Many different things can happen in the ear to cause a hearing loss.

Our ear and hearing are made up of many parts:

• The outer ear
• The middle ear
• The inner ear
• The ear (auditory) Nerve – The hearing (auditory) System pathway in the brain

These terms describe hearing loss where part of the hearing system is not working in a usual way:

• A conductive loss — hearing loss caused by something that stops sounds from getting through the outer or middle ear.
• A sensorineural loss — hearing loss that occurs when there is a problem in the way the inner ear or hearing nerve works.
• A mixed hearing loss — hearing loss that includes a conductive and a sensorineural hearing loss.
• Auditory Neuropathy Spectrum Disorder — Hearing loss that occurs when sound enters the ear normally, but because of damage to the inner ear or the hearing nerve, sound isn’t organized in a way that the brain can understand. For more information, visit the National Institute of Deafness and Other Communication Disorders.

These terms describe the degree or the amount of hearing loss a child has:

• Mild Hearing Loss — a person with a mild hearing loss may hear some speech sounds but soft sounds are hard to hear.
• Moderate Hearing Loss — a person with a moderate hearing loss may hear almost no speech when another person is talking at a normal level.
• Severe Hearing Loss — a person with severe hearing loss will hear no speech of a person talking at a normal level and only some loud sounds.
• Profound Hearing Loss — a person with a profound hearing loss will not hear any speech and only very loud sounds.

These terms describe when the hearing loss happened:

• Pre-lingual — the hearing loss occurred before the child learned to talk.
• Post-lingual — the hearing loss occurred after the child learned to talk.

These terms describe the side or sides on which the hearing loss occurs:

• Unilateral — there is a hearing loss in one ear.
• Bilateral — there is a hearing loss in both ears.

Parents and professionals will use these terms to describe a child’s unique type of hearing loss when talking to others.

If professionals and other parents use terms that you don’t understand, please ask questions.

Our ear and hearing is made up of many parts. Hearing loss can happen when any part of the ear or auditory (hearing) system is not working in the usual way.

Outer Ear

The outer ear is made up of three parts;

• the part we see on the sides of our heads (pinna),
• the ear canal, and
• the eardrum (tympanic membrane).

Middle Ear

The middle ear is made up of the eardrum and three small bones (ossicles) that send the movement of the eardrum to the inner ear.

Inner Ear

The inner ear is made up of:

• the snail shaped organ for hearing (cochlea),
• the semicircular canals that help with balance, and
• the nerves that go to the brain.

The ear (auditory) Nerve

The hearing (auditory) System pathway in the brain

Hearing loss has many causes. 50% to 60% of hearing loss in babies is due to genetic causes. There are also a number of things in the environment that can cause hearing loss. 25% or more of hearing loss in babies is due to “environmental” causes such as maternal infections during pregnancy and complications after birth. Sometimes both genes and environment work together to cause hearing loss. For example, there are some medicines that can cause hearing loss, but only in people who have certain mutations in their genes.

Genes contain the instructions that tell the cells of people’s bodies how to grow and work. For example, the instructions in genes control what color a person’s eyes will be. There are many genes that are involved in hearing. Sometimes, a gene does not form in the expected manner. This is called a mutation. Some mutations run in families and others do not. If more than one person in a family has hearing loss, it is said to be “familial”. That is, it runs in the family.

About 70% of all mutations causing hearing loss are non-syndromic. This means that the person does not have any other symptoms. About 30% of the mutations causing hearing loss are syndromic. This means that the person has other symptoms besides hearing loss. For example, some people with hearing loss are also blind.

The cochlea (the part of the ear that changes sounds in the air into nerve signals to the brain) is a very complex and specialized part of the body that needs many instructions to guide its development and function. These instructions come from genes. Changes in any one of these genes can result in hearing loss. The GJB2 gene is one of the genes that contains the instructions for a protein called connexin 26; this protein plays an important role in the functioning of the cochlea. In some populations about 40% of newborns with a genetic hearing loss who do not have a syndrome, have a mutation in the GJB2 gene.

