a grant to create an internet-based resource center for parents and professionals working with children with disabilities to provide a fundamental understanding of the key concepts of the Individuals with Disabilities Education Act 2004 (IDEA 2004).
Oral Deaf Education Programs
Oral deaf education enables children who are deaf and hard-of-hearing to listen and talk.
Learning More about Communication Options
Here you'll find lots of information on raising a deaf or hard-of-hearing child.
There are three types of hearing loss that your child may have. As more testing and information are obtained from your child, the specific type of hearing loss will be determined. Please reference the diagnosis that your child has been given below. Consult your audiologist if you are unsure of the exact diagnosis.
Conductive Hearing Loss: This type of hearing loss occurs from any sort of interference with the external auditory canal as well as any malfunction of the tympanic membrane (eardrum) or middle ear bones or within the middle ear space. Ear infections are also a common cause of conductive hearing loss and therefore are the most common type of hearing loss found in children. This can also occur as a result of craniofacial malformations. Some causes of conductive hearing loss can resolve spontaneously (i.e. ear infections) but some will require medical or surgical treatment. The sensory and nerve functions of hearing typically function within normal limits. Otolaryngologists (ENT doctors) will assist in locating the cause of this type of hearing loss.
Sensorineural Hearing Loss: This type of hearing loss can be caused by damage to the sensory organ (cochlea) or hair cells located within the cochlea or the dysfunction of the auditory nerve. Testing will assist the audiologist in differentiating clearly between sensory or neural hearing impairment. This type of hearing loss is nearly always permanent and irreversible. This type of hearing loss may be due to a wide variety of causes such as bacterial and viral infections, familial inheritance, diseases that can affect the otic capsule, auditory nerve or membranous labyrinths and possibly metabolic disorders.
Mixed Hearing Loss: This type of hearing loss is a combination of both conductive and sensorineural hearing loss. This type of hearing loss will improve only as much as the conductive component is able to be resolved.
The severity of a hearing loss is an important consideration. You will hear your audiologist or otolaryngologist (ENT) refer to this as either the severity or degree of hearing loss present. The degree of hearing loss is defined as mild (15-30 dBHL), moderate (31-50 dBHL), moderately-severe (50-60 dBHL), severe (61-90 dBHL), or profound (greater than 91 dBHL) and anacusis (total hearing loss). In addition to the severity of the hearing loss, knowing which ear is affected is also important. Terms such as unilateral meaning one ear or bilateral meaning two ears will be used to identify the ear(s) affected. A complete description of your child's hearing loss will be provided to you by his/her audiologist.
There are several causes of hearing loss as mentioned above. It is very important that you work with specialists such as otolaryngologists, pediatricians and/or geneticists to determine the cause of your child's hearing loss. There are several types of hearing loss that can be progressive so this knowledge can help you and your audiologist plan for your child's future.
Hearing loss affects 30-50 infants out of every 1000 births in the United States. The number one effect that hearing loss has on children is that it can cause delays in speech and language development. When a child is born, the human auditory system is in place but not fully developed. The auditory system needs input and experience with sound to fully grow and develop its ability to listen to and understand sounds and speech.
The critical language learning time is from birth to age 2 and if a child with hearing loss isn't identified until later in life, their speech and language development has already fallen behind. The English language consists of vowels and consonants and the nature of speech sounds lies in the energy residing in voiced vowels and consonants. As infants, toddlers and young children are learning to produce speech, they need to hear all the sounds clearly in order to verbally produce them. Simply stated, the effect of hearing impairment is that there is a loss of audibility for some or all of the important acoustic cues. You may notice this with an older family member who has hearing loss and complains that they are unable to understand speech and will continuously say "what" or "huh". Speaking louder makes the conversations audible but it does not necessarily provide clarity because the hearing loss is distorting the acoustic signal and interferes with the brain's ability to process what is heard. Page 9 of this packet will assist you in understanding the sounds that your child may be missing. This is a "Familiar Sounds Audiogram".
Ask your audiologist to plot out your child's hearing evaluation results and review this together. The better understanding you have of your child's hearing status, the better able you will be to assist him/her in determining the appropriate forms of amplification (if applicable) or other resources in order to enhance their speech development.
The effects upon speech will depend on the severity, configuration, duration and stability along with the age of the child upon onset. A child who acquires a hearing loss after acquiring language will have less severe linguistic deficits than a child whose hearing loss was present at birth. Be advised that pediatric hearing examinations are an ongoing process.
