Early Identification of Hearing Loss

Identification of hearing loss in infants and children requires careful observation, a thorough medical examination with an extensive case history, and an audiological evaluation. Help identify young children who may need a medical and/or audiological evaluation by familiarizing yourself with the facts.

When and How to Evaluate
If speech and language development begins normally and then stops, refer immediately for a hearing evaluation. A child of any age can have an audiological evaluation. The evaluation technique used depends upon the developmental age of the infant or child. Methods include Auditory Brainstem Response (ABR) testing at any age (including premature infants), and Visual Response Audiometry (VRA), which is designed to elicit consistent and reliable responses from only a few months of age. Play Audiometry is used at around 2 1/2 years of age until the child is able to respond consistently to the conventional evaluation techniques used with adults. Our pediatric audiology team can help decide which method is best for a child. In order to obtain complete and accurate test results, children may need to be seen on more than one occasion.

Early identification and assessment are the first steps in the successful management of the hearing impaired child. for information about identifying hearing loss or to schedule an appointment, call the Hearing, Speech & Deafness Center at (206) 323-5770 V/TTY.

High Risk Factors
Birth – 28 days:

• Malformations of the ear, nose or throat
• Rubella during pregnancy
• Rh incompatibility
• Family history of hearing loss
• Apgar score from 0 – 3
• Severe neonatal infections
• Meningitis
• low birth weight (under 3.3 lbs.)
• Hyperbilirubinemia
• Ototoxic medications
• Severe respiratory distress and/or prolonged mechanical ventilation (10 days or more)

29 days – 2 years

• Meningitis
• Presence of neonatal risk factors
• Head trauma
• Stigmata
• Ototoxic medications
• Neurodegenerative disorders
• Childhood infectious diseases associated with hearing loss (e.g. mumps, measles)

A child who has had one or more of these conditions is considered “at risk” for a hearing impairment and should have a comprehensive audiologic evaluation by a pediatric audiologist.

Milestones of Normal Development
Some babies have a significant hearing loss due to unknown factors. Use these developmental guidelines to watch for hearing and speech milestones.

0 – 4 months: Stops movement or quiets in response to speech. Startles to loud sounds. Moves eyes toward sound source. Arouses from light sleep to sudden loud noises.

4 – 7 months: Begins head turn toward sounds and voices out of sight (4 months) and turns head directly toward the sound source (7 months). Smiles in response to speech. Looks in response to own name. Babbling begins.

7 – 9 months: Turns to find a sound source out of sight. Gurgles or coos to sounds out of sight. Intonation patterns heard in speech. Comprehends “no.” Babbles in multiple syllables.

9 – 12 months: Acquires first true word. Imitates sounds. Looks at a common object when named. Responds to music. Understands simple commands.

13 – 18 months: Uses sentence-like intonation. Perceives emotions of others. Uses 3 – 20 words. Uses all vowels and consonants in jargon.

19 – 24 months: Uses more words than jargon. Asks question by rising intonation at end of phrase. Comprehends about 300 words. Uses about 50 words. Produces animal sounds. Combines 2 words into phrases. Listens to simple stories.