Condition: Hearing Loss

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Developmental Norms by Age                     Evaluation and Screening                       Suggested Goals                         Therapy

Definition:

Hearing loss is the result of impaired auditory sensitivity and/or diminished speech intelligibility of the physiological auditory system. Individuals with hearing loss are sometimes described as deaf or hard of hearing based on the type, degree, and configuration of hearing impairment.

There are three basic types of hearing loss: sensorineural, conductive, and mixed.

Sensorineural hearing loss (SNHL) is hearing loss due to cochlear (sensory) or VIIIth nerve (neural) auditory dysfunction. Most of the time, SNHL cannot be medically or surgically corrected. Presbycusis is a sensorineural hearing loss that occurs gradually, later in life, affecting hearing in both ears over time. The loss associated with presbycusis is usually greater for high-pitched sounds.

Conductive hearing loss occurs when there is a problem conducting sound waves easily through the outer ear canal, tympanic membrane, or middle ear (ossicles). Conductive hearing loss makes sounds softer and more difficult to hear. This type of hearing loss may be responsive to medical or surgical treatment.

Mixed hearing loss is the result of damage to conductive pathways of the outer and/or middle ear and to the nerves or sensory hair cells of the inner ear.

Degree of Hearing Loss

Degree of hearing loss refers to the severity of the loss. The table below shows one of the more commonly used classification systems.

Degree of hearing lossHearing loss range (dB HL)
Normal–10 to 15
Slight16 to 25
Mild26 to 40
Moderate41 to 55
Moderately severe56 to 70
Severe71 to 90
Profound91+

Adapted from Clark, 1981.

The degree of hearing loss can have significant implications for children with hearing loss, as even a slight hearing loss can be educationally significant for children in the school setting. Educationally significant hearing loss has been defined as “any hearing loss that potentially interferes with access to classroom instruction and impacts a child or youth’s ability to communicate, learn and develop peer relationships (Johnson & Seaton, 2012, p. 43).

Source: https://www.asha.org/practice-portal/clinical-topics/hearing-loss/ 

Developmental Norms by Age:

For Infants:

An infant with normal hearing should be able to do the following:

Around two months of age

  • Startles to loud sound
  • Quiets to familiar voices
  • Makes vowel sounds like “ohh”

Around four months of age

  • Looks for sound sources
  • Starts babbling
  • Makes squeals and chuckles

Around six months of age

  • Turns head toward loud sounds
  • Begins to imitate speech sound
  • Babbles sounds like “ba-ba”

Around nine months of age

  • Imitates speech sounds of others
  • Understands “no-no” or “bye-bye”
  • Turns head toward soft sounds

Around 12 months of age

  • Correctly uses “ma-ma” or “da-da”
  • Gives toy when asked
  • Responds to singing or music
 

Source: https://www.audiology.org/children-and-hearing-loss 

For Older Children: 

Young children with normal hearing sensitivity generally develop listening and communication skills in a predictable developmental sequence and by a certain age. A delay in these communication milestones may be a sign of hearing loss.  School-age children may demonstrate poor academic performance, behavioral concerns, or auditory processing problems as well.

Source: https://www.asha.org/practice-portal/clinical-topics/hearing-loss/#collapse_2 

Evaluation and Screening:

Audiological assessments are conducted by an audiologist. But speech-language pathologists can assist with screening individuals with hearing loss and evaluating speech/language development in children with known hearing loss.

Screenings: 

Speech-language pathologists (SLPs) play a role in the screening, speech/language/communication assessment, and rehabilitation of individuals with hearing loss and the referral of individuals suspected of having hearing loss to an audiologist as appropriate. See ASHA’s Scope of Practice in Speech-Language Pathology (ASHA, 2016b).

Appropriate roles for speech-language pathologists include

  • collaborating with audiologists in the development of screening protocols, equipment selection, and quality improvement;
  • performing hearing screenings;
  • referring children who do not pass screenings for audiologic, medical, and/or other professional services as indicated;
  • referring children who are difficult to test to an audiologist;
  • communicating screening results to families, including recommendations for timely follow-up;
  • sharing screening results with appropriate program and/or school representatives, state public health agencies, state EHDI programs for children under 3 years, primary care physicians, and diagnostic audiology centers as indicated;
  • providing counseling and education for families, educators, and other service providers;
  • collaborating with audiologists, school nurses, teachers, physicians, and/or other professionals to ensure appropriate follow-up and outcomes.

As indicated in the Code of Ethics (ASHA, 2016a), SLPs who serve this population should be specifically educated and appropriately trained to do so.

Evaluations

Hearing screenings should be conducted as part of any comprehensive speech-language evaluation.  Any child who does not pass the screening should be referred on for hearing loss.  For children with known hearing loss, a full speech-language evaluation should include updated information about the child’s current hearing status.  This can be obtained through medical record requests or new hearing evaluations.

Source: https://www.asha.org/practice-portal/professional-issues/childhood-hearing-screening/#collapse_1

Additional Resources on Evaluating Children with Hearing Loss:

Evaluation for a Child who is Deaf and has Autism

This short video provides some tips when evaluating a child with autism and hearing loss.

Suggested Goals:

Children with hearing loss may be treated medically with some amplification or other assistive hearing device.  Speech-language pathology can help develop the child’s listening skills as well as speech-language development for children who have deficits in those areas.  Here are some goals that may need to be addressed in children with hearing loss.  You can click on one of the goals below to learn more.  Or, scroll down to the therapy section for more in-depth resources and support for treating this condition.

Therapy:

Here are some more resources and information that may help you when it comes to treating this condition.

What to Know When Working with a Child with a Hearing Loss: Birth-5yrs – Webinar Recording

This one-hour webinar recording covers tips, strategies, and therapy activities for young children with hearing loss.

Overview of Speech/Language Therapy for Children with Hearing Loss – Webinar Recording

This hour-long webinar gives information about what speech/language skills to target with children with hearing loss and how to address them.

How to Teach Less Visible Sounds

This short video focuses on how to teach a child with hearing loss to produce speech sounds that are not easy to see/demonstrate.

Hearing Loss and Cognitive Delays

This short video answers a question from a member about whether hearing loss causes cognitive delays.

Young Child with Hearing Aids and Pacifier Use

This short video answers a question from a member about how to help a 3-year-old who won’t wear his hearing aids and won’t give up the pacifier.

Phonological Processes in Children with Cochlear Implants

This is the answer to a member question about which phonological processes tend to occur in children with cochlear implants.

Helping Children with Auditory Processing Disorders – Webinar Recording

One-hour webinar recording that covers auditory processing and how to help children with auditory processing disorders.

Processing Problems in Children

Additional information about processing disorders, including auditory processing.

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