How Do You Know if Your Baby Has Hearing Problems?

KEY POINTS

• Hearing loss is a common birth defect that can affect a baby's ability to develop speech, language and social skills.

• Hearing loss can happen when any part of the ear isn't working in the usual way.

• Most babies get their hearing checked as part of newborn screening before they leave the hospital after birth.

• If you think your baby may have hearing loss, tell her health care provider right away.

• Early treatment for hearing loss is important for your baby's health and development.

What is hearing loss?

Hearing loss can happen when any part of the ear isn't working in the usual way. It can range from mild to profound:

• Mild: You can hear some speech sounds, but soft sounds are hard to hear.
• Moderate: You can't hear very many speech sounds when someone is talking at a normal level.
• Severe: You can't hear any speech sounds when someone is talking at a normal level. You can only hear some loud sounds.
• Profound: You can't hear any speech sounds. You can only hear very loud sounds.

Hearing loss is a common birth defect. Birth defects are structural changes present at birth that can affect almost any part of the body. They may affect how the body looks, works or both. Birth defects can cause problems in overall health, how the body develops, or how the body works. Up to 3 in 1,000 babies (less than 1 percent) are born with some kind of hearing loss in the United States each year.

When a baby is born with hearing loss, it's called congenital hearing loss. Hearing loss also can develop later in babies or during childhood or adulthood.

What are signs of hearing loss?

Signs of hearing loss in your baby can include:

• Not being startled by loud sounds
• Not turning toward a sound after he's 6 months old
• Not saying single words like "mama" or "dada" by the time he's 1 year old
• Turns his head if he sees you, but not if you only call out his name
• Seems to hear some sounds but not others

If your baby shows signs of hearing loss at any time, call his health care provider to get your baby's hearing checked.

What are common types of hearing loss?

Your baby's auditory system is the system in the body that helps her hear. It makes sense of sound information as it travels from the ear to the brain. Problems in these parts of the auditory system may cause hearing loss:

• Outer ear. This includes the part of the ear on the outside of the head, the ear canal and the outside of the eardrum. The eardrum separates the outer and middle ear.
• Middle ear. This is made up of the inside of the eardrum and three small bones called ossicles. Sound coming into the ear moves through the ear canal to the eardrum, causing the eardrum to vibrate (move back and forth quickly). When the eardrum vibrates, it moves the ossicles. This helps sound move to the inner ear.
• Inner ear. This is made up of the cochlea (a curled tube filled with fluid) and canals that help with balance. The inner ear also has nerves that change sound vibrations into signals that travel to the brain through the auditory nerve (also called the hearing nerve). The auditory nerve sends sound information from the ear to the brain.

Common types of hearing loss include:

• Conductive hearing loss. This happens when there's a problem in the outer or middle ear that slows or prevents sound waves from passing through. Problems may include a blockage in the ear canal or fluid in the middle ear. This kind of hearing loss often is temporary and usually can be treated with medicine or surgery.
• Sensorineural hearing loss. This happens when there's a problem with the way the inner ear or auditory nerve works. It may happen when certain cells in the inner ear are damaged. This kind of hearing loss is usually permanent.
• Mixed hearing loss. This when a baby has both conductive and sensorineural hearing loss.
• Auditory neuropathy spectrum disorder (also called ANSD). In this condition, a problem with the inner ear or auditory nerve prevents the brain from understanding sound.

How do you know if your baby has hearing loss?

The Centers for Disease Control and Prevention (also called CDC) and the American Academy of Pediatrics (also called AAP) recommend that all babies get screened for hearing loss before they're 1 month old. Most babies get their hearing checked as part of newborn screening before they leave the hospital after birth. Newborn screening checks for serious but rare and mostly treatable health conditions at birth. It includes blood, hearing and heart screening.

If your baby doesn't pass her newborn hearing screening, it doesn't always mean she has hearing loss. But she needs a full hearing test as soon as possible before she's 3 months old. A full hearing test can help your baby's health care provider diagnose hearing loss.

If your baby has hearing loss, getting treatment right away is important. Every state has an Early Hearing Detection and Intervention (also called EHDI) program that works to help children with hearing loss and their families. It can help with full hearing tests and other services for your baby. You can find your local EHDI program through the National Center for Hearing Assessment and Management website.

What hearing tests are part of newborn screening?

Your baby has one of these hearing tests as part of newborn screening:

• Auditory brainstem response (also called ABR or brainstem auditory evoked response test or BAER). This test uses patches called electrodes and a computer to check how the brain and auditory nerve respond to sound. Your baby's provider puts the patches on your baby's head and soft earphones in your baby's ears. The provider sends sounds through the earphones and measures your baby's brain waves to see how your baby's brain reacts. This test can show if the brain isn't getting sound information in a clear way. Your baby can be asleep for this test.
• Otoacoustic emissions (also called OAE). This test checks how the inner ear responds to sound. Your baby's provider places a small earphone in your baby's ear. The earphone is connected to a computer. The earphone plays sounds that should echo in your baby's ear canal. If there's no echo, your baby may have hearing loss. Your baby can be asleep for this test.

