Testing Your Baby’s Hearing

By Dr. Bridgid Whitford Au.D. CCC-A

Director of Hearing Services, Cleveland Hearing & Speech Center

I remember the days my children were born clearly….well, kind of. Some moments are crystal clear and will be etched in my memory till the end of time “Your baby boy has red hair!” “It’s a girl!” In contrast; many of the details were a complete blur – countless nurses, doctors, aides, monitors and medications. There were informational videos to watch, and tearful meetings with lactation consultants. The constant hum of activity allowed for very little sleep.

Universal Newborn Hearing Screenings (UNHS)

As an audiologist, I know the importance of identifying hearing loss in children as early as possible. However, because my children were born in Ohio before 2004, only my son who was born with Down Syndrome received a hearing screening. My other two children had no risk factors and, thus, did not warrant a screening. Fortunately, this has changed. Today, Universal Newborn Hearing Screenings (UNHS) ensure that all children receive a hearing screening before they are discharged from the hospital. Fifty percent of children born with hearing loss have no risk factors. We are fortunate now to be able to identify children who may have otherwise not been diagnosed until developmental delays associated with hearing loss (like speech and language concerns) emerge.

Early Hearing Loss Detection and Intervention (EHDI) Program

The Early Hearing Loss Detection and Intervention (EHDI) Program has a clear goal of having every child receive a hearing screening by 1 month of age, a diagnostic hearing test (if the baby did not pass the hospital screening) by 3 months of age, and enrollment in early intervention (if hearing loss is identified)  by 6 months of age. These 1/3/6 month standards are nationwide. There is also a strong movement to meet these markers by a 1/2/3 month standard, as we know the earlier a child receives intervention for hearing loss the better the outcome.

Apparently, my son Jamie, who has Down Syndrome, received a hearing screening in the days after his birth. I have no idea when (so much was a blur at that time). But, I do clearly recall talking with the nurse because he did not pass the screening. This meant we needed to bring him back for further testing. Given my profession, I was fortunate to understand that time was of the essence. The Auditory Brainstem Response (ABR) testing that they needed to complete to know how well my son was hearing required Jamie to be fully asleep. A newborn will sleep naturally and the testing can usually be completed quickly in the audiologist’s office.  However, if we waited months to go back, there was a high likelihood that he would have to be sedated to get an accurate test. I definitely would have sedated had it been necessary, but was glad that was not the case. I knew that I needed to be sure that my son could hear, or if not, how much hearing loss there was and how to arrange to get help for him. How could I expect he would learn to talk, if he could not hear?

Like every mother, I wanted to do everything possible to help my baby. I quickly scheduled a follow up hearing test. When he was just a few weeks old, my husband and I brought Jamie back to the hospital for the diagnostic ABR testing. He slept in my arms as the audiologist taped wires (electrodes) to his forehead and behind his ears. Then the audiologist put little headphones on him that made noises and watched his brain’s response to those sounds. Jamie slept the entire time! It was easy, and I was thankful to learn that Jamie had normal hearing.  However, given his diagnosis of Down Syndrome, the audiologist suggested frequent (every 6 month) tests to monitor his hearing.

Jamie also enrolled in early intervention through Help Me Grow.  Jamie was eligible due to his Down Syndrome diagnosis, however, this is the same program that children who are identified with hearing loss are eligible for. It was wonderful! We had a specialist who came to our home and helped our family work with Jamie to meet the goals we decided were important to us.  The best part was that it was absolutely free.  It did not matter what insurance (if any) we had. It is free to everyone.

Cleveland Hearing & Speech Center has early interventionists that specialize in hearing loss.  We work as part of the Help Me Grow team and go to a family’s home to help them understand their child’s hearing loss and how it may impact their child’s development. We help families identify outcomes important to them and help them achieve those outcomes.  Every family is unique and has their own strengths and own dreams. Some families want to learn sign language and meet members of the Deaf community.  Some families need more information about technology such as hearing aids or cochlear implants.  Some families want strategies on how to encourage language within their home.  We know that babies and toddlers learn best in their natural environment so our goal is not to teach the baby, but to coach the parents so that they may be their child’s best teacher.  Learning happens in every day routines and situations.  We help families recognize and maximize those opportunities.

