• 
• 
• 
• 
• 
• 
• 
• 
• 

Newly Identified Babies

The Infant Hearing Screening and Communication Development Program (Infant Hearing Program) was announced in the Ontario Government’s 2000 budget.

Starting in the spring of 2002, children who are born deaf, hard of hearing or at risk of developing hearing loss in early childhood will be identified and receive the services and support required for communication development.

All babies will have their hearing tested before leaving the hospital. The tests are simple and usually only take a few minutes. The machine used for Stage 1 screening is called a DPOAE (Distortion Product Otoacoustic Emission). Babies are normally asleep through the whole procedure. Most babies will receive a “pass result” and some babies will receive a “refer result”.

Those babies who receive a “refer result” are then sent to a specially trained pediatric audiologist for a Stage 2 AABR (automated auditory brainstem response) and hearing assessment usually done between eight and sixteen weeks of age. Those babies who are discovered to have a hearing loss are then referred to a pediatric otolaryngologist for consultation and evaluation.

Please contact the IHP program at 416-338-8255 or by TTY at 416-338-0025 for more information.

Facts about the Ontario Infant Hearing Program

• about 4 in 1000 babies are born deaf or hard of hearing or will develop hearing loss in early childhood
• with new technology, babies can be identified as young as a few hours after birth
• 20 to 100 babies out of 1000 fail the first stage screening and of these babies 1-3 of them have permanent hearing loss

Why is the Infant Hearing Program So Important?

Think about how quickly babies develop.

Hearing and listening in the first few months of life prepares the baby to learn language. Babies begin to babble the words they hear in the first few months and by the first birthday infants are already figuring out what words mean. Sometimes words and phrases are picked up by listening to conversations between family members.

Imagine if the baby is now hearing impaired.

Impairment of hearing can severely limit the infant's ability to develop speech and language. Later in life this may cause problems both in academic and social environments.

Early detection and intervention will definitely help to prevent these problems.

What is an Otoacoustic Emission Test?

This test involves the placement of a tiny microphone in the ear of the baby, sounds are played and a response is measured. If a baby has normal hearing then an echo is reflected back into the ear canal and is picked up by the microphone. When the baby has a hearing loss then no echo can be measured.

What is an Auditory Brainstem Response?

Also known as an ABR this test involves the placement of band-aid like electrodes on the baby's head which detect brainwaves. Sounds are played into the baby's ears and brainwaves are measured. Babies with normal hearing produce a certain type of brain wave whereas babies with hearing loss produce an abnormal wave.

What Else Causes Hearing Loss in Babies?

Some babies will fail the initial screening test but may have absolutely normal hearing. There are several reasons for this but most commonly:

• vernix in the ear canal
• fluid in the middle ear
• movement/crying during the test

The only real way to assure accurate results with your baby's hearing is follow up testing. It is important to keep in mind that it does not matter how old your baby is, there are effective and accurate tests that are used to determine your baby’s hearing.

Signs of Hearing Difficulties

Parents should always be aware of their child’s ability to respond appropriately to different sounds. Sometimes children do not respond to sound because of a lack of attention but it is important to determine whether or not the no responses stem from hearing difficulties.

• no startling when intense sounds present
• intently watching the faces of speakers
• sitting close to the television with the volume way up
• using “what” or “huh” frequently
• not aware of someone who is out-of-view is talking, especially when distractions are minimal

Speech and Language Developmental Milestones

• 9 months: demonstrate an understanding of simple words such as ‘mommy’, ‘daddy’, ‘no’ and ‘bye-bye’
• 10 months: babbling should sound speech like with single syllables strung together (‘da-da-da’). The first recognizable words emerge at about this time
• 1 Year: One or more real words spoken
• 18 months: Understand simple phrases; retrieve familiar objects on command (without gestures) and point to body parts. Should have a spoken vocabulary between 20 and 50 words and should use short phrases like (no more, go out, mommy up)
• 24 months: Spoken vocabulary should be at least 150 words, coupled with the emergence of simple two word sentences. Speech by other adults who are not with the child on a daily basis should be understandable. Child should also be able to sit and listen to read- aloud picture books
• 3-5 years: Spoken language should be used constantly to express wants, reflect emotions, convey information and ask questions. A preschooler should understand nearly all that is said. Vocabulary grows from 1000 to 2000 words that are linked into meaningful sentences.

These milestones represent a general rule of thumb but children with a suspect hearing loss should be professionally evaluated by an audiologist or speech language pathologist.

My Child has been Diagnosed with Hearing Loss - What Do I Do Now?

Once the baby has been seen by both an ENT specialist and an audiologist has performed all the necessary testing, a recommendation for hearing aids will follow. The audiologist is responsible for the selection of the appropriate hearing aid to fit the specific hearing needs of each baby. There are many different manufacturers of hearing aids and different sizes. The make, model and size will depend on a number of different factors:

1. the degree of hearing loss
2. the specific age of baby, child
3. size and shape of child’s ears (some children may have extremely small, malformed or missing pinnae (ears))
4. sometimes cost may be a huge factor, although there are many different government organizations that may help pay for hearing aids.

