So Your Child Has a Hearing Loss: Next Steps for Parents

Types of Hearing Aids

There are three main types of hearing aids. Behind-the-ear hearing aids are used most frequently in infants and children.

1. Behind the ear (BTE) hearing aids, not surprisingly, fit behind your child's ear. They are frequently used with pediatric patients as they tend to be most compatible with the physical characteristics of infants and young children. Additionally, a mini-FM system can be used in combination with BTEs to improve a child's ability to hear speech. BTEs are connected to earmolds, which are pieces of soft plastic custom-made to fit your child's ear. Earmolds help keep the hearing aid in place and provide the channel through which sound is delivered into the ear canals. As with clothing and shoes, children do outgrow their earmolds and will need to have them replaced once or twice per year. Infants' earmolds, however, will need to be replaced about once every two months due to your child's rapid growth across his or her first year. One symptom of children outgrowing their earmolds is the presence of "acoustic feedback". When the earmold isn't fitting well, sound will be able to escape the ear canal and will be re-amplified by the hearing aid microphone, producing feedback in the form of a high-pitched squealing sound.
   
   
2. In the ear (ITE) hearing aids fit completely in the outer ear. The case, which holds the components, is made of plastic and must be replaced as the ear grows. For this reason, ITE aids are not used frequently with young children. This style of hearing aid is used most frequently for those with mild to severe hearing losses.
   
   
3. In the canal (ITC) hearing aids fit into the ear canal and are customized to fit the size and shape of the user's ear canal. Like ITE aids, ITC aids must be replaced as the ear grows and, as a result, are not often selected for pediatric use. Like ITE aids, ITC aids are employed most frequently for mild to moderately severe hearing loss. The small size of both ITE and ITC aids make them difficult to adjust and/or to remove for young children.
   
   
4. On the horizon: Implantable hearing aids (IHAs) comprise both bone-anchored hearing aids (BAHAs) and middle ear implants (MEIs). A BAHA is useful for those with either congenital atresia of the ear canal or chronic middle ear dysfunction (typically chronic otitis media) that prevents the optimal use of conventional hearing aids. Many of the candidates for a BAHA are those who have used bone conductors worn on the scalp with a spring-loaded device that exerts pressure on the skin. The BAHA offers a level of sensitive hearing not achievable with these conventional bone conductors. The FDA has approved the use of BAHAs for all age groups, including children as young as 2 years. The long-term experience with use of the BAHA in Sweden and England suggests that the device may be a preferred alternative to surgery to open the ear canal or repair the middle ear mechanism, particularly in children with the Treacher-Collins or Goldenhaar syndrome. MEIs are used for persons with purely sensorineural hearing losses.

Parents' Hearing Aid Survival Kit

1. Hearing aid battery tester-to check the battery level each day
2. Hearing aid stethoscope-to perform a daily listening check
3. Forced-air stethoscope-to remove moisture and ear wax from the sound channel of the earmold
4. Hearing aid dehumidifier-to store hearing aids overnight
5. Earmold lubricant-to facilitate earmold insertion and reduce the likelihood of acoustic feedback
6. Earmold disinfectant-to keep your child's ears healthy and happy!

   -ASHA, Let's Talk, May/June 99, pp. 43-44.