For more information, please call: Children s Hospital Audiology Clinic. Seattle Office 4800 Sand Point Way N.E. P.O. Box 5371 Seattle, WA

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1 .. For more information, please call: Children s Hospital Audiology Clinic Seattle Office 4800 Sand Point Way N.E. P.O. Box 5371 Seattle, WA PATIENT AND FAMILY EDUCATION Voice (206) TTY (206) Bellevue Office th Ave. N.E. Suite 400 Bellevue, WA Voice (425) This handout has been reviewed by clinical staff at Children s Hospital. However, your child s needs are unique. Before you act or rely upon this information, please talk with your child s health care provider. 1998, 1999, 2001, 2004 Children s Hospital and Regional Medical Center, Seattle, Wash. All Rights Reserved Sand Point Way N.E. Seattle, Washington (Voice) (TTY) (Toll-free/Voice) PE225 Rev. 02/04 (mb) Printed on recycled paper No one knows children like Children s

2 ... TABLE OF CONTENTS Section Page Professionals Hearing Tests How Often Will My Child s Hearing Be Tested? Your Child s Hearing Loss Your Child s Audiogram Listening Devices When Will My Child Get Hearing Aids? How Will My Child Communicate? First Steps Following a Diagnosis Early Intervention Programs in the Local Area Going to School Programs for Hearing Impaired Children candidates for FM systems are children who wear hearing aids consistently, children with a unilateral hearing loss, and children with high frequency hearing losses who get limited benefit from hearing aids. For more information, call: (206) (voice) (206) (TTY) Psychiatric Services For Deaf and Hard of Hearing offers both inpatient and outpatient services. They provide individual, family and group therapy, parent education, support groups, day treatment, community support, home visits, case management, mental health, Deaf Culture awareness training, and consultation. For more information: (206) (voice) (206) (TTY) Hearing Aid Lending Library- King County Part C provides loaner hearing aids for a trial period of up to three months. Your child can try conventional, programmable, and digital hearing aids through this program. To qualify, your child must live in King County, have a hearing loss, be between the ages of birth-to-three years and qualify for funds through the Part C program. For more information, call: (206) (voice) (206) (TTY). Audiology Department 2 Audiology Department 15

3 ... Private Schools Private schools in the local area for deaf and hard of hearing children are: Listen And Talk (programs for children ages 3 5 years) Bothell Way NE Bothell, WA (425) Northwest School for Hearing Impaired Children (programs for children ages 3 junior high) PO Box Seattle, WA (206) ADDITIONAL PROGRAMS FOR CHILDREN WITH HEARING LOSS AT CHILDREN S HOSPITAL Aural Rehabilitation Clinic offers aural rehabilitation therapy for children with hearing loss from birth to 21 years of age. The clinic focuses on the development of hearing and speaking using the child and family s preferred mode of communication. All avenues of communication may be used during therapy, including auditory, visual, verbal, sign and tactile. For more information, call: (206) (voice) (206) (TTY) Cochlear Implant Program offers comprehensive evaluations and support to children and families who have decided to explore the option of receiving a cochlear implant. The evaluations focus on learning about your child s health, hearing with and without hearing aids and how a cochlear implant might fit into your family s everyday life. For more information, call: (206) (voice/tty) FM Program dispenses FM systems to children who may benefit from this device. FM systems can improve the listening environment of hearing impaired children by reducing background noise and increasing the ability to hear speech sounds. The best A PARENTS GUIDE TO HEARING LOSS You may have just found out your child has a hearing loss. The period of time after the diagnosis of a hearing loss is an extremely emotional one for parents. A child with a hearing loss can give unique challenges to each family. However, much can be done to help your child communicate and be successful. The following is a guide to help parents start learning about hearing loss, where to get more information, and how to make decisions about what is in the best interest of your child. PROFESSIONALS Below is a list of professionals who will be a part of your family s care team. If you have any questions, these people can help you. Audiologists are specialists trained to test hearing. The audiologist recommends and fits hearing aids and other listening devices. Aural Rehabilitation Specialists develop your child s listening skills to help your child learn speech and language. Counselors/Therapists give emotional support for children and families. You or a member of your family can see a counselor or therapist to help with emotional issues surrounding your child s hearing loss. Early Intervention Specialists work with families of children with communication and learning needs. They work with children 0-3 years of age. They may also perform assessments of your child s abilities. Family Resource Coordinators (FRC) help families with children under 3 years of age decide what services they need and how to pay for services. Otolaryngologists / Ear doctors diagnose and treat middle ear infections and medical problems that may affect your child s hearing. This doctor must examine your child before he or she receives a hearing aid. Speech Language Pathologists provide therapy to help make your child s speech more understandable. They may also perform assessments of your child s speech and language skills.. Audiology Department 14 Audiology Department 3