Ear impressions will have to be made of the baby's ear in order to channel sound into the ear. This procedure usually appears to be a lot worse than it actually is. Parents should ask the audiologist or dispenser about what experience they have had making molds on small ears. This person should be specially trained to make these impressions.

The Initial Fitting

The dispenser or audiologist will inform you when both the ear mold impressions and hearing aids are ready. This is a very anxious and emotional time for parents as not much is known as to what is to be expected of the parents as well as the child. Parents should have a list of questions prepared before going to pick up the hearing aids. Often emotions and anxiety prevent parents from thinking clearly and often important concerns or questions remain unanswered.

The dispenser or audiologist will guide you through the entire procedure especially insertion of the molds and operation of the actual hearing aids themselves. There is a fair bit of maintenance and testing that must be done by the parents.

Battery Quality

Believe it or not, batteries are not all equal. Some batteries work better in some devices than others. Hearing aids require premium zinc air batteries in order to operate correctly. Often, most patients will opt for the most cost effective of the lot — not a good idea.

Battery Insertion

Most hearing aids have little battery doors in which to insert the battery. The general rule is if the door does not close than the battery is in wrong. A battery door should never be forced closed. The little sticky tabs should never be inserted in the battery doors. Instead, take the little sticker off the battery and place it on a calendar on the particular day of insertion which will give you an idea of when to replace the battery. Generally, batteries in behind the ear hearing aids should last 10 days to 2 weeks.

Hearing Aid Operation

Due to the ridiculous amount of hearing aids out on the market it would be foolish to think that any one web site could in fact explain the operation of each. Most all behind the ear hearing aids have 2 or 3 different functions:

• Volume Control: usually has numbers 1 to 4 on a small wheel. 1 being the lowest volume and 4 being the highest. Generally, the volume control should be set by the audiologist or dispenser and should not be moved. If the volume is set at 2, then it should stay at 2. Programmable and digital hearing aids have volume controls that can be disabled or internally set. Analogue hearing aids come with “volume control” covers which can be placed over the volume to prevent movement.
• M-MT-T Switch: this may have several variations:
• M stands for microphone and is where the hearing aid is switched most of the time. In the M position the hearing aid wearer essentially “hears”.
• T stands for telephone. All behind the ear and some in the ear hearing aids come with a telecoil. When the hearing aid is in the "T" position the microphone is shut off and a small coil is turned on within the hearing aid which picks up the magnetic resonance that is generated by the phone. The biggest mistake hearing aid users make is to hold the receiver end of the phone on their ear in this position. The receiver of the phone must touch the hearing aid in order for the telecoil to work properly. Although it may seem awkward at first, hearing aid users benefit most when the T switch is used properly. For very small children this may not even be an option and the T switch may be de-activated or removed. Why? Sometimes the hearing aid may switch to telecoil by accident which may cause a lot of grief for parents especially those parents with hearing impaired infants who are lying on their back most of the time. Programmable and digital hearing aids have telecoils that can be de-activated internally.
• MT (not on all models) is both microphone and telephone at the same time. This function, in some models, is absolutely essential in order for the hearing aid to work properly with an FM system.
• Program Button: some programmable and digital hearing aids come with a program button which accesses different programs for different listening environments. This button often comes with the option of de-activation. Although not recommended for very young children, the program button can serve a number of purposes later on in life.
• Ear Hook: the ear hook which sits at the top of the actual mechanism. This hook is usually threaded and may be removed. Some ear hooks contain filters (680ohm, 1000ohm, 2000ohm etc.) which can occasionally become blocked with moisture or cerumen which must be blown out from time to time.

Insertion of the Ear Mold

The most difficult part of the hearing aid fitting is the insertion of the ear molds.

Infant and children’s ear molds are usually made of soft material that is difficult to insert. The canal portion of the mold must be inserted into the ear first with the concha part of the mold in a semi-clockwise position. Pressure is applied towards the head and the concha part of the mold is rotated in a counter-clockwise direction until the concha part of the mold slips into place.

It is absolutely imperative to make sure the sub-helix is tucked into position properly to avoid any pressure soars in this area.

It is best to use a lubricant to insert the ear mold and overcome the friction associated with silicone or PVC. Vaseline, light mineral oil, and otoease are all acceptable lubricants for use. Lubricant is applied to the canal part of the mold making sure not to get any into the bore at the end of the mold. Discontinue the use of any lubricant if irritation develops in the ear canal or concha bowl.

Some ear mold materials may cause irritation of the ear canal and concha bowl if the child is allergic to latex, vinyl, etc.

If irritation develops, please contact your audiologist or hearing aid dispenser immediately.

Dealing with Acoustic Feedback

One of the biggest concerns when fitting ear molds especially to infants and small children is acoustical feedback.