What other kinds of hearing tests can babies have?

If your baby doesn't pass his ABR or OAE test in newborn screening, her provider refers her to an audiologist. This is a person with special training to diagnose and treat hearing loss in newborns, children and adults. Your child's provider also may refer your baby to an otolaryngologist (also called ENT). This is a doctor with special training in ear, nose and throat care.

An audiologist gives your baby a full hearing test to check for hearing loss. This can include the ABR and OAE tests, as well as other hearing tests. The audiologist also may use a behavioral audiometry evaluation to check how all parts of your baby's ear work. For this test, the audiologist sees how your baby responds to sound by watching for changes in behavior. Your baby has to be awake for this test. The audiologist plays a sound and checks to see if your baby reacts. For example, your baby's eyes may move or your baby may turn her head, suck on a pacifier, get quiet or seem to be listening for the sound. If your baby responds to the sound, the audiologist gives your baby a reward, like a toy with flashing lights. This is called visual reinforcement audiometry.

How can hearing loss affect your baby?

Early screening, diagnosis and treatment can help children with hearing loss develop speech, language and social skills. Without early treatment, hearing loss can lead to:

• Delayed or limited language and speech development. For example, babies and children with hearing loss may have trouble understanding things that other people say, learning new words and saying words the right way. Children with untreated hearing loss may have poor communication skills.
• Learning and social problems. Without early treatment, children with hearing loss may have problems learning in school. Hearing loss also may make it hard for them to be social with other children.

What causes hearing loss?

We're not sure what causes all forms of hearing loss. Possible causes include:

Genes. Genes are parts of your body's cells that store instructions for the way your body grows and works. Genes are passed from parents to children. Genes may play a role in about half of the cases of hearing loss in babies and children. If you or your partner has a family history of hearing loss, you may want to talk with a genetic counselor before getting pregnant. This is a person who is trained to help you understand about how genes, birth defects and other medical conditions run in families, and how they can affect your health and your baby's health.

Sometimes the instructions in genes change. This is called a gene change or a mutation. Gene changes can cause two kinds of hearing loss:

1. Syndromic. The hearing loss happens with other health problems, like blindness.
2. Non-syndromic. This is when hearing loss is the only condition a baby has. About 7 in 10 mutations causing hearing loss (70 percent) are non-syndromic.

Premature birth or low birthweight. Premature birth is birth that happens too early, before 37 weeks of pregnancy. Premature babies often have more health problems (like hearing loss) at birth and later in life than babies born full term.  Low birthweight is when a baby is born weighing less than 5 pounds, 8 ounces. Learn more about things you can do to help reduce your risk for premature birth.

Problems with the way the ears, head or face develop. If your baby has a birth defect that changes the shape or structure of his ears, head or face, he may have hearing problems.

Viruses and infections during pregnancy. You can pass certain viruses and infections to your baby during pregnancy that may cause hearing loss in your baby. These include:

• Cytomegalovirus (also called CMV). This is a common virus that can cause a sore throat, fever, swollen glands and fatigue (feeling tired all the time).
• Herpes. This is an infection caused by a herpes simplex virus (also called HSV). Herpes infections can affect many parts of the body, including the eyes, mouth, skin, buttocks and genitalia.
• Measles. Measles is an infection that spreads easily. It can cause rash, cough and fever.
• Rubella (also called German measles). This is an infection that causes mild flu-like symptoms and a rash on the skin.
• Syphilis. This is a sexually transmitted infection (also called STI) that at first causes sores and a rash. An STI is an infection you can get from having unprotected sex or intimate physical contact with someone who is infected. This means you get it from having unprotected sex with a person who is infected with syphilis. You also can get syphilis by having direct contact with (touching or kissing) an infected person's syphilis sore. If you have syphilis during pregnancy and don't get treated, it can cause serious problems for your baby, including hearing loss.
• Toxoplasmosis. This is an infection you can get from eating undercooked meat or touching cat poop. It can cause problems like body aches, headache, fatigue (being really tired) or fever.

Infections your baby has after birth. Infections that can cause hearing loss include:

• Ear infections. These most often cause temporary hearing loss. But if the infection damages your baby's eardrum, the bones of the ear or the auditory nerve, hearing loss can be permanent. This is rare.
• Other infections, like meningitis and measles. To protect your baby from infections like these, make sure he gets all his vaccinations. Use our vaccination schedule to find out when your baby gets each vaccination. Meningitis is an infection that causes swelling in the brain and spinal cord.

Other conditions after birth. These include:

• Head injuries
• Jaundice that's severe enough to need a blood transfusion. Jaundice is when a baby's eyes and skin look yellow. A baby has jaundice when his liver isn't fully developed or isn't working. A blood transfusion is having new blood put into your body.
• Taking high doses of some medicines, like an antibiotic called streptomycin. Antibiotics are medicines that kill certain infections.
• Buildup of ear wax or buildup of fluid behind the eardrum
• Injury to the eardrum
• Objects stuck in the ear canal, like food, toys or pieces of crayon
• Being around loud sounds, like the sounds of machines

How is hearing loss treated?

