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Questions About Amplification
For Children
When Should My Child Get A Hearing Aid
Most newborns have their hearing tested at birth and can be fitted with hearing aids within a few weeks. Research tells us that fitting a hearing aid as soon as possible helps to minimize the effect of the hearing loss on language development. Ideally, an infant will be fit before 3 months of age and no later than six months of age.
What Is A Hearing Aid?
A hearing aid is a device for the ear, which makes sounds louder in the range of a particular hearing loss. The goal is to provide the ability to hear speech and environmental sounds at levels which are above the speech banana when possible.
Who Decides Which Hearing Aid Is Best?
Parents and the child's audiologist should come to a careful decision regarding amplification after consideration of the infant or child's individual needs, including the characteristics of the hearing loss, available technology as well as financial resources. Hearing aids are prescribed to assure the best possible fit with the information available. As more specific information about the hearing loss is obtained, the hearing aids will be adjusted. The audiologist will perform tests with the hearing aids on your child to further confirm the fitting benefit. This should include both behavioral and real ear testing. Real ear testing is an objective measure of the amount of amplification the child is receiving in their ear. Amplification can be influenced by the earmold and size of the ear canal. This test is critical for children when no concrete behavioral measures were obtained. The child's physician will provide a medical clearance statement to permit the fitting of hearing aids on a child in compliance with the FDA (Food & Drug Administration) requirements.
What Styles of Hearing Aids Are Available For Children
Hearing aid styles differ by how they are worn on the ear.
 BEHIND-THE-EAR (BTE): Hearing aids are positioned behind the ear and coupled to the ear with a custom fitted earmold. BTE hearing aids are utilized for infants and young children due to the following features:
- BTE earmolds are made from soft materials, which are more comfortable and less easily broken, for physically active children.
- Earmolds can be replaced as the child's ears grow. It is not necessary to recase or replace the hearing aid itself
- BTE hearing aids are often more reliable and less easily damaged.
- BTE hearing aids are easily connected to a FM system or assistive listening device.
- BTE hearing aids and earmolds are available in colors and with accessories designed specifically for children.
IN-THE-EAR (ITE): Other completely in-the-ear hearing aid styles may be available to older children and adults.
How Does A Hearing Aid Work?
Sounds are picked up by a microphone and carried to a digital signal processor (amplifier) where they are made louder and shaped to match the hearing loss characteristics such as frequency (pitch) and intensity (loudness). The sound is then sent through the receiver and delivered by the earmold into the ear.
Digital Signal Processing: Modern hearing aids use digital circuitry; these circuits use an internal microprocessor to convert the sound to numbers according to a mathematical formula called an algorithm. The algorithm is sensitive to changes in speech and environmental noises. Additionally, hearing aids have numerous amplifier channels. This advanced processing technology allows the hearing aid to be programmed with the specific amount of amplification needed for the different frequencies. Hearing aids are able to have several programs for different listening environments. They are able to switch automatically to accommodate for changes in background noise, making soft sounds more accessible and loud sounds more comfortable.
Earmold: Custom made, seals the ear to prevent sound leakage which then causes feedback (whistling)
Tubing: Soft, flexible; connects the earmold to the hearing aid; securely attached to the earmold and detachable from the earhook; replaceable if torn, hard, cracked or too short.
Earhook: Curved, hard plastic; supports the hearing aid on top of the ear; protects the receiver and channels sound to the earmold. May have a filter to further shape the sound for the hearing loss.
Receiver: Sound speaker inside the hearing aid that opens into the earhook.
Microphone: Collects sound for amplification through a small opening in the hearing aid case.
Internal Adjustment Controls or Computer Cable Connector Port: Accessed by the audiologist to modify the hearing aid sound response.
Switch: Usually 0 = Off; T = Telephone or FM System, M = Microphone, M/T Mic/telephone
Volume Control: Usually a numbered wheel that changes the loudness of the sound. Typically the smaller the number the lower the volume. Some hearing aids may not need this control. The volume control can be disabled by your audiologist.
Battery Door: Holds the battery which is changed regularly; opening the door will turn off the hearing aid; batteries are toxic if swallowed and tamper resistant doors are recommended for children.
What Other Types Of Hearing Aids
Might Be Necessary?
Bone Anchored Hearing Aids (BAHA): Some children with conductive hearing loss, and/or malformed or missing outer ears (Microtia/Atresia)* may also choose to use a bone anchored hearing aid (BAHA). The BAHA is available in a soft band/headband for younger children and is available with a surgically implanted abutment for children at least 5 years of age.
*For more information about Microtia/Atresia, please contact one of Hands & Voices Statewide Unilateral Parent Guides at http://cohandsandvoices.org/gbys/statewide.htm
Tactile Aids: A type of hearing instrument that produces a vibration or "tactile" signal to indicate the presence of sound(s). It is worn on the body and triggers the sense of touch or feeling to draw attention to information that cannot be heard by the individual with hearing loss.
Finally, ALL hearing aids have limitations. Hearing aids cannot cure a hearing loss, they cannot amplify all frequencies across the frequency range, they cannot make sounds more clear if the inner ear (cochlea) is damaged and distorting these sounds and they cannot completely separate speech from background noise. Hearing aids will enhance your child's life and development when a close working relationship exists between the parents, their child, the audiologist and the intervention team.
