Does your little one have a hearing problem? Let's learn about hearing loss.

Sometimes you may feel like your little one doesn't pay much attention when you talk, or doesn't respond well to sounds. Although this is very common, sometimes one of the reasons for this can be a hearing impairment. Shall we talk about this condition called `(Hearing Loss)`, that is, hearing loss, in a simple way that you can understand? There is nothing to be afraid of, the most important thing is to be aware.

What does it mean to have hearing loss?

Simply put, a young child with hearing loss, or what we medically call ``Hearing Loss,'' has difficulty hearing and understanding some or all sounds. They feel as if the volume on a radio has been turned down. There are three main reasons why this could be happening:

• Problems with different parts of the ear: Our ear is a very complex organ. It has parts called the outer ear, the middle ear, and the inner ear. If there is a defect or blockage in one or more of these parts, sound may not be heard properly.
• A problem with the nerves that carry sound to the brain: Understand that after receiving sound from the ear, it needs to be carried to the brain. If there is any weakness in these nerves that carry sound, the sound does not go to the brain properly.
• A problem with the part of the brain that understands sound: Even after the sound reaches the brain, there is a special part of the brain that understands it as "this is mom's voice," "this is a song." If there is any weakness in that part, even if you hear the sound, you will not be able to understand what it is.

What are the types of hearing loss?

Hearing loss can come in many forms. Let's look at some of the main types.

Conductive hearing loss

What happens in this case is that something is blocking the sound from reaching the ear. Imagine, if something were to get stuck in the water pipe in your house, the water wouldn't come out.

• There is something wrong with the small bones in the middle ear (these are what vibrate sound and send it inward).
• The ear is filled with a lot of wax-like material (we call it earwax).
• Or, things like frequent ear infections can cause this type of noise to stop.

This is called ``Conductive hearing loss.`` This type of hearing loss can sometimes be corrected with medication or minor surgery.

Sensorineural hearing loss (SNHL)

This is a little different. What happens here is that there is damage to either the very sensitive part of the inner ear called the cochlea (this is a snail shell-shaped part), or to the nerves that carry sound to the brain.

• This `(Sensorineural hearing loss)` or `(SNHL)` can sometimes be hereditary (meaning that your mother, father, grandmother, or grandfather had it).
• Or it could be part of some genetic syndrome.
• Also, some infections (for example, some diseases that the mother develops during pregnancy) and some strong medications can damage the inner ear or nerves. This type of weakness is usually permanent.

Mixed hearing loss

In this case, both the previously mentioned ``Conductive'' and ``Sensorineural'' causes can occur together. This means that there is an obstruction to the sound entering the ear, and there is also a problem with the inner ear or nerves.

Central hearing loss

In this case, the problem is not in the ear, but directly in the brain. That is, ``Central hearing loss`` occurs when something is damaged in the part of the brain that controls and understands sound. This is a very rare occurrence.

Auditory processing disorder (APD)

This is also very special. Children with `(Auditory Processing Disorder)` or `(APD)` have their ears and brains not working properly together. They can hear normally (meaning they don't show any problems on hearing tests), but their brains have some difficulty recognizing and understanding sounds, especially speech. It's like the radio signal is distorted and the sound is broken up, or the words in the sound are not clear.

What are the causes of hearing loss?

There are actually many reasons why hearing loss can occur. But sometimes it is not possible to find the exact cause. However, if these factors are present, a young child is more likely to have hearing loss:

• Being born with a hearing impairment, or having a family member (mother, father, siblings) who had hearing impairment at a young age.
• The baby was born prematurely (we call it preterm) and/or received treatment in the Neonatal Intensive Care Unit (NICU) .
• Jaundice develops during the newborn period, and the level of bilirubin in the blood increases to the point where a blood transfusion is required.
• Frequent ear infections, ruptured eardrums, or exposure to loud noises. For example, some parents let their young children listen to loud music with headphones or give them loud toys. These can damage a child's delicate ears.
• Infections such as meningitis (a type of brain infection) or cytomegalovirus (a type of viral infection) have developed.
• Some medications that can damage hearing (these are called `ototoxic drugs`) are safe for the mother to take during pregnancy, and safe for the baby to give. (Doctors are usually very careful when giving these, but in some essential cases they have to be given).

What are the symptoms of this? How do you recognize it?

It can sometimes be difficult to tell if a child has a hearing loss, especially very young children. They may not be able to say, "I can't hear." Children with this type of hearing loss may not respond well to sounds or speech. Their speech development (language development) may be delayed. If your child doesn't respond well to these things during the first year of life, you should definitely talk to a doctor:

Newborn babies (0-3 months):

• The startle reflex (we call this the `startle reflex`) when you suddenly hear a loud noise.
• Becoming calm and stopping crying when hearing mom and dad's voice (around 3 months).

At around 4-6 months:

• Turning your eyes or head in the direction of a new sound.
• Showing a preference for toys that make noise.
• Repeating sounds like "Uh...", "Ah...", "Guh...", as if talking to yourself.

At 7-12 months (one year):

• Making various sounds that don't make sense (we call these `babbling sounds`, like "myself", "bababa").
• Responding to his name (turning around when his name is said).
• Trying to understand simple instructions like "ta ta" and "look if mommy is coming."
• Imitating words.
• Saying a few simple words like "Mom", "Dad", and "Bye-Bye".

