Understanding & Treating Hearing Loss

Is a Cochlear Implant Right for My Child?

Milestones for Speech and Language Development:

0-3 months

• Reacts to loud and sudden sounds (wakes up, scares, startles)
• Recognizes a parent's voice
• Reacts in response to a familiar voice (quiets, smiles)
• Looks around to see where a new sound is coming from
• Smiles when spoken to
• Makes pleasure sounds, coos, chuckles
• Uses specific crying patterns (e.g., hunger-cry)

3-6 months

• Experiments with own voice
• Pays attention to music
• Discriminates between sounds, such as friendly/angry voices
• Localizes sound source/voice
• Recognizes own name
• Uses different cries, stops crying when spoken to

6-9 months

• Babbling begins and quickly becomes more varied
• Listens attentively to music/singing
• Reacts to own name
• Understands simple verbal requests
• Recognizes names of some common objects

9-12 months

• Uses exclamations
• Speaks first words ("dada," "mama," "bye-bye")
• Follows simple commands
• Understands simple questions ("Where is the ball?")

12-18 months

• Says one-word sentences
• Says and understands up to 20 words
• Understands more new words every week
• Enjoys nursery rhymes
• Comprehends simple questions
• Uses words rather than gestures to express wants and needs

18-24 months

• Uses 2–3 word sentences
• Follows simple commands
• Understands simple questions
• Enjoys being read to
• Understands more complex sentences
• Points to body parts when asked

2-3 years

• Speaks in simple sentences
• Says and understands 200+ words
• Follows simple tasks when asked
• Points to the right picture in a book when asked

3-4 years

• Speaks clearly enough that people outside the family usually can understand him or her
• Uses sentences of four or more words in length
• Speech and understanding improve considerably

The most vital period for hearing development in a child's life occurs in the first two years. Children who receive no auditory stimulation during this critical period will face difficulties learning to speak. The brain's ability to learn to process sound and develop spoken language decreases after this critical period until about age seven, when learning language becomes much more difficult. Children's development of speech and language varies individually. There are, however, milestones for speech and language development that can serve as a guideline.

Typical Signs of Hearing Loss Are:

• Child does not react to loud sounds
• Child is unable to detect where a sound is coming from
• Child may start to babble, but soon stops
• Babbling does not develop into understandable speech
• Child does not react to voices, especially when he or she is not being held
• Child does not follow commands or misunderstands directions
• Child may start acting frustrated

Hearing Tests

A variety of different methods are available to test your child's hearing. The audiologist will choose a method that is best suited for your child's age. Usually, hearing tests performed on newborns and babies use objective measuring methods to assess the baby's hearing and do not require the active participation of the baby. All these tests are quick, simple and painless and are performed while the baby is asleep. Parents can stay with the baby while the hearing test is being carried out.

In Otoacoustic Emission (OAE) screening, the function of the hair cells in the cochlea is checked. A tiny earpiece is placed into the baby's ears emitting clicking sounds. When the cochlea receives these sounds, it produces an echo that the screening equipment picks up. A similar screening method, the Auditory Brainstem Response (ABR), measures brain waves in response to auditory stimuli (usually a clicking sound). Older children can participate more actively in audiometry tests. The child indicates when he or she hears a sound (pure-tone audiometry) or understands speech (speech audiometry).

Early Intervention

Newborns are already able to recognize their mother's voice. During the first few months, infants learn to understand a variety of sounds around them. They can very quickly distinguish between human speech and other environmental sounds. The first two years are especially important for language acquisition. Children with hearing loss cannot easily develop these abilities later on.

Early intervention means acting without delay to treat your child's hearing loss. If your child has an irreversible hearing loss that cannot be otherwise remedied, it is vital to get hearing instruments as soon as possible. It is also very important to assess how well the hearing instrument(s) work(s) for the child. If hearing aids are not going to be enough to help the child to develop spoken language, it is crucial to determine this as quickly as possible so that other alternatives can be evaluated while the child is still in the critical language learning phase.

The younger a child's age when receiving a hearing device, the easier it will be for him/her to learn to hear and speak. A baby's brain is better able to process new information than that of older children, and when children are provided with a hearing device at a very young age, they often develop spoken language quickly and can "catch up" with other children born with normal hearing.

Is My Child a Candidate for a CI?

If you and your audiologist or speech-language professional consider a cochlear implant to be the best solution for your child, the next step is to contact an ENT clinic with a cochlear implant program. A list of cochlear implant centers is available from MED-EL. Your local team of CI specialists will work with you to determine whether your child is a candidate for cochlear implantation.

• Your child has a profound sensorineural hearing loss in both ears.
• Your child receives little or no benefit from hearing aids.
• There are no medical reasons your child cannot undergo surgery.
• Your child has access to appropriate education and rehabilitation follow-up.
• You and your child are highly motivated to participate in required rehabilitation programs.

• If your child can receive a significant benefit from hearing aids, they are likely the better solution.
• If your child's hearing loss comes from somewhere other than the inner ear, or the absence of the hearing nerve, an alternative solution might be more effective.
• To gain the greatest hearing benefit from a CI, it is important for children to have full support from their family and to participate in rehabilitation programs. If a family cannot commit to participation in a rehabilitation program, other options besides a CI may need to be considered.

Advantages of Early Cochlear Implantation

Your child may benefit from a cochlear implant regardless of his or her age, but as previously mentioned, if children with a profound hearing impairment are implanted early enough, their hearing and speech can develop much like a normal hearing child's. Spoken language appears to emerge almost naturally.

For children who have had hearing experience and have lost their hearing later, a similar rule applies: the shorter the time period of deafness, the more likely they will benefit from the cochlear implant. Children are being implanted younger and younger because of improved surgical procedures and research proving better results with children implanted at very young ages.

On the Way to Success

It is important to remember that the cochlear implant is a technical tool for your child's hearing. Success with the implant depends on many factors. Age of implantation is only one factor influencing the benefit a child will receive from a cochlear implant. A rich communication environment, effective audio processor programming, motivation, rehabilitation and realistic expectations are all important factors contributing to a child's overall success.

Want to Know More?

Download a Parent's Guide to Cochlear Implants

For more information about cochlear implants, to find out if you might be a candidate for this device, or for a list of cochlear implant centers near you, please visit www.medel.com.