Acoustical feedback is caused by a "break in the seal". Sound leaks out of the ear and travels back into the hearing aid microphone which causes the whistling sound we hear.

With very small infants and young children occasional whistling is normal — constant whistling is not.

There are many ways to combat feedback but a good fitting ear mold is the best avenue. The audiologist or dispenser must have good experience fitting ear molds to infants and children. Some centers in Ontario specialize in pediatrics so it is probably a good idea to research the center previous to making your appointment.

Quite frequently ear molds are not inserted correctly and therefore “whistle”. The use of otoease usually makes insertion of ear molds correctly more probable. Sometimes the infant will outgrow the molds within a week or two weeks. Otoferm (a special type of silicone based sealer) can be used temporarily to provide a little more seal until the molds can be remade or built up. Parents may unfortunately have to make several trips to the center at the beginning for the build up or remake of the mold. In extreme cases an ear mold may not even be physically possible to make due to ear canal size restrictions. These cases are rare but extremely difficult to fit. Talk to your audiologist or dispenser for options. No case is unsolvable!!

Ear mold maintenance

Ear molds must be kept clean for obvious reasons of bacterial infestation and transmission. One of the most economical ways of cleaning ear molds is using mild hand soap and lukewarm water. A gentle brush may be used on the mold to remove any hard wax and debris. An air-blower is used to remove all water from the tubing of the mold post wash. There are special ear mold cleaning kits that may be purchased that contain fizzing tablets that essentially fizz away wax and debris. Alcohol should not be used on molds as it shrinks soft PVC molds and cracks the hard lucite molds.

The tubing on molds must be inspected regularly to ensure there are no cracks and breaks. If there is a burst of feedback all of a sudden it is usually due to a crack in the ear mold tubing especially where the tube joins the mold. In an emergency the crack can be temporarily sealed with RTF silicone or scotch tape. In some cases people have used crazy glue which may solve the problem temporarily but may actually ruin the mold all together. When ear mold tubing stiffens up where it can not be bent then it must be replaced. This may occur several times before actually having to replace the mold. Drastic temperature change also will have an ill effect on soft molds. Unfortunately, for Canadians, we are all too familiar with this phenomenon — warm and mild one day, freezing cold the next. Do not be surprised if the mold shrinks and stiffens up after 2 or 3 months because of this. A light application of mineral oil on the mold from time to time has been known to combat this.

If a child has had an ear infection it is recommended to make new ear molds after the end of medicinal treatment or medical clearance to prevent transmission of infections organisms that may cause another ear infection. Soft molds are porous and hard molds have tiny nooks and spaces which may harbor micro organisms that can not be destroyed by conventional ways of cleaning. Eardrops may also significantly shrink and stiffen the molds and tubing and cause discoloration.

Some parents have also opted to trim the length of the ear mold tubing. Please note that short tubing may cause pressure soars at the top of the ear and tubing that is too long will risk feedback as well as the aid may completely fall out of the ear. Ask your hearing professional to show you exactly how the tubing must be cut.

Checking the Hearing Aid

Every parent must have the following:

• Stetoclip: this looks like a doctor’s stethoscope and is used to listen to the hearing aid to check to see if it is working or if it sounds distorted. The sound one hears the day the instrument is fit is the same sound that should be hear throughout the life of the hearing aid provided the internal settings have not been modified. A listening check should be preformed at least once a day.
• Air blower: this is used to remove any debris or moisture from the ear mold tubing. The air blower can also be used to remove moisture from ear hooks if they are removable. Some ear hooks are threaded and can be essentially unscrewed from the hearing aid. Do not attempt this before asking you hearing health care professional first.
• Battery tester: all parents should have the ability to test the battery to see whether or not the battery is dead. This is an excellent means of trouble shooting the hearing aid. If the battery is tested and appears to be good and the hearing aid still does not work when switched on then there is a blockage or internal problem with the hearing aid.
• Dry aid kit: this is not absolutely necessary but can be very handy. The dry aid kit can be easily made (refer to tips and tricks sections). This is usually a form of desiccant that is used to remove moisture form the hearing aid. The hearing aids are placed into the dry aid kit, usually at night, without the batteries as the desiccant can drastically reduce the battery life.
• Hearing aid clips: these colorful clips can be used to secure the hearing aid to the child's clothing. Dental floss or fishing line can also be used. While not as attractive as the hearing aid clips, dental floss or fishing line and a safety pin can provide the same security. It is important to make sure the length of the string is kept short.
• Loss and damage warranty: Most manufacturers in Ontario offer loss and damage warranty when the hearing aids are purchased. If the manufacturer of the hearing aids does not offer this option, there are companies that provide hearing aid insurance such as ESCO. It is extremely important to read over the details of these policies thoroughly as there is usually fine print or clauses. Please ask you hearing professional about these warranties. Some homeowner policies will also cover the loss of hearing aids-ask your insurance agent.