As your child grows older, more accurate hearing results can be obtained and their hearing will need to be monitored to account for stability of hearing and to look for any changes in hearing.
For the estimated 28 million children and adults in the United States who have a hearing loss, selecting the most suitable hearing aid(s) can be the critical factor to enjoying life to its fullest.
Hearing aids differ in design, size, range of amplification, ease of handling, volume control, and availability of special features. They do have similar components that include:
- a microphone to pick up sound
- amplifier circuitry to make the sound louder
- a receiver (miniature loudspeaker) to deliver the amplified sound into the ear
- batteries to power the electronic parts
Styles of Hearing Aids
- Custom Hearing Aids (Typically more appropriate for teens and adults.)
- ITE (In-the-Ear) ITC (In-the-Canal) CIC (Completely-in-the-canal)
- Behind-the-Ear (Most appropriate for children)
Advantages for fitting BTE hearing aids on children:
- Easy for parents and teachers to handle
- Earmold(s) can be removed for cleaning
- Earmold(s) can be replaced as child grows (and ear grows!)
- Less expensive to replace
- More sturdy
- Made with telecoil (for use with sound field systems and FM systems)
- Made with Direct Audio Input, to link to other assistive listening devices
- Can be fit to a wide variety of hearing losses
- Less feedback in severe loss fits
Most hearing aid circuitry dispensed today is digital technology which will allow for more flexibility in programming your child's hearing aid. Your audiologist will work with you and your child to determine which style, computer circuit and manufacturer is most appropriate for your child and his/her hearing needs.
A cochlear implant is another form of hearing assistance that is designed for children who have a severe to profound sensorineural hearing loss. A cochlear implant bypasses the damaged or missing sensory structures of the inner ear to stimulate the auditory nerve directly with an electrical equivalent of the sound signal.
Hearing with a Cochlear Implant:
- Does not replicate 'normal' acoustic hearing
- Provides detection but does not guarantee comprehension
- Sounds high in pitch compared to what a recipient 'remembers' (progressive loss)
- Improves with consistent device use
- Often requires aural rehabilitation to enhance success of the device
Sometimes hearing aids and cochlear implants are not enough to assist children in understanding speech, especially in a more challenging environment such as a noisy classroom. An FM system is a device that can couple to the hearing aid, cochlear implant or can be used without (for those with normal to near normal hearing) to assist children in these challenging environments.
FM technology refers to a type of wireless system that helps people better understand speech in noisy situations as well as overcoming distance. FM systems commonly work together with a user's hearing aids, although systems are also available for those with otherwise normal hearing (such as people who suffer from APD, ADHD etc.). (2) The FM systems can transmit through objects and can operate as effectively in sunlight as they do indoors unlike infrared systems. FM systems do not require any installation.
- Visit www.phonak.com and watch the video on FM technology.
- Visit www.eSchoolDesk.com which is an FM support tool aimed at teachers and hearing professionals.
eSchoolDesk includes a clear cut explanation of FM technology and its benefits, along with how-to movie clips, a product configuration and further reading links.
Hearing assistive devices (also known as assistive listening devices or ALD's) are available for use alone or in combination with many hearing aids. These devices provide extra help in specific listening situations, such as the telephone, noisy backgrounds, or small or large group listening settings (e.g., restaurants, concert halls, movie theaters).
Some examples of ALD's include:
- amplified telephones
- bed shakers
- amplified alarm clocks
- door bell alerting systems
- strobe light smoke detectors
- Bluetooth devices
- TV Ears, etc
For children with normal to near normal hearing, the use of an ALD is sometimes all they need to assist them in specific situations. For those with mild to profound hearing losses, ALD's can work in conjunction with hearing aids and cochlear implants. Your audiologist can provide you with additional information on which assistive listening device(s) might help with your child's particular listening needs.
Who can help to pay for services?
Hearing aids vary in price according to selected style, electronic features, and related needs for professional consultation and rehabilitation services. Hearing aid costs increase with more complex and sophisticated circuitry and smaller size. Purchase price, an important factor, should be only one consideration in buying hearing aids. Product reliability can save repair costs as well as the frustration of a malfunctioning hearing aid.
Cost of a particular type of battery used by the hearing aid and the rate at which the battery needs to be replaced can also influence the overall cost of owning and maintaining a hearing aid. Batteries may last from several days to several weeks depending on the power requirements of the aid, the type of battery, and whether the aid is used routinely with assistive listening devices.
