Hearing Problems (Common Problems of Former Preemies)

Hearing Problems

How common are hearing problems in preemies?

At birth, moderate to severe hearing impairment occurs in about three per 1000 infants born on time, but in about three per 100 (3%) of high risk infants. High risk factors include:
  • Birth weight under 1500 grams (3lb 5oz), especially those with IVH or PVL
  • Family history of childhood hearing loss
  • Viral infection present at birth
  • Any abnormality in the formation of the face or the ear
  • Very high bilirubin levels necessitating exchange transfusion, see Bilirubin
  • Infection of the fluid surrounding the brain, called meningitis
  • Severe lack of oxygen near the time of birth
Children can also develop hearing loss after birth during childhood.

How will I know if my baby has a hearing problem?

Many nurseries screen babies for hearing. Commonly used hearing tests are:
  • Auditory Brainstem Response (example, ALGO) - Three electrodes are placed on the baby's head and a click sound is delivered to the baby's ear by a small headphone. The baby's brainwave response to the sound is recorded and compared to a normal baby pattern.
  • Otoacustic Emissions - A small rubber probe is placed in the ear canal. It delivers a sound which travels to the inner ear. The inner ear sends back an echo which is picked up by a microphone in the probe.
  • The Crib-o-gram - A loud sound is presented to the infant during light sleep. If the baby responds by arousing from sleep or startling, s/he passes. This test only detects severe hearing loss.

If my baby does not pass the screening test, is s/he deaf?

Hearing tests are designed to not miss a possible hearing problem. There are many "false positives" or abnormal tests in babies who eventually turn out to have normal hearing. Things that cause false positive tests include:
  • Ear wax or other substance blocking the canal
  • Narrow ear canal
  • Testing in a noisy setting
  • Ear infection
  • Restless, fussy baby
  • Certain medications
Some medical problems of preemies cause changes in hearing which go away when the problem resolves. For that reason, babies are usually tested near the time of discharge, not when they are the sickest.

Any abnormal screening test must be verified by another test at later point in time.

After discharge how will I know if my child has a hearing problem?

The following is a check list for hearing. All ages listed are based on the child's age from his/her due date, not the date of birth.

Due Date
  • Does your baby awaken, startle or cry to a loud sound?
  • Does your baby seem to listen to speech part of the time?
At 3 Months
  • Does your baby seem to recognize mother's voice?
  • Does your baby appear to listen to sounds or speech?
  • Does your baby smile when spoken to?
  • Does your baby turn toward the person speaking?
At 6 months
  • Does your baby distinguish friendly sounds from angry or warning sounds, such as NO!?
  • Does your baby notice and look around for the source of new sound?
  • Does your baby turn toward the side a sound is coming from?
  • Does your baby enjoy vocal play?
  • Does your baby coo in more than one tone?
At 9 months
  • Does your child turn or look when you call?
  • Does your child look for the source of a new sound?
  • Does your child listen to sounds or people talking?
At 12 months
  • Has your child begun to respond to requests, such as Where is.....?
  • Does your child babble?
  • Does your child have 3 words?
At 18 months
  • Does your child understand and respond to requests?
  • Does your child have at least 8 words?
  • Does your child have a way of indicating no, either verbal or gesture?
  • Does your child respond to rhythm music?
After 24 months hearing loss may be suspected if:
  • The child's speech sounds like s/he has a cold even when s/he does not
  • The child's speech is difficult to understand
  • The child has fewer words than other children his/her age
  • The child does not pay attention when someone is speaking
  • The child cannot follow simple directions
Hearing is often decreased during a cold or ear infection. When children are young, their speech and communication may be noticeably poorer during a cold or ear infection, but should return to the previous level after the illness.

What should I do if I suspect my child has a hearing problem?

Notify your child's doctor of your concern and make arrangements to have his/her hearing tested. This testing should be done at your earliest convenience and when your child does not have a cold or ear infection. Do not delay several months; early detection of hearing loss is very important!

Why is early detection of hearing loss so important?

Hearing is essential for speech and language development. The sooner a hearing loss is detected, the sooner the child can be treated and the better language and speech s/he will develop.

How is hearing loss treated?

If there is some hearing, sounds can be amplified (increased) by a hearing aids. If the loss is severe, children may also be taught other forms of communication such as sign language or lip reading. Speech and hearing therapists can teach you how to best communicate with your child. Specialists must determine the location of the hearing problem (outer, middle or inner ear) before deciding on the best treatment.