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Audiology

Pediatric audiologists focus on diagnosing specific types of hearing loss in children. At Cook Children's, our audiologists work closely with your child, as well as family, speech pathologists, school personnel and physicians to enhance functional hearing to help your child learn and develop.

Hearing and speech are essential to learning for children. Most babies are born with normal hearing but every year three out of every 1,000 babies are born with hearing loss. This loss can be in one or both ears. Hearing loss many times affects how your child's brain develops. Hearing loss can also lead to a delay in speech and language development. Social-emotional development and academic performance at school is often affected, too.

Signs and symptoms of hearing loss in children can be different for every child. If your child was born with hearing loss, it is most often discovered during a newborn hearing screening in the hospital shortly after birth. Most of the complications of hearing loss can be prevented if your child is diagnosed by 3 months of age and appropriate treatment begins before your child is 6 months old. If the hearing loss happened after your child was born, you might be one of the first people to notice hearing or speech difficulties.

Pediatric audiology services

Pediatric aural rehabilitation services are provided by LSLS, certified auditory-verbal therapists or speech-language pathologists who have specific mentoring and training in auditory-verbal therapy strategies and techniques. For more information, please see links to: Speech Therapy and Cochlear Implant Program.

Hearing testing

  • Behavioral audiometry
  • Auditory brainstem response
  • Otoacoustic emissions
  • Infant newborn hearing screenings

Evaluation and selection of assistive devices

  • Hearing aids (includes dispensing, testing and repairs)
  • FM systems
  • Other assistive listening devices
  • Custom ear plugs for swimming and noise protection
  • Cochlear implants

Types of hearing loss and causes

There are three main types of hearing loss. These types of hearing loss can be present at birth or acquired after birth.

Sensorineural Hearing Loss (SNHL): This type of hearing loss is related to the inner ear or the neural connection to the brain.

Conductive Hearing Loss (CHL): This type of hearing loss occurs in the outer or middle ear.

Mixed Hearing Loss (MHL): This is simply a combination or mix of both SNHL and CHL.

Causes of hearing loss

Hearing loss in children can be present at birth (congenital) or acquired later in childhood.

Possible causes of congenital hearing loss

  • Infection from the mother (examples: cytomegalovirus, herpes, syphilis, rubella toxoplasmosis)
  • Low birthweight
  • Syndromes
  • Hereditary/inherited problems
  • Malformations of the outer ear
  • Malformations of the middle ear (ear drum or bones of the middle ear)

Possible causes of acquired hearing loss

  • Medications that can be harmful to the ears
  • Loud noise exposure
  • Trauma
  • Infections
  • Ear wax blockage
  • Middle ear infections
  • Perforation of the eardrum
  • Tumors in the middle ear
  • Problems with the eustachian tube
  • Foreign objects in the ear canal

Noise exposure in children and teens

Loud noise and sounds can be damaging to a person's hearing. The level of noise and the length of time you listen can put your and your child at risk for noise-induced hearing loss. Sound levels are measured in decibels (dB). The higher the decibel (dB) number the more at risk you are for this type of hearing loss. Sounds that are louder than 85 dB can cause permanent hearing loss.

Things to watch to prevent noise exposure in your children:

  • For young children it is important to watch out for loud toys. Many toys are designed to be played at a distance from the body but a young child will often hold toys close to their face and ears.
  • Use hearing protection when playing musical instruments and attending concerts, Cook audiologists can help you find the right hearing protection to keep ears safe but keep musical quality.
  • Use hearing protection when hunting, firing guns, mowing, or using power tools.
  • Limit your tween and teens time and loudness when using personal headphones to listen to music or games.

Resources for noise-induced hearing loss:

Hearing tests

Hearing tests for newborns

Test What it measures How it's done
Tympanometry This test helps find problems with the eardrum and middle ear. This test does not measure hearing but it can detect the possibility of changes in pressure of the middle ear, fluid behind the eardrum, or a hole in the eardrum. A small earphone is placed in your baby's ear. The earphone measures how well sound enters the middle ear at different air pressures.
Otoacoustic emissions (OAE) This test looks at the hair cells of the cochlea. The cochlea is the organ of hearing. A small earphone is placed in the ear. Your baby will need to remain still and quiet for a few minutes. Sounds will come through the earphone and then a response from the hair cells will be recorded.
Auditory Brainstem Response (ABR) This test measures the response of your baby's hearing nerve and the lower part of the brain. It can tell us the type and degree of hearing loss. This test must be performed while your baby is asleep or sedated. Sound is presented to each ear and we measure the brainwaves that are related to hearing.

Hearing tests for infants and toddlers

Test What it measures How it's done
Tympanometry This test helps find problems with the eardrum and middle ear. This test does not measure hearing but it can detect the possibility of changes in pressure of the middle ear, fluid behind the eardrum, or a hole in the eardrum. A small earphone is placed in your child's ear. The earphone measures how well sound enters the middle ear at different air pressures.
Visual Reinforcement Audiometry (VRA) This test determines the quietest levels your child responds to various sounds. For this test, your child will to look toward a toy or video screen in response to a sound made from a speaker or earphone.