Infants and Babies’ Hearing Can Be Checked

Do you know that your baby’s hearing can be checked even before leaving the birth hospital? Many states, communities, and hospitals now offer hearing screening for babies. A baby’s hearing can be screened using Automated Auditory Brainstem Response (AABR), Otoacoustic Emissions (OAE), or both.

Babies usually have their hearing screened while still in the hospital, either in the nursery or in their mothers’ room.

All babies should have a hearing screening before they are one month old

Hearing screening is easy and is not painful. In fact, babies are often asleep while being screened. It takes a very short time — usually only a few minutes. Sometimes the screening is repeated while the babies are still in the hospital or shortly after they leave the hospital.

Babies who do not pass hearing screening should be tested by an audiologist. An audiologist is a person trained to test hearing. This person will do additional testing to find out if there is a hearing loss. There are many kinds of tests an audiologist can do to find out if a baby has a hearing loss, how much of a hearing loss there is, and what type it is.

All babies who do not pass the first screening should have a complete hearing test before three months of age

Finding a hearing loss early and getting into a program that helps babies with hearing loss (beginning before a baby is six months old) helps a child to:

• Communicate better with others.
• Do well in school.
• Get along with other children.

All babies with hearing loss should begin intervention services before six months of age

Intervention services are types of programs and resources available for children and their families. An intervention might be:

• Meeting with a professional (or team) who is trained to work with children who have a hearing loss, and their families.
• Working with a professional (or team) who can help a family and child learn to communicate.
• Fitting a baby with a hearing device, such as a hearing aid.
• Joining family support groups.
• Other resources available to children with a hearing loss and their families.

The best way to find out if your baby may be deaf or hard of hearing is by a hearing screening. Early diagnosis and intervention will help them reach their full potential.

Thousands of babies are born deaf or hard of hearing each year in the United States. Babies diagnosed early with hearing loss and begin intervention early are more likely to reach their full potential. The best way to find out if your baby may be deaf or hard of hearing is by a simple hearing test, also called a hearing screening.

Why is a hearing screening important for my baby?

Starting from day 1, babies begin to learn language skills by listening to and interacting with those around them. If babies miss these opportunities, their language development can be delayed. Many times, children’s hearing loss is not obvious and can go unnoticed for months or even years.

Hearing screening at birth can determine if your baby may have a hearing loss and if more tests are needed. An early diagnosis is essential to help babies who are deaf or hard of hearing reach their full potential, and allows families to make decisions about the intervention services that are best for their baby’s needs. Early diagnosis of hearing loss and beginning intervention helps to keep children’s development on track and improve their future language and social development.

Your baby probably had a hearing screening

Almost all states, communities, and hospitals now screen newborns for hearing loss before the babies leave the hospital. The hearing screening is easy and painless, and it can determine if more testing is needed. In fact, many babies sleep through the hearing screening, and the test usually takes just a few minutes.

What if my baby did not pass the hearing screening?

Additional testing is the next step to tell if your baby has hearing loss and what type of loss it is. A healthcare professional trained to test hearing, such as an audiologist, will be able to perform more detailed hearing tests. Your baby’s doctor (or an ear, nose, and throat doctor) should perform or order any medical tests needed to find out the cause of the hearing loss.

Making sure your baby gets this additional testing quickly is also important. CDC-funded research shows just how important it is. Children with hearing loss who are identified before 3 months of age, and receive services before 6 months of age, have better vocabularies than those identified or receiving services later. For more information about this research, visit Giving Every Child the Gift of Words

If my baby passed the hearing screening, is everything fine?

Because a newborn baby can pass the hearing screening and still develop a hearing loss later, your baby’s doctor should routinely follow your baby’s general health and development.

Where can I go for help?

Every state has a program that works to help make sure that babies who are deaf or hard of hearing are diagnosed early. If you have any concerns about your baby’s hearing, ask the doctor for a hearing test or screening as soon as possible. To learn more about this topic, you can also call toll free 1-800-CDC-INFO or visit the CDC EHDI Program site.

The Centers for Disease and Control and Prevention’s (CDC’s) Early Hearing Detection and Intervention (EHDI) program works with your state to ensure that all babies are screened for hearing loss and receive any needed follow-up tests and services. CDC’s EHDI program supports the ongoing search for new ways to improve services.