Cleveland Hearing & Speech Center also has a team of audiologists.  We conduct hearing testing at all 3 of our locations (University Circle, Broadview Heights, South Euclid), although we do not have the equipment to test a newborn. It is typically the large hospital systems that have the ABR equipment.  However, our audiologists can test children from 9 months of age and up and we also fit hearing aids on people of all ages, including infants.  If a child has a hearing loss, we hope to have hearing aids fit by 3 months of age. Access to sound is important as children are learning language.  Children are like sponges and they spend the better part of the first year listening and taking it all in, and it is not typically until the second year of life that the words they heard begin to come back out. It is important that all babies have the opportunity to develop language.

Every baby’s journey is unique; however, all parents need to know how well their baby hears in order to provide him/her with a language rich environment. If you have questions about your child’s hearing or about hearing loss, please contact Cleveland Hearing & Speech Center at 216-231-8787.

How to Prevent Noise Induced Hearing Loss

Ok. I have to be real about this.

Back in the day, before I became an audiologist, I did some really unkind, unhealthy things to my hearing.  Pretty please, promise you won’t tell my 14 year old.  You know, as the saying goes  “do as I say not as I did.”

I attended some REALLY loud indoor concerts – Nine Inch Nails, Bowie, Pink Floyd.

In college I would lay on the floor with my head sandwiched between speakers and play Genesis’s entire Trick of the Tail album. Loud.  Then some Crosby Stills Nash & Young. Loud. And, oh yeah, can’t forget, Prince’s epic 1999 (still can’t believe he’s gone). That was even louder.

I remember leaving one show at the old Coliseum in Richfield and feeling as if my hearing was muffled and laughing as I asked friends, “huh, what did you say?”

Summer meant Blossom Music Center. One summer: 17 concerts on the lawn. Loud, but not quite as loud as the indoor shows.

If I only knew then what I know now.

I now know that temporarily reduced hearing after loud sound exposure has a name – Temporary Threshold Shift (TTS). I didn’t know that TTS can be a precursor to a permanent threshold shift ( PTS) in hearing.  I didn’t know that tinnitus or ringing in the head or ears is most commonly associated with hearing loss.  I didn’t know that time of exposure + overall loudness can prove to be a dangerous combination for my hearing. In high school, when my parents would holler upstairs to “TURN IT DOWN”, I just thought they were being uncool.

As a young (don’t even go there) audiologist, I began to respect my ears and hearing more. I saw how hearing loss impacted lives, jobs, and relationships.  I saw that although hearing aids offer many people with hearing loss significant benefit, the best plan was to protect my hearing.  It just mattered to me more. So, when portable music (remember the old Walkman radios and CD players?) first became popular, I developed the Safe Sound (now known as Sound Choices) hearing conservation program for elementary aged children. Originally presented to classrooms, the student and teacher materials are now available on our website: www.chsc.org/soundchoices

Fast-forward to MP3 players. Today, it is not uncommon to see a smartphone in the hands of young children. Music, movies, and videos are more accessible, portable, devices have longer run times, and speakers are commonly worn IN THE EARS.

Some people erroneously think that it is only rock music that will cause damage. Admittedly, rock and roll is often played loud, but ANY music (country, gospel, orchestra) can cause damage if loud enough and you listen long enough.

We also now know that loud sound can impact hearing differently in some people. Some ears just seem to be more tender and fragile than others.  The problem that remains is that we don’t know who that is ahead of time.

I am more concerned than ever about the hearing of future generations. Parents and other authority figures have a hard time monitoring risky hearing behavior.  But just like we teach our children to use sunscreen to protect their skin and to brush their teeth twice a day to prevent cavities, we need to talk to them about hearing loss related to loud sound exposure. The younger they start practicing good habits, the better. And, as parents, remember to model good hearing hygiene habits when you are with them.

Noise Induced Hearing Loss (NIHL) is completely and 100% preventable.