4 ... HEARING TESTS How is my child s hearing tested? There are four ways to test your child s hearing. The kind of test your child has depends on your child s needs and abilities. 1. BAER Test BAER stands for Brainstem Auditory Evoked Response evaluation. A BAER test measures how well your child s hearing nerve responds to sounds. It is used for children who are too young to respond to sounds by turning their heads. It is also used for children who may not always respond to behavioral hearing tests. Sometimes a BAER test is done to confirm the results of a behavioral hearing test. The steps for the BAER test are as follows: 1) Your child must be asleep. If your child is tested before 6 months of age, the test is done while he or she sleeps naturally. If your child is over 6 months of age, your child falls asleep with a mild sedative prescribed by his doctor. 2) Your child s skin is cleaned and recording pads are put on his forehead and behind each ear. 3) Sounds are played into each ear through a small earphone. 4) A computer records the response of your child s hearing nerve. 5) Your child s audiologist looks for the softest sound your child s hearing nerve responds to. 2. EOAE Test EOAE stands for Evoked Otoacoustic Emissions. An EOAE test measures how well your child s cochlea, or inner ear, works. An EOAE test is usually done during the same visit as a BAER test. Your child needs to be still and very quiet for this test. The steps for an EOAE test are as follows: 1) A small earphone is placed in each of your child s ears. 2) Sounds are played through the earphones. 3) A computer measures the response of your child s inner ear. 4) The audiologist evaluates the response of your child s inner ear. If your child s inner ear is not working as well as it should or if your child has any middle ear problems, your child will not have any EOAEs. Tacoma Parent Infant Program provides services using total communication for children from birth to 3 years of age and their families. Services include home visits, play groups, parent groups, and one-on-one communication therapy sessions. Tacoma Parent Infant Program serves families living in the Tacoma School District and may be an option for other families living in Pierce County. Parent Infant Program, Birney Elementary School (253) (Voice/TTY) GOING TO SCHOOL Where Will My Child Go To School? Public School If your child is over 3 years of age, contact your local school district to find out what options it offers for children with hearing loss. By law, any child with a hearing loss and a need for services is entitled to special education services. Your child may qualify for services such as speech therapy or a specialized classroom for hearing impaired children. You will work with your school district s representatives to develop an individualized education plan that is most appropriate for your child. Your audiologist can provide you with additional information and help you explore your options and other resources. Residential School The Washington School for the Deaf (WSD) is a residential state school, located in Vancouver, WA. WSD provides classes for students in preschool through high school. Students who attend WSD live on campus. Washington School for the Deaf 611 Grand Blvd Vancouver, WA (360) (voice) /(360) (TTY) web site: Audiology Department 4 Audiology Department 13

