Expert: Harriet B Jacobster, Au.D. - 2/11/2009

Question
Our son is now 18 months.  He does not respond to his name, does not point, does not look at you when spoken too.  We know he hears because he responds to sound - usually water, load noises, or knocking.  If he observes another child screaming, he will do it too.  He does not say any words - he babbles his own words.  He will not say, Mama, Dada, etc. He is very young, and it is hard to determine whether or not it could be his hearing.  He always covers his ears frequently (at least 10-20 times a day) and pounces them, usually he screams when he does this task.  He has never had an ear infection.  We had his hearing evaluated with an audiologist - but the only test that was done was in a room where I held him and he responded to sound by looking in the direction it was coming from, but the television would come on as well (I don't feel that test was accurate).  He never had anything put inside his ears or measured his eardrums at the evaluation.  Do you think it would be wise to get this screening completed?  The audiologist thought it would not be necessary since he responded to the sound and movies in the dark room.  However, since that visit a month ago, many friends and family members feel that we should get a second opinion.  Could there be fluid in his ears or earwax build up?  As these tests are not inexpensive, I thought it would be wise to ask.

Answer
Hi Angela,
At 18 months, your son should have a vocabulary of at least 20 words.  Since he doesn't, your son seems to have, at the least, a language delay.  This can be due to many factors, not the least of which is a hearing disorder.

The first step in determining the reason for the delay is to have a complete auditory evaluation by an audiologist specializing in pediatrics. At the very least, he needs a middle ear evaluation to determine if there is any fluid, as well as behavioral thresholds.  A skilled pediatric audiologist will be able to obtain ear specific information even on an 18-month-old.  Based on the results of these test, the audiologist will recommend either further audiologic testing, or a speech evaluation or even a behavioral evaluation to see if there is some type of spectrum disorder.

Your child is at a critical age for cognitive development.  If cost is an issue, there are many universities that may be able to perform these tests on a sliding scale.  But, they are imperative for his development.

Hope this helps.
Harriet B. Jacobster, AuD
Board Certified in Audiology