To conserve what you have, some easy tips:

• Limit time of exposure
• Limit overall loudness
• Use noise canceling earphones
• Look for loudness limiting parental controls in devices
• Limit noisy toys or remove the batteries
• If someone is  arms reach away and can hear your music, it is too loud
• In noisy places, If you have to raise your voice to be heard, it is too loud
• Sound that causes ringing in the ears or a temporary reduction in hearing is too loud
• Use earplugs or muffs when operating a lawnmower, snow blower or leaf blower
• ALWAYS use hearing protection when hunting or shooting

Facts About Noise

Although the definition of “noise” may be interpreted on a personal basis, it can be described simply as unwanted sound. Unwanted sound, or noise, can result in hearing loss, which is known as noise-induced hearing loss. Noise-induced hearing loss (NIHL) can be instantaneous and caused by just one single exposure to a very loud sound (like a firecracker or gunshot). NIHL can also be caused by cumulative exposure to loud sounds which gradually build over time to cause the hearing loss. So, even though hearing loss due to loud sound may not always be evident immediately, NIHL may be present later, in teenagers or adulthood. Any reduction in the overall lifetime noise “dose” will be good for hearing in later years.

• Noise is one of the leading causes of hearing loss
• Noise-induced hearing loss is permanent – but preventable
• Continuous exposure to noise can lead to physiological changes in blood pressure, sleep, digestion, and other stress-related disorders
• Noise-induced hearing loss typically occurs gradually and without pain
• Continued exposure to noise above 85 decibels will eventually harm one’s hearing
• In general, the louder the sound, the less time required before damage occurs

How Noise Affects Hearing

The cochlea is the organ of hearing.  It is shaped like a snail and is approximately the size of a nickel.  Inside the cochlea are thousands of tiny nerve endings called hair cells.  These hair cells are surrounded by fluid.  When you hear a sound, the sound vibrations cause the fluid to ripple through the cochlea and bend the hair cells, thereby activating the nerve endings.  If the sounds are very loud, the vibrations, in turn, are very strong and cause the hair cells to not only bend, but to break.  Once a hair cell is damaged in this fashion, it cannot be repaired, renewed, or replaced.

Knowing When It’s Too Loud

As a general rule, if you must raise the volume of your voice above the noise level to carry on a conversation, the noise is too loud.

Noise and Hearing Conservation

• According to the National Center of Disease Statistics, 5.2 million children between the ages of 6-19 years have hearing loss directly related to noise exposure.
• The Occupation Safety and Health Administration estimates that nearly 5 million Americans work in levels of noise that are potentially harmful to their hearing.

What should you do if you suspect a Noise Induced Hearing Loss (NIHL)?  The audiologists at CHSC can assess your hearing to determine if a loss is present and make recommendations regarding hearing protection and conservation including customized noise earplugs.  To schedule an appointment with an audiologist, please contact us at 216-231-8787.

 

How “Clear Speech” Helps Those with Hearing Loss

As audiologists at Cleveland Hearing & Speech Center, we are best known for rehabilitating hearing loss.  However, we don’t stop at evaluating your hearing.  We care about communication.  When you come to one of our audiologists for a diagnostic hearing evaluation, we discuss with you your lifestyle and your communication needs.  We talk to you about how your specific hearing loss impacts your ability to communicate in a wide range of listening environments.  Just as important— we work with family, friends, and other communication partners to help them better understand how to communicate with a loved one who has hearing loss.  During May – Better Hearing and Speech Month – we want to discuss how Clear Speech can lead to better hearing.  The following strategies can help you improve your communication with family and friends who have a hearing loss.

What is Clear Speech?

Clear Speech is a method of speaking in which the speaker makes a concerted effort to express every word, sentence, and idea in a very precise, accurate, and deliberate way.  When you practice Clear Speech with a friend or family member, you don’t shout at them or speak in unnatural ways – like exaggerating sounds, or speaking in a monotone or “sing-song” voice.  Rather, you speak slowly and clearly at a slightly elevated – but not strained – volume.  It is a way of conveying your message in a clear, purposeful way to help a person with a hearing loss better understand what you said AND avoid the need for repetition.