5 ... Children s Hospital & Regional Medical Center (206) voice / (206) ext TTY EARLY INTERVENTION PROGRAMS IN THE LOCAL AREA There are many resources in your community offering programs and assistance for young children with hearing loss. The following are programs for children ages birth to three. Family Conversations-Early Childhood Home Instruction Program focuses on the parent and child relationship through home-based and group instruction. Families have a choice of communication options that support the primary language of the home. Families may participate in playgroups, parent support groups, Signing Exact English classes, cued speech instruction as well as other services. Family Conversations serves qualifying children and their families throughout Western Washington up to age 3. Children s Hospital & Regional Medical Center (206) (voice) (206) (TTY) Listen and Talk is an auditory-verbal program. Your child must use a hearing aid or cochlear implant to be in this program. Listen and Talk provides families with individual therapy sessions, parent support groups, and children s playgroups. It also provides individual therapy and mainstream services for older children. Listen and Talk serves families throughout Washington State. Listen and Talk (425) hear@listentalk.org Seattle Parent Infant Program (PIP) is a family-centered program for children from birth to 3 years of age. This program offers a bilingual/bicultural approach to meet each family s needs. Seattle Parent Infant Program offers home visits, playgroups, parent support groups, counseling, and American Sign Language classes. This program serves families in Snohomish and King counties. Parent Infant Program, Hearing Speech and Deafness Center (206) (voice/tty) web site: 3. Behavioral Hearing Test A behavioral hearing test measures the softest sounds your child responds to. Audiologists use a behavioral test if your child is older than 6 months. The steps for a behavioral test are as follows: 1) Your child sits on your lap or at a small table. 2) Your child hears sounds through a speaker or earphones. 3) The audiologist teaches your child to respond to the sounds she hears by playing a game. 4) When the audiologist finds the softest sounds your child can hear the audiologist puts a mark on a graph. The graph is called an audiogram. 4. Tympanometry Test The tympanometry test helps the audiologist find out how your child s middle ear is functioning. 1) The audiologist puts a rubber tip in your child s ear. 2) The tip is connected to a machine that changes the air pressure in your child s ear and prints out a graph. 3) The graph gives information about whether there is fluid in the middle ear or if the eardrum is not moving well. This test is most reliable when your child is at least 6 months old. HOW OFTEN WILL MY CHILD S HEARING BE TESTED? Your child s hearing will be tested on a regular basis. These tests will monitor your child s hearing to make sure that his hearing has not changed. Your child will also need to be tested with his hearing aids on. This kind of test is called an aided test. Aided tests measure how well your child hears with hearing aids. YOUR CHILD S HEARING LOSS What is hearing loss? Hearing loss is the inability to detect sound. Many people try to describe hearing loss as a percentage. It is best defined by the type and the degree of hearing loss. If a child has a profound or severe to profound degree of hearing loss, she may be referred to as deaf. If a child has a mild to severe degree of hearing loss, she may be referred to as hard of hearing.. Audiology Department 12 Audiology Department 5

6 ... skills. Families learn to communicate with their child, using the primary language of the home, simultaneously combining both signed and spoken language. Ear Canal Ear Drum Total Communication: The total communication approach uses a combination of communication methods. Families learn how to use spoken language and some form of sign language, gestures, facial expressions, finger spelling and pantomime to communicate. Signs and speech are typically paired, but are sometimes used separately. Your child does not have to use amplification to communicate this way. Families learn to communicate with their child using a combination of signed and spoken language. FIRST STEPS FOLLOWING A DIAGNOSIS Types of Hearing Loss The type of hearing loss depends on where it occurs in the ear. The ear can be divided into three parts: Outer Ear: the pinna (the part we see) and the ear canal Middle Ear: the eardrum, the ossicles (malleus, incus, stapes) and the Eustachian tube Inner Ear: the vestibular system (used for balance) the vestibular nerve, the cochlea, and the auditory (hearing) nerve A hearing loss is Conductive when there are problems with the outer and middle parts of the ear. Medicine or surgery can sometimes help this type of hearing loss. A hearing loss is Sensorineural when there is a problem with the cochlea (inner ear) or the auditory nerve. This type of hearing loss is usually permanent. A hearing loss is Mixed when there is a problem in both the outer or middle and the inner ear. Discoveries is a program that provides families a transition from the suspicion and/or diagnosis of a hearing loss to an early intervention or school program. The program helps families gather the information they need to make informed decisions about the best communication approach for their child and family. The program provides resource information and opportunities to meet with other families. Families can get help developing an education plan to receive additional services for their child. Discoveries serves families throughout Washington State. Services are provided collaboratively with other centers and in natural environments Degree of Hearing Loss The degree of hearing loss describes the severity of the hearing loss. There are four degrees of hearing loss, measured in decibels (dbhl):. Audiology Department 6 Audiology Department 11