As the child gets older (after 1 year), signs of hearing loss may include:

• Limited speech, slurred speech, or failure to speak in an age-appropriate manner.
• Appearing not to pay attention to what is being said, not following instructions (sometimes we think the child is doing this "out of malice", but it could actually be because he is not listening).
• Not responding when spoken to in a normal voice, or repeatedly asking "Huh?" "What?", or giving irrelevant answers.
• When there is a lot of noise around you (e.g., in a crowded place, with the TV on), it is easy to get distracted, feel restless, and have difficulty understanding what is being said.
• Having to turn up the volume on the TV or radio to watch/listen.
• Having difficulty with schoolwork and learning.
• Responding only to certain sounds (e.g., hearing high-pitched sounds but not low-pitched sounds).

Important: Some hearing problems can develop gradually after birth, or they can develop later in life (e.g. after an illness or head injury). If you have any concerns about your child's hearing, be sure to talk to a doctor. Your child may also need to be referred to an audiologist , a doctor who specializes in hearing.

How exactly do you diagnose hearing loss?

It's best to catch hearing problems as early as possible. Because treatment is most effective when started before a child is 6 months old. That's when a child's brain is developing rapidly to learn language.

• Newborn Hearing Screening: That's why every newborn baby undergoes a hearing screening test before leaving the hospital. This is a painless test for the baby and can be done in a few minutes.
• If you were unable to have your baby tested before going home, or if your baby was born at home or in a birth center, you should definitely have your baby's hearing tested within the first 3 weeks of birth.
• A "fail/refer" on this hearing test does not necessarily mean that the baby is deaf. However, it does mean that further diagnostic audiology tests should be performed as soon as possible, usually within a month or two of birth. If a hearing loss is found, treatment can be started immediately.
• Even children with normal hearing should have their hearing checked regularly during their regular medical check-ups (at the clinic). These hearing tests are usually done at ages 4, 5, 6, 8, and 10, as well as during preteen and young adulthood. In addition, hearing tests can be done at any time if the doctor suspects something is wrong.

How is this treated?

Treatment depends on the type of hearing loss, its cause, and how severe it is. Children with permanent hearing loss should be seen by a team of specialists. This team may include an audiologist (hearing specialist), an ear, nose, and throat doctor (ENT doctor), a speech-language therapist, and possibly an education specialist.

Children with some types of hearing loss can be helped with medical treatments (e.g., medication for an ear infection), therapies, and surgeries (e.g., inserting a small tube to drain fluid from the ear). There are several main treatments for permanent hearing loss:

• Hearing aids: These amplify and clarify sounds so that your child can hear. They are like small, highly sensitive microphones that fit in your ear. If a baby with permanent hearing loss starts using hearing aids before 6 months of age, their speech and brain development are greatly enhanced. There is no one style or manufacturer that is right for every child. Your audiologist can help you choose the best hearing aid for your child's needs and ear size. Many children with hearing loss in both ears use two hearing aids.

• Frequency modulation (FM) systems: This (FM) system reduces background noise and allows the child to hear only the speaker's voice (e.g., teacher, mother) clearly and loudly. Imagine a school class. The teacher wears a small microphone and a transmitter. This transmitter sends an electrical signal to a wireless receiver that the child wears on their ear or is attached directly to the hearing aid. Since it can be carried around, it can be used at home, at school, or in places where there is a lot of noise.

• Cochlear implants: Cochlear implants can be a great help for children with severe to profound hearing loss who cannot benefit from hearing aids. These are sophisticated electronic devices that are surgically implanted in the ear. They bypass the parts of the ear that are not working properly and directly stimulate the auditory nerve. Once implanted, along with special training and speech therapy, children with a cochlear implant can learn to hear better and speak clearly.

• Hearing habilitation/rehabilitation: This is the process of teaching children who are born with hearing loss to listen and communicate. This may include things like Auditory-Verbal Therapy (AVT) , speech therapy, speech/lip reading, or, if necessary, learning sign language (such as American Sign Language (ASL) or local sign languages). Your audiologist and doctor will work with you to help your child find the best way to communicate. Older children who lose their hearing learn these communication skills through a process called hearing rehabilitation.

What else do I need to know?

Even a very small, that is, mild, hearing loss can cause problems with a child's speech, language, learning, and social skills. That is why it is said that babies and young children with hearing loss should be referred to a service called ``early intervention.'' This is a program that provides free or low-cost treatment services to eligible children. In Sri Lanka, such services are also implemented through the Ministry of Health and various non-governmental organizations. You can find out about it by asking your local family health service officer or doctor. Older children may also be eligible for ``special education services'' when they go to school.

Remember, you are not alone. There are places to get help and information when you are facing a situation like this. Ask your doctor, audiologist, etc. You can also gain strength and knowledge by joining support groups formed by other parents of children with hearing loss.

Finally, things to remember

Okay, so I hope you can remember some of the most important points from what we talked about today.

• Early detection is very important: Don't miss the hearing test that your baby gets after birth. If you have any doubts, even if they are small, see a doctor as soon as possible. Don't delay.
• Not all hearing loss is the same: there are different types and different causes. Finding out exactly what the problem is is essential for treatment.
• There are treatments: Technology is very advanced these days. There are many things that can help a child, such as hearing aids, cochlear implants, and special therapies.
• Early intervention can make a big difference: it helps a child's speech, learning, and social interactions. It paves the way for a child to live a normal life like other children.
• You are not alone: ​​there are doctors, specialists, and support groups to help and guide you on this journey. Get their help.

Taking care of your child's hearing is a big investment in their entire future. Therefore, it is very important to be aware of this and take the necessary steps. If you have any further questions about this, don't be afraid to ask your doctor.

Hearing loss, hearing, young children, infant hearing screening, hearing aids, cochlear implants, speech therapy