What is the goal of Clear Speech?

Hearing loss impairs communication by filtering out certain speech sounds, so the individual with hearing loss only hears a portion of the sounds spoken to them.  Different types and degrees of hearing loss filter out different speech sounds and different amounts of speech information.  The goal of Clear Speech is for the communication partner to employ good speech techniques to help the individual with hearing loss to compensate for the speech sounds filtered out by their hearing loss.

How can I practice Clear Speech?

• Articulate sounds precisely and accurately
• Speak more slowly
• Take clear pauses between phrases and thoughts. This gives the individual with hearing loss time to process key ideas before you continue with your thoughts.
• Increase volume – but only slightly, and avoid speaking where you are straining. When you strain to speak loudly, you are distorting your speech sounds and the way your lips are moving (thus impairing visual lipreading cues).

Examples of Clear Speech:

You may be reading this thinking “I speak clearly, what more can I do?”  What many people don’t realize, though, is that English speakers actually don’t speak very clearly – even when we think we are!  We often blur words together and blend speech sounds of neighboring words in a sentence.  Take a look at the following examples of typical spoken English and the transformation into Clear Speech (Kricos, 2005).

• “She leffer the store onabus”
  • Using Clear Speech, the speaker would say – at a modestly elevated vocal volume – “She left for the city   on a bus.”  The pauses give the individual with hearing loss time to process what has been said – and to understand the meaning of key ideas before the speaker adds further detail.  Also Clear Speech avoids blending of sounds like “leffer” in this particular example.
• “The kids ‘r swim’n inthepool.”
  • The Clear Speech version would be: “The kids     are swimming    in the pool.”  Once again, strategic pauses in key places help the individual with hearing loss to follow ideas in the sentence.  Also, by not blending words and sounds together, you make your ideas more easily understandable to a family or friend with hearing loss.
• “Yermother’ll haftagotothe denistomorrow”
  • With Clear Speech, you would say “Your mother will have to go to the   dentist tomorrow.”  Words like “hafta” are common in spoken English, but they are difficult for the individual with hearing loss.  With Clear Speech, you avoid familiar sayings like this to make sure your speech is clear and understandable.  It may take some effort to avoid speaking like this, but if you do, you may avoid having to repeat yourself!
• Another Clear Speech tip is to take a pause before and after very important words in a sentence. For example, if you want to ensure an individual with hearing loss hears the correct name in a sentence, take a pause before and after saying the person’s name.  The same goes for any very important word in a sentence.

Other Communication Strategies:

In addition to Clear Speech techniques, there are numerous strategies for improving your communication with friends and family members with hearing loss.  Below are some ideas:

• Make sure you get the individual’s attention before speaking. This could mean saying his/her name and waiting until he/she makes eye contact with you.  Or it could mean gently tapping the person on the shoulder.
• Don’t try to communicate from different rooms in the house! We hear this one a lot  when see patients.  We know it may feel more convenient to try shouting from another room, but individuals with hearing loss can’t communicate this way!
• Reduce background noise and distractions when communicating. Background noise is very detrimental for individuals with hearing loss.  Even background noise that you perceive as soft may make speech understanding more difficult for an individual with hearing loss
• Make sure the individual with hearing loss can see your face. Speak face-to-face with good lighting.  Visual cues help a lot!
• If an individual with hearing loss asks for repetition, consider using different words/phrasing when you repeat. Some words are difficult for an individual with hearing loss to hear, so repeating in different words may help.
• Check for understanding.  When expressing ideas, you may need to step back to check that the listener is on the same page before continuing on with other ideas.
• Most importantly, be patient! Listening with a hearing loss is hard work.

If you suspect a friend or family member has hearing loss, we want to help!  The above tips are a general guide for communicating with a friend or family member with hearing loss, but only a diagnostic hearing evaluation performed by a licensed audiologist can provide individualized recommendations.  Call Cleveland Hearing & Speech Center at 216-231-8787 to schedule a consult with one of our experienced audiologists.  In the meantime, we encourage you to practice Clear Speech with friends and family members who have hearing loss.  This month, better speech is better hearing!