7 ... Auditory/Oral: The auditory oral approach uses your child s aided hearing and lip reading to teach spoken language. Lip reading means your child uses both hearing and sight to help him understand spoken language. Your child must wear amplification (hearing aids or a cochlear implant) to learn language in this way. Families learn how to communicate with their child using spoken language. This approach does not use sign language. Auditory/Verbal: The auditory verbal approach is similar to the auditory/oral approach, except it does not use speech/lip reading. Your child must use amplification with this approach. Families learn how to communicate with their child using spoken language. This approach does not use sign language. Bilingual/Bicultural (American Sign Language): The bilingual/bicultural method focuses on teaching your child American Sign Language (ASL). ASL uses the body, face and hands to communicate language. ASL is a completely separate language and does not follow the same sentence structure as English. English is taught as a second language. Your child does not have to wear amplification to communicate this way. The Deaf community uses this method. Members of the Deaf Community have a strong cultural identity of their own. Cued Speech: Cued speech uses eight hand shapes near the mouth that represent the sounds in spoken language. These hand shapes combined with lip reading give your child visual access to spoken language. The goal of this method is for your child to develop speech. Although amplification is not required, it is recommended. Families learn to communicate with their child using hand cues simultaneously with speaking Mild loss (25 to 40 dbhl) Moderate loss (40 to 65 dbhl) Severe loss (65 to 90 dbhl) Profound loss (90 dbhl or greater) AN AUDIOGRAM Tones indicated in Hertz (Hz) LOW TONES HIGH TONES 250 Hz 500 Hz 1000 Hz 2000 Hz 4000 Hz 8000 Hz NORMAL BORDERLINE NORMAL MILD MODERATE SEVERE PROFOUND Simultaneous Communication: Simultaneous communication involves speaking and signing the same words at the same time. Amplification is recommended, but not required for this method. The family learns a sign language system, such as Signing Exact English, that is designed to be used with speech to promote your child s understanding and use of language. The goal of this method is to develop your child s language, listening, and speech YOUR CHILD S AUDIOGRAM What is an audiogram? An audiogram is a graph of the softest sounds your child hears. A few tips will help you understand the graph. Across the top of the graph are the frequencies. The frequencies, or pitches, are organized like a piano keyboard.. Audiology Department 10 Audiology Department 7

8 ... A Parent s Guide to Hearing Loss The low tones are on the left and the high tones are on the right. An example of a low pitch is a drum and an example of a high pitch is a bird chirp. These pitches or frequencies are measured in Hertz. The letters Hz stand for Hertz (along the top of the graph). Down the side of the graph is intensity, or loudness of sounds. The sounds at the top of the graph are soft. The sounds at the bottom of the graph are loud. Loudness is measured in decibels. The letters db stand for decibel. Your child will have marks on her audiogram. The marks represent the softest sounds to which your child responded. If your child wore earphones during the test, you will find X s and O s on the graph. X = left ear. O = right ear. If your child did not wear earphones during the test, you will find S s on the audiogram. The S means your child was tested using speakers. When using speakers, only your child s better ear is tested. The audiogram shown has shaded areas. Each shaded area has a label that describes the amount or degree of hearing loss. LISTENING DEVICES Listening devices help your child make the most of his hearing. However, they cannot make your child hear normally. They help him become aware of sounds. When your child becomes aware of sounds, he can begin to understand what sounds mean. Here are several types of listening devices. The audiologist can talk with you about the different options, and help you decide what is best for your child. Hearing Aids amplify sound, or make sounds louder. Hearing aids for young children rest behind the ear and attach to an earmold that fits inside the ear canal. An earmold is a small piece of soft plastic made for the child s ear that helps hold the hearing aid in place. The hearing aid is set by the audiologist to fit the shape of your child s hearing loss. The hearing aid picks up sound through a microphone, changes it, and makes it louder. The sound is channeled through the earmold into the child s ear. FM Systems make a speaker s voice louder without making background sounds louder. The speaker wears a microphone and transmitter and your child wears a receiver. The system sends the speaker s voice to your child s ears. FM systems can be used with or without hearing aids. Cochlear Implants change sound into electrical impulses that stimulate your child s hearing nerve. This device must be surgically put into your child s inner ear. Not all children can have an implant. WHEN WILL MY CHILD GET HEARING AIDS? The process to fit your child with hearing aids takes a few weeks. This may seem like a long time, but important things must happen first. 1) Your child must have medical clearance from an otolaryngologist/ear doctor. The doctor must examine your child and give approval for your child to wear hearing aids. 2) The audiologist must make impressions of your child s ears. The impressions are made into earmolds. It takes two weeks to make the earmolds and get them from the factory. 3) Your child must have a special measurement taken for each ear, called RECD (Real Ear to Coupler Difference). This measurement helps the audiologist choose the best hearing aid for your child. The measurement is made with the earmolds in place. 4) After the RECD measurement, it takes about two more weeks to get your child s hearing aids. HOW WILL MY CHILD COMMUNICATE? Relating to people (communication) is very important. Speech (or talking) is one way we communicate. We can also communicate by using our hands, as with sign language. For a child with hearing loss, there are many choices for communication. Following are ways families of children who have hearing loss can communicate.. Audiology Department 8 Audiology Department 9