Each person's hearing loss presents unique characteristics. The expertise of your audiologist about product quality and the monitoring and follow-up services your child may need are important considerations in your purchase decision.
Cochlear implants are typically something that most insurance companies will pay for and you should review your insurance policy if this is a device you are considering for your child to ensure that it will be a covered procedure. If you have questions about this, our surgery scheduling coordinator can assist you in determining insurance coverage.
Most FM devices and assistive listening devices are not generally covered by insurance.
Below are listings of providers that can assist in the purchase of these as well as hearing aids if financial assistance is needed.
- North Carolina Assistive Technology Program: www.ncei.org/ei/itp.html
- NC Health Choice: www.nchealthystart.org/public/childhealth
- North Carolina Medicaid: www.ncdhhs.gov/dma/home.htm
- North Carolina Division of Services for the Deaf and Hard of Hearing: http://dsdhh.dhhs.state.nc.us
- Carolina Children's Communicative Disorders Program: www.med.unc.edu/earandhearing/pedsprogs/cccdpgrant
- Funding Assistance for Audiology Services: www.asha.org/familyfunding
- Hearing Aid Loaner Programs:www.infanthearing.org/HA-loaner
From the moment your child is diagnosed with a hearing loss, your family will enter a new world of information and terminology. Having a good support team is very important to help provide you with the basis for understanding this new information and ensuring that your child is being cared for by professionals you feel comfortable with. As a parent, you will be the head of your child's support team to help him/her get the best possible start in life. Securing the best care possible will require dedication, energy and determination. A broad support team is a great base for your child's future.
This team will consist usually of:
- an audiologist
- speech language pathologist
- teachers (sometimes teachers for the deaf and hard of hearing are required)
- possibly psychologists to help you, your child and your family cope with this information and support you along your child's journey.
What is an Audiologist?
An audiologist is someone who has been trained either at the masters or doctorate level on the hearing and vestibular system. The audiologist will provide your child with frequent hearing assessments and necessary adjustments to their hearing aids, cochlear implants, FM devices or ALD. Your audiologist will also train you and your child (if applicable) on how to operate your hearing assistance device and provide necessary information pertaining to the management of your child's hearing loss.
What is an Otolaryngologist?
An otolaryngologist is more commonly referred to as an ENT (Ear, Nose & Throat doctor) and is a medical doctor who will likely conduct medical clearance before a hearing aid or cochlear implant is pursued. They are also whom you will see for otitis media (ear infections) and assist you and your child with any complications associated with their hearing. Your child will likely follow up with their ENT annually, or as warranted, to continue to monitor their ears and hearing status.
What's a Speech Language Pathologist?
A speech language pathologist(SLP) is trained in assisting with speech and language development. A SLP can offer various techniques and tools to assist your child in developing good speech and language skills. SLP's are available in schools, hospitals and private practices. A SLP will instruct you on the appropriate communication practices for your child's home and school environments.
You are likely more familiar with are pediatricians, psychologists, and teachers. Pediatricians will not only assist and medically manage the majority of your child's overall development but will also assist the ENT and audiologist in regularly monitoring the ears. Psychologists will help you and your child cope with this news and process as well as help implement assistance for your child either with an IFSP or IEP. Teachers will need to understand the importance of your child's listening environment and you will need to be your child's advocate to communicate this to their teachers as they begin school; especially if they do not have either an IEP or 504 plan. Sometimes more specialized teachers such as teachers of the hearing impaired may be required. These teachers are specialized to meet your child's individual needs and will be able to assist you also in ensuring their scholastic success.
The North Carolina Early Hearing Detection and Intervention Program (EHDI) is a great place to start to find out about local referrals. Their primary goal is to ensure that your child is being evaluated and receiving the services they need to be successful in life. They have a list of those professionals who specialize in the pediatric population and can direct you to an audiologist, otolaryngologist, SLP, psychologist, etc. in your area that can assist your child with their hearing care needs.
- (919) 707-5632, Email: firstname.lastname@example.org
- Web: www.ncnewbornhearing.org
Our website, www.earcentergreensboro.com, also has a list of speech language pathologists who have training and experience with the pediatric population.
Finding other families like yours is another important part of assisting you in your and your child's success.
Below is a listing of support groups that are available in this area:
- Triad Hitch-Up
- The North Carolina AG Bell Association
- Camps for Deaf or Hard-of-Hearing Children
- Family Support Network
- Hands & Voices
To find out more go to: www.communicatewithyourchild.org to get further answers about your child's hearing loss. The web site contains all the web sites already mentioned in this packet to ensure that you know who can help you and your child during this process, where services are offered, and available books you can read to assist you in further helping your child.