Re-screening

All babies who do not pass the first hearing screening should be re-screened again one to two weeks later, or have a complete hearing test. Your baby’s doctor, medical home, or the hospital where your baby was born can tell you where to take your child for the hearing re-screen or test.

Regardless, all babies who do not pass the hearing screen or re-screen should have a complete hearing test before 3 months of age.

Testing

A complete hearing test (audiology evaluation) will be done by an expert (audiologist) who is trained to test your baby’s hearing. An audiologist who works with children is sometimes called a pediatric audiologist.

An audiology evaluation is more than just one test. Some of the tests the audiologist might use include:

• A test that will tell the audiologist how your baby’s outer and middle ear are working.
• A test that measures how your baby reacts to sounds.
• A test measures how the ears respond to sound.
• A test that finds out how the ear nerve responds to sound.

The audiologist will also ask you questions about your baby’s birth history, ear infection, hearing loss in your family, and how well you think your baby hears.

The results from all the tests and what you told the audiologists are examined together and the audiologist will make a conclusion. With your permission, the audiologist will share the results with your baby’s doctor and perhaps an ear, nose and throat doctor (called an otolaryngologist). Working together, these professionals can help you understand more about your baby. They might want your baby tested by another expert, such as an eye doctor (ophthalmologist), a doctor who is trained to know about genes (geneticist), or others.

No single treatment or intervention is the answer for every child or family. Good intervention plans will include close monitoring, follow-ups and any changes needed along the way. There are many different options for children with hearing loss and their families.

Some of the treatment and intervention options include:

• Working with a professional (or team) who can help a child and family learn to communicate.
• Getting a hearing device, such as a hearing aid.
• Joining support groups.
• Taking advantage of other resources available to children with a hearing loss and their families.

Early Intervention and Special Education

Early Intervention (0-3 years)

Hearing loss can affect a child’s ability to develop speech, language, and social skills. The earlier a child who is deaf or hard-of-hearing starts getting services, the more likely the child’s speech, language, and social skills will reach their full potential.

Early intervention program services help young children with hearing loss learn language skills and other important skills. Research shows that early intervention services can greatly improve a child’s development.

Babies that are diagnosed with hearing loss should begin to get intervention services as soon as possible, but no later than 6 months of age.

There are many services available through the Individuals with Disabilities Education Improvement Act 2004 (IDEA 2004). Services for children from birth through 36 months of age are called Early Intervention or Part C services. Even if your child has not been diagnosed with a hearing loss, he or she may be eligible for early intervention treatment services. The IDEA 2004 says that children under the age of 3 years (36 months) who are at risk of having developmental delays may be eligible for services. These services are provided through an early intervention system in your state. Through this system, you can ask for an evaluation.

Special Education (3-22 years)

Special education is instruction specifically designed to address the educational and related developmental needs of older children with disabilities, or those who are experiencing developmental delays. Services for these children are provided through the public school system. These services are available through the Individuals with Disabilities Education Improvement Act 2004 (IDEA 2004), Part B.

Early Hearing Detection and Intervention (EHDI) Program

Every state has an Early Hearing Detection and Intervention (EHDI) program. EHDI works to identify infants and children with hearing loss. EHDI also promotes timely follow-up testing and services or interventions for any family whose child has a hearing loss. If your child has a hearing loss or if you have any concerns about your child’s hearing, call toll free 1-800-CDC-INFO or contact your local EHDI Program coordinator to find available services in your state.

Technology

Many people who are deaf or hard-of-hearing have some hearing. The amount of hearing a deaf or hard-of-hearing person has is called “residual hearing”. Technology does not “cure” hearing loss, but may help a child with hearing loss to make the most of their residual hearing. For those parents who choose to have their child use technology, there are many options, including:

• Hearing aids
• Cochlear or brainstem implants
• Bone-anchored hearing aids
• Other assistive devices

Hearing Aids

Hearing aids make sounds louder. They can be worn by people of any age, including infants. Babies with hearing loss may understand sounds better using hearing aids. This may give them the chance to learn speech skills at a young age.