What OTHER Considerations/Devices Are Available?
There are other devices and resources you may find helpful for your child now or in the future. You may want to discuss these options with your audiologist:
Cochlear Implant: (CI) An electronic device that is surgically implanted in the cochlea of the inner ear. It transmits auditory information directly to the brain, by-passing damaged or absent auditory nerves. Technically, it synthesizes hearing of all sounds, but the wearer requires training to attach meaning to the sounds. This is called auditory "habilitation", or "rehabilitation". Typically, cochlear implant users have severe to profound hearing losses and do not get much benefit from hearing aids. Successful CI users gain useful hearing and improved communication abilities. The FDA has approved CIs for qualified candidate adults and children starting at age 12 months. (see next page)
Closed Captioning: This assistive device is either attached to a television or built in to a television to provide written text of the spoken words. (The FDA requires all analogue and digital televisions have built in closed captioning capability as of 1997).
FM System: A hearing assistance device that transmits the speaker's voice via a frequency modulated signal to an electronic receiver worn by the listener. The receiver may be in a hearing aid, earphones or ear buds, or a speaker. The device reduces the problem of background noise interference and the problem of distance from the speaker.
Sound Field System: Hearing assistance technology that disperses the speaker’s voice to the audience, usually a classroom. The system includes a microphone worn by the speaker and strategically placed speakers. These systems are beneficial to all listeners.
Telephone Amplifier: This type of assistive listening device makes the telephone signal louder and may be used with or without a hearing aid.
Telecommunication Devices for the Deaf (TDD'S): Originally and often still called TTY’s, these electronic devices allow deaf and hard of hearing persons to communicate via a text telephone system. This term appears in ADA regulations and legislation
Video Relay/Video Phone: Video Relay Service (VRS) is a communication technology where the deaf and hearing consumers are in different locations and are linked through an interpreter provided through a relay center. Users of VRS must have equipment that allows them to send their image to the Relay Center. Once connected, a deaf caller can simply sign a message to the sign language interpreter, who conveys it to the person called. That person, in turn, can reply and the interpreter will transmit the message in sign language back to the deaf caller.
What Is A Cochlear Implant?
 The cochlear implant is an electronic device surgically implanted in the cochlea of the inner ear. The cochlear implant’s electronic array transmits auditory information from the cochlear via the auditory nerve to the brain; by-passing the inner ear. By completely by-passing the damaged part of the cochlea, the cochlear implant uses its own electrical signals to stimulate the auditory nerve, allowing the person to perceive sounds. Candidates for a cochlear implant, or CI, typically have severe to profound hearing loss and do not benefit much from hearing aids. The use of bilateral implants is increasing due to the benefits of binaural hearing or hearing with both ears. The FDA has approved CIs for adults and children who are profoundly deaf at age 12 months and for those with severe hearing loss at age 24 months. The wearer requires training, called auditory habilitation or rehabilitation, to attach meaning to sounds. Successful CI users gain useful hearing and improved communication abilities. Despite progress in technology, it is important to note that cochlear implants are not a “cure” for hearing loss, and like any surgical procedure, cochlear implant surgery is not without risk.
Family decisions surrounding cochlear implantation can be difficult. There is much to consider and the amount of information available can be overwhelming. Connecting with other families is often helpful in this process. Internet resources are informative, but be careful to ensure sites are reliable and factual. Online communities of parents and CI users can be rich in experience and support. There are three primary CI manufacturers available in the US (websites listed below along with other helpful sites and articles) which are important sources of specific information regarding their devices, although be aware these sites also serve to market devices.
 The cochlear implant has two basic pieces:
- The Processor – This piece is outside the body. It picks up sounds, processes them, and sends signals to the Cochlear Implant
- The Implant – This piece is placed behind the ear, under the skin, during surgery. It receives signals and sends them to the hearing nerves, skipping over any non-working parts in the middle and inner ear.
Where Can I Find More Info About Cochlear Implants?
Information regarding candidacy, technology, surgery, risks, and rehabilitation:
Information about meningitis risks and the recommended vaccine schedule for children with cochlear implants:
CI Manufacturers:
All have online communities of users, information about devices, how to contact representatives for questions, resources for auditory training, and more.
Sampling of Family Stories:
Online community of parents of children with cochlear implants:
Other Questions You Might Want
To Ask An Audiologist:
- Is the loss permanent?
- Does my child need more testing?
- How often should my child’s hearing be tested?
- Can you tell if my child’ hearing loss will get worse or change?
- Do both ears have the same hearing loss?
- How will the hearing loss affect my child’s speech and language development?
- What could have caused my child’s hearing loss?
- Would you suggest genetic counseling for our family?
- May I have copy of the hearing test results?
- How much do hearing aids or a cochlear implant cost?
- Can I get help to pay for the hearing aids?
- Can you help me contact a program that can lend me hearing aids?
- What will my child hear with the hearing aids/cochlear implant?
- How often will my child need new hearing aids or parts?
- What are the parts of a hearing aid that may need to be replaced?
- With my child’s hearing loss, should I consider a cochlear implant?
- Where can I go for more information?
- Can you give me resources of people who will have different perspectives on our decision making process? (i.e. other professionals/other parents/deaf and hard of hearing adults)
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