Visit our web site at www.earcentergreensboro.com in order to learn about the hearing aids we offer as well as information about cochlear implants. This website will provide you with additional answers to your questions regarding receiving hearing assistance options, testing conducted at our office, FM devices and information about speech language pathologists that our office works with that can assist your child with their communication needs.
Other web sites for learning about hearing loss include:
There are different modes of communication and exactly what and how your child hears will be dependent upon their type of hearing loss. Your hearing health care professional can assist you in describing your child's hearing loss and how you can help your child to communicate as effectively as possible.
Speech language pathologists can offer training sessions and therapy to further enhance the development of both receptive and expressive forms of speech. The SLP will design a learning environment where your child can easily recognize and produce certain sounds, words and sentences. Supplementing training with alternative teaching methods such as the use of lip-reading, gestures and expressions, signs or finger spelling may be needed. Finding an SLP is the best way to begin enhancing your child's speech and language skills. Please visit our website at www.earcentergreensboro.com for a list of qualified pediatric SLP's in the Greensboro area.
Once your child is ready to begin school, they may transition from an IFSP to a 504 or IEP if an academic need exists. These documents are legally binding and spell out the accommodations that are needed in the academic arena. A comprehensive evaluation process may include some or all of the following evaluations: communication, psychological, educational, and a social/developmental evaluation. A number of federal laws mandate the provision of assistive technology devices and services in the United States.
The major one that will assist you and your child is IDEA- Individuals with Disabilities Education Act http://www.ed.gov/offices/OSERS/IDEA/overview.html. IDEA evolved out of a number of laws that were aimed at maximizing the educational potential for all children with disabilities. This law mandates the provision of hearing assistive technology for hard-of-hearing and deaf students in both academic and extracurricular activities. There are really no hard fast rules when it comes to receiving services from the State Board of Education.
Each child is served according to the individual needs determined by assessments. By law the state is required to assist your child if he/she has an academic need. Assistance can include hearing aids, assistive listening devices, FM's, classroom modifications such as note takers, extended test taking time, interpreter, closed captioning, modified assignments, real time captioning (CART) with a court stenographer, etc. Whatever services or assistance that is "appropriate" for your child to enhance learning should be provided. This will be provided in your child's communication mode (for example, sign language, spoken English, Spanish, etc.) and at their learning level. Most of the services that are offered are for in school use, however if the child is going to be participating in after school activities that would require them to utilize the devices offered (i.e. field trip, homework assignment, school sponsored programs, etc.), they are permitted to use these off school grounds as long as it is reasonable to assume that they will be utilized for educational purposes.
Specific sections of IDEA that explains what assistive technology devices are and the services they can provide to your child
Sec. 300.5 Assistive technology device
Assistive technology device means any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of a child with a disability. The term does not include a medical device that is surgically implanted (such as a cochlear implant), or the replacement of such device.
Sec. 300.6 Assistive technology service
Assistive technology service means any service that directly assists a child with a disability in the selection, acquisition, or use of an assistive technology device. The term includes:
- The evaluation of the needs of a child with a disability, including a functional evaluation of the child in the child's customary environment
- Purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices by children with disabilities
- Selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing assistive technology devices
The intension of this information was to help make this journey as knowledgeable and comfortable as possible for you and your child. If after reading this packet you have additional questions, please do not hesitate to call The Ear Center of Greensboro, P.A. at 336-273-9932 or feel free to contact one of the other resources that were mentioned in this packet. We are all here to help your family make this transition a natural part of the everyday life for you and your child.
1. The North Carolina Early Hearing Detection and Intervention Program (EHDI): www.ncbegin.org
2. Phonak: www.phonak.com
3. BEGINNINGS, For Parents of Children Who are Deaf or Hard of Hearing, Inc., www.ncbegin.org
4. Cochlear Americas
6. Widex: www.widex.com, "Your Child's Hearing a Comprehensive Guide for Parents on Hearing and Hearing Loss".
7. Patricia P. Warf, AuD, Educational Audiologist
13. Northern, Jerry L., Downs, Marion P., Hearing in Children Fifth Edition.
Published with the permission of the author, Amy M. Daughton, M.Ed., CCC-A, our head of audiology at The Ear Center.
August 1, 2010