There are many styles of hearing aids. They can help many types of hearing losses. A young child is usually fitted with behind-the-ear style hearing aids because they are better suited to growing ears.

Cochlear and Auditory Brainstem Implants

A cochlear implant may help many children with severe to profound hearing loss — even very young children. It gives that child a way to hear when a hearing aid is not enough. Unlike a hearing aid, cochlear implants do not make sounds louder. A cochlear implant sends sound signals directly to the hearing nerve.

Persons with severe to profound hearing loss due to an absent or very small hearing nerve or severely abnormal inner ear (cochlea), may not benefit from a hearing aid or cochlear implant. Instead an auditory brainstem implant may provide some hearing. An auditory brainstem implant directly stimulates the hearing pathways in the brainstem, bypassing the inner ear and hearing nerve.

Both cochlear and brainstem implants have two main parts — the parts that are placed inside the inner ear, the cochlea, or base of the brain, the brainstem ear during surgery, and the parts that are worn outside the ear after surgery. The parts outside the ear send sounds to the parts inside the ear.

Bone-Anchored Hearing Aids

This type of hearing aid can be considered when a child has either a conductive, mixed or unilateral hearing loss and is specifically suitable for children who cannot otherwise wear ‘in the ear’ or ‘behind the ear’ hearing aids.

Other Assistive Devices

Besides hearing aids, there are other devices that help people with hearing loss. Following are some examples of other assistive devices:

• FM System
  An FM system is a kind of device that helps people with hearing loss hear in background noise. FM stands for frequency modulation. It is the same type of signal used for radios. FM systems send sound from a microphone used by someone speaking to a person wearing the receiver. This system is sometimes used with hearing aids. An extra piece is attached to the hearing aid that works with the FM system.

• Captioning
  Many television programs, videos, and DVDs are captioned. Television sets made after 1993 are made to show the captioning. You don’t have to buy anything special. Captions show the conversation spoken in soundtrack of a program on the bottom of the television screen.

• Other devices
  There are many other devices available for children with hearing loss. Some of these include:

• Text messaging
• Telephone amplifiers
• Flashing and vibrating alarms
• Audio loop systems
• Infrared listening devices
• Portable sound amplifiers
• TTY (Text Telephone or teletypewriter)

Medical and Surgical

Medications or surgery may also help make the most of a person’s hearing. This is especially true for a conductive hearing loss, or one that involves a part of the outer or middle ear that is not working in the usual way.

One type of conductive hearing loss can be caused by a chronic ear infection. A chronic ear infection is a build-up of fluid behind the eardrum in the middle ear space. Most ear infections are managed with medication or careful monitoring. Infections that don’t go away with medication can be treated with a simple surgery that involves putting a tiny tube into the eardrum to drain the fluid out.

Another type of conductive hearing loss is caused by either the outer and or middle ear not forming correctly while the baby was growing in the mother’s womb. Both the outer and middle ear need to work together in order for sound to be sent correctly to the inner ear. If any of these parts did not form correctly, there might be a hearing loss in that ear. This problem may be improved and perhaps even corrected with surgery. An ear, nose, and throat doctor (otolaryngologist) is the health care professional who usually takes care of this problem.

Placing a cochlear implant, auditory brainstem implant, or bone-anchored hearing aid will also require a surgery.

Learning Language

Without extra help, children with hearing loss have problems learning language. These children can then be at risk for other delays. Families who have children with hearing loss often need to change their communication habits or learn special skills (such as sign language) to help their children learn language. These skills can be used together with hearing aids, cochlear or auditory brainstem implants, and other devices that help children hear.

Family Support Services

For many parents, their child’s hearing loss is unexpected. Parents sometimes need time and support to adapt to the child’s hearing loss.

Parents of children with recently identified hearing loss can seek different kinds of support. Support is anything that helps a family and may include advice, information, having the chance to get to know other parents that have a child with hearing loss, locating a deaf mentor, finding childcare or transportation, giving parents time for personal relaxation or just a supportive listener.

Every child is unique. All children, including infants, have their own special personality and talents. Just as each child is unique, a child’s hearing loss is also unique. One child’s hearing loss may be very different from another child’s hearing loss.