Treatment depends on your baby's overall health and the cause of the hearing loss. If your baby has hearing loss, it's important to start treatment as soon as possible and before she's 6 months old. This can help her develop speech, language and social skills. Treatment may include:

Cochlear implant. This is a small electronic device that can help some babies with severe or profound hearing loss. One part of the implant sits on the head behind the ear. The other parts are placed inside the ear during surgery. The part behind the ear sends sounds to the parts inside the ear. Babies as young as 1 year old may get a cochlear implant. It doesn't give a baby complete hearing, but it can give a baby a sense of sound. Hearing through a cochlear implant is different from normal hearing. Specialists, like audiologists and speech therapists, can help your baby learn to hear through the implant and develop her speech, language and social skills.

Ear tubes. These are tiny tubes placed through the eardrum. Ear tubes allow air into the middle ear and prevent fluids from building up behind the eardrum. Your child may need ear tubes if:

• She gets a lot of ear infections (about three or more in 6 months or four or more in 1 year)
• She has fluid buildup and inflammation (redness and swelling) behind the eardrum
• If she has hearing loss due to ear infections

Hearing aid. Hearing aids make sounds louder. Hearing aids can help babies as young as 1 month old. If your baby has severe or profound hearing loss, a hearing aid may not help.

Learning special language skills. Children with hearing loss may need special language skills to communicate with others. For example, some may learn American Sign Language (also called ASL) to communicate. ASL uses the shape, placement and movement of hands, along with facial expressions and body movement, to communicate.

Medicines, including antibiotics. If your child has an ear infection that causes hearing loss, her health care provider may prescribe an antibiotic like amoxicillin. Her provider also may suggest over-the-counter (also called OTC) medicines to help with fever and pain. These medicines may include ear drops, acetaminophen (brand name Tylenol®) and ibuprofen (brand names Motrin® or Advil ®).

Speech therapy. This is therapy to teach your child how to speak more clearly or communicate in other ways. Speech-language pathologists (also called speech therapists) are professionals who can help children learn how to make sounds, improve their voices and interact with others.

Surgery. Surgery can sometimes correct problems with the structure of the outer and middle ears.

How can you prevent hearing loss in your baby?

Some types of hearing loss, like hearing loss caused by gene changes, can't be prevented. But you can help prevent hearing loss related to other causes, like infections and premature birth.  Here's what you can do:

Before pregnancy

• Get a preconception checkup. This is a medical checkup you get before pregnancy to help make sure you're healthy when you get pregnant.
• Make sure your vaccinations are up-to-date. Talk to your provider about vaccinations you need before you get pregnant. For example, you may need the MMR vaccination that protects you from measles and rubella.
• Get checked for infections, like STIs. Early testing and treatment can help you have a healthy pregnancy and a healthy baby.

During pregnancy

Go to all of your prenatal care checkups. Prenatal care is medical care during pregnancy. At each prenatal care visit, your health care provider checks on you and your growing baby. Getting early and regular prenatal care can help you have a healthy pregnancy. Go to all your checkups, even if you're feeling fine.

Protect yourself from infections. Here's what you can do:

• If you need vaccinations, get them. Ask your provider about vaccinations that are safe to get during pregnancy.
• Wash your hands with soap and water after using the bathroom or blowing your nose.
• Have safe sex. This means having sex with only one person who doesn't have other sex partners. If you're not sure if your partner has an STI, use a barrier method of birth control. Barrier methods include male and female condoms and dental dams. A dental dam is a square piece of rubber that can help protect you from STIs during oral sex.
• Don't eat undercooked meat.
• Don't touch cat poop.

After birth

Take your baby to all his well-baby checkups. At these checkups, your baby's provider checks your baby's overall health, growth and development. Your baby also gets vaccinations to help protect her from harmful infections.

Get early treatment for ear infections. If you think your baby has an ear infection, call his provider right away. Signs and symptoms of ear infection include:

• Tugging on ears
• Having trouble hearing or sleeping
• Crying more than usual, especially when your baby is lying down
• Having balance problems
• Fever
• Headache
• Fluid coming out of the ears

Keep your baby away from loud sounds. Close windows and doors in your home to limit loud sounds near your baby. Keep TV and radio volumes low. Give your baby quiet toys or toys with volume control set to the lowest volume. Don't take your baby to noisy events, like concerts or fireworks shows. If you do take your baby to a loud place, use earplugs or earmuffs to limit noise. If your baby is covering his ears or looks uneasy in a noisy place, it's probably best to leave.

More Information

• Individuals with Disabilities Education Improvement Act (IDEA)
• Hearing loss treatment and intervention services

Last reviewed: June, 2019

How Do You Know if Your Baby Has Hearing Problems?

Source: https://www.marchofdimes.org/complications/hearing-loss-and-your-baby.aspx

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