About Harriet Jacobster, Au.D. Expertise I can answer questions regarding non-medical treatment of hearing loss such as hearing aids and aural rehabilitation. I am also able to answer your questions regarding hearing testing, what types of tests are appropriate, what information a hearing test gives you and what it doesn't give you. As a classically trained musician, I can also answer issues dealing with hearing loss specific to musicians.
Experience I am a Board Certified Doctor of Audiology with over 25 years' of experience working with both children and adults. I have given lectures on Hearing Loss and Hearing Aids to several state chapters of national organizations for the deaf and hard of hearing. I also taught Speech Reading and Aural Rehabilitation both privately and for the Florida Deaf Service Center.
Organizations American Academy of Audiology
American Speech Language Hearing Association
Education/Credentials Au.D. Doctor of Audiology, Nova Southeastern University 2000
Question My partner and I are presently in a bit of a dilemma. We hope you can
perhaps gives us some insight and advice.
Our son who is now 4.5 months old, was diagnosed with sensorineural
hearing loss.
This is the current situation:
He was born on December 1, 2008, he was 5.5 weeks premature (he was 34
weeks and 3 days to be exact).
His first hearing test (OAE) was inconclusive. No signal could be read.
Two weeks later on January 7, 2009, he underwent an A-ABR test at home
which resulted in a satisfactory reading for the left ear and an unsatisfactory
reading for the right ear.
On January 14, he underwent a BERA test which concluded a hearing loss at
3000hz of 40db in both the left and right ear equally.
On April 9, he received a second BERA test with a hearing loss result at
3000hz of 40db in the left ear and 30 db in the right ear.
We have been told that the margin of accuracy discrepancy is approximately
5-10db. And therefore the hearing loss has remained on a consistent level of
circa 35db to 40db for both ears equally.
The question now essentially is, should we begin with a hearing aid for him
now? Should we wait, and if so how long should we wait? What are the pros
and cons to starting early or later, or perhaps even not at all?
We have been given advice by two different audiologists. One suggested we
start with hearing aids in May, the other audiologist suggested we wait until
it is more apparent whether or not he will need the hearing aid and at what
age.
We would really appreciate your opinion on this and also to know if there is a
'standard practice' for similar situations among audiologist.
Thank you very much in advance,
Monique Hoksbergen
Answer Hi Monique,
Since I have not seen your baby, or have seen the test results, I cannot give specific recommendations. However, I am more than happy to give you some information.
Generally, if a baby has a hearing loss, aiding prior to the age of six months will give optimal results as far as language, speech and cognitive development. So, based on that, you still have a bit of time for your decision.
Next, the decision to aid a baby with suspected hearing loss is determined by a lot of factors, not the least among them is the presence of any risk factors. These risk factors are:
* Family history of hereditary childhood sensorineural hearing loss
* In utero infections (toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus infection, syphilis)
* Craniofacial anomalies
* Birth weight <1500 g.
* Hyperbilirubinemia requiring exchange transfusions
* Ototoxic medications (aminoglycosides alone or in combination with loop diuretics)
* Bacterial meningitis
* Postnatal asphyxia (Apgar <5 at 1 min. or <6 at 5 min)
* Mechanical ventilation lasting 5 days or longer
* Stigmata associated with syndrome associated with hearing loss
Obviously, if your baby has any of these risk factors, then your decision to aid is made simpler.
Next, how was the ABR/BERA conducted? Were headphones or insert phones used? Was bone conduction testing done as well? Was your baby fussing or sleeping? All these affect the results.
Now, for the results themselves. Actual hearing thresholds are usually 5-10 db BETTER than the ABR indicates. Thus, if your baby has an ABR threshold of 30 n(ormal)dBHL then actual threshold is around 20 dBHL, which is within the normal range. The threshold of 40 ndBHL is actually around 30 dBHL which is a very mild loss. So, to come to the conclusion that your baby has a sensorineural hearing loss based on these figures is not something I would do. At least, not at this point.
Since your baby's chronological age is now 4.5 months and he was born approximately a month early, his "gestational" age is only around 3 months. These results are not all that out of the ordinary for this age.
If it were my baby, I would probably wait another month to have one more ABR (if feasible) and make my decision then.
However, if you do decide to go ahead with amplification, you must be very careful. You must find a professional who specializes in fitting hearing aids to babies. Special testing is needed to make sure there is just the right amount of amplification. If there is too much, there is the possibility of damaging the inner ear.
Hope this helps.
Harriet B. Jacobster, AuD
Board Certified in Audiology