Hearing tests for preschoolers

Test What it measures How it's done
Tympanometry This test helps find problems with the eardrum and middle ear. This test does not measure hearing but it can detect the possibility of changes in pressure of the middle ear, fluid behind the eardrum, or a hole in the eardrum. A small earphone is placed in your child's ear. The earphone measures how well sound enters the middle ear at different air pressures.
Conditioned Play Audiometry (CPA) This test determines the quietest levels your child responds to various sounds. During this test, your child is asked to respond to sounds by playing a simple game, such as throwing blocks in a bucket or stacking blocks to make a tower. Testing is done with earphones on each ear.

Hearing tests for school-aged children

Test What it measures How it's done
Tympanometry This test helps find problems with the eardrum and middle ear. This test does not measure hearing but it can detect the possibility of changes in pressure of the middle ear, fluid behind the eardrum, or a hole in the eardrum. A small earphone is placed in your child's ear. The earphone measures how well sound enters the middle ear at different air pressures.
Conventional audiometry This test determines the quietest levels your child responds to various sounds. For this test, your child is asked to respond to sounds played through earphones. It requires your child's cooperation to either raise their hand or say 'yes' when they hear a beep. This is like a traditional adult hearing test.

Treatments for hearing loss

Hearing aids – These electronic, battery-operated devices can amplify and modify for your child. A wide variety of colors and styles are available for you and your child. A Cook Children's pediatric audiologist will be there to guide you in this process.

Cochlear implants – This is a surgically placed device that helps to transmit electric stimulation to the inner ear. Only certain types of children are candidates for this type of device, the most likely candidates are children with severe to profound sensorineural hearing loss (SNHL). Find more information about cochlear implants.

Bone anchored devices – This is a device for children with conductive hearing loss, mixed hearing loss, or single sided deafness (SSD). A bone anchored device can be utilized after birth like a hearing aid or it can be implanted later by an otologist.

Frequently asked questions on hearing loss

If my child wears hearing aids, will they learn to talk?
There are many things that determine if your child with hearing loss will learn to talk. First your child must wear their hearing aids or implant processor during all waking hours of each day. Second you must give your child continuous auditory input – talk to your child, describe what you're doing all day, and read to them every day. Other developmental delays can delay your child's speech development despite proper hearing aid use and good auditory input. Your child's audiologist can help you through this process. Cook also offers a parent support group for hearing loss where you can also learn from other families.

Is earwax normal?
Ear wax is normal. It protects and moisturizes your ears. It is completely normal to have a small amount of ear wax in your ears. If ear wax completely fills the ears, it can cause a slight hearing loss. Hearing will return to normal once the wax is removed.

How do I remove earwax?
It is best to let a licensed medical professional remove ear wax from your child's ears. Putting objects in your child's ears can permanently damage their ears and hearing.

How are you going to test my baby's/toddler's/child's hearing?
Cook Audiologists are experts in testing hearing in children. They will customize testing based on your child's developmental level.

How I prepare my child for an ABR?
Auditory Brainstem Response (ABR) testing helps an audiologist get information about the hearing system when infants are too young to respond or previous testing has been unsuccessful for older children. ABR testing requires your child to sleep soundly throughout the test. The appointments for unsedated ABR testing are two hours long to make sure you have time to get your baby sound asleep and ensure good test results. It is important you bring your infant tired and ready for a nap. Feeding right before your appointment time or right when you arrive for your appointment is recommended to help get your baby comfortable and ready for sleep. Sedated ABR tests are completed only at the Main Hospital location in Fort Worth, Texas. Because of anesthesia, your child will have eating and drinking restrictions for the test. A representative from the hospital will call you prior to your appointment with those specific details.

How do I schedule an appointment or follow-up appointment?
Call 682-885-3898 for new appointments or follow-up appointments.

How much does a hearing test cost?
The age and developmental status of your child will determine which procedures are likely to occur during your child's appointment. Once your appointment is booked, the scheduling professional can help you determine an estimated cost for your child's appointment.

How often does my child need to return for follow-up visits after hearing aids are fit?
Once your child is fit with hearing aids, your child will need an initial follow up appointment in 4 to 6 weeks. Depending on the age of your child, follow up appointments will be set at 3 month, 6 month, or yearly intervals.

When will I find out the test results?
Once testing is complete, the audiologist will go over the results with you and make recommendations before you leave the appointment. You will be given time to ask questions and give feedback about the results as well.

Will my insurance cover the procedure and/or hearing aids?
Each insurance company has different coverage for hearing aids. Once your child has been tested and your audiologists makes recommendations our insurance reimbursement specialist can help you determine what your insurance covers.

My amplification is broken, what do I do?
If your child's hearing aids or earmolds are broken, you may drop off the broken hearing aids at your audiologist's office or call 682-885-3898 to make an appointment with your audiologist.

My child needs new earmolds, what do I do?
Please call 682-885-3898 to make an appointment with your audiologist.

How do I let school know the results of today's recommendations?
The audiologist will provide information for your school when hearing aids or other devices are fit on your child. You can also fill out a Release of Information to have copies of your child's results sent to the child's school directly from Cook Medical Records at 682-885-1012.

Can I have a copy of today's test?
Your audiologist will provide a family friendly information sheet of the testing results at the end of the appointment. This information sheet gives the hearing results and recommendations for your child.

We're here to help.

If your child has been recommended to us, you probably have lots of questions. We can help. If you would like to schedule an appointment, refer a patient or speak to our staff, please call our offices at 682-885-4063.

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