Research studies show that about 30% of all children with hearing loss may have one or more special needs that have nothing to do with the ear or hearing. These can include visual, physical, or other special needs. You will want to discuss these other conditions with your child’s doctor or professional team.

All of these factors are important while you are deciding which intervention program best meets the strengths and needs of your child. You will be designing a program that is unique for your child.

Now let’s take a closer look at some of the professionals who may be on your child’s team, the intervention services your child might get, and how you can put all the intervention services together.

Remember, all babies with hearing loss should begin to get intervention services before they are 6 months old.

Your child’s team includes you and a team of professionals. The team includes a number of people with knowledge and experience in many different health and education fields. As you begin to meet with professionals who will work with you and your child, you are building your team.

Sometimes teams of professionals work in the same place or facility — under “one roof” — like in a hospital or clinic. When you take your child for an appointment at a facility like this, all or most of the professionals can meet with you and your child. Such teams of professionals work closely with each other.

Other times, the professionals you want to see are not in the same building and may not even know one another. They may work far from each other. Even so, these professionals can work with you and your child as a team, and accomplish the same goals. But it is very important to make sure that your team communicates with each other about your child. You will want to encourage them to share information by telephone, fax or e-mail. You can also personally deliver or mail reports to the different team members.

Whatever your child’s team looks like, remember YOU play a very important role. You are the team leader! You are hiring the team. The professionals you select should share information and their expertise, and you might want to share what you know about your child. Together, you will decide on the best plan for your child. But never forget — you have the final word.

There are many different types of options for children with hearing loss and for their families. Some of these options include

• Family support services
• Technology and audiology services
  • Hearing aids
  • Cochlear implants
  • Other assistive devices
• Medical and surgical options
• Putting It All Together
  • The Part C Program

These different types of options allow families and professionals to design individual programs that best fit the strengths and needs of individual children and their families.

For many parents, their baby’s hearing loss is unexpected. Many parents need time and support to adapt not only to having a new family member but also to the baby’s hearing loss.

Parents of children with recently identified hearing loss can seek different kinds of support. Family support is anything that helps a family. This help may include advice, information, having the chance to get to know other parents that have a child with hearing loss, finding childcare or transportation, giving parents time for personal relaxation or just a supportive listener.

Other Parents

Many families find it helpful to meet and talk with other families that have older children with hearing loss. In some states there are parent-to-parent support groups that help match parents with other parents for support. There are also national support groups available. Ask your professional team about these resources in your community.

Faith Based

Sometimes families get support from their clergy or other members of the faith-based group to which they belong.

The Team

Another important place to find support is from the members of the child’s team of professionals. The members themselves can provide help, or refer a parent to a counselor or a social worker to talk about personal, financial, family, or marriage issues.

Families find support in many ways. Other types of support might include friendships with deaf or hard-of-hearing adults, community resources, their own families, and others. Each family is unique. Therefore families can build supports that work for them.

Many children who are deaf or hard-of-hearing have some hearing. The amount of hearing a deaf or hard-of-hearing child has is called “residual hearing“. There are many ways to make the most of your child’s residual hearing. In this section, you can learn more about some of these different ways. This section will give you more information about:

• Hearing aids
• Cochlear implants
• Other assistive devices

Hearing aids

Hearing aids make sounds louder. They can be worn by people of any age — including infants. Young babies with hearing loss can understand sounds better using hearing aids. This gives them the chance to learn speech skills right from birth.

There are many styles of hearing aids. They can help many types of hearing losses — mild, moderate, severe, and profound. Your baby’s audiologist will help you pick the best type for your baby’s hearing loss. A young child is usually fitted with behind-the-ear (BTE) style hearing aids because they fit better on growing ears. Behind-the-ear hearing aids come in skin color as well as many bright colors.

Earmolds

A plastic earmold is connected to a behind-the-ear hearing aid and is fitted for the child’s ear. It directs sound from the hearing aid into the ear canal. Each person’s ear is shaped differently, and a child’s ear will change as he or she grows. Because of this, and to make sure they fit comfortably, earmolds are individually made for each child.

An audiologist uses a soft material to make a copy of the child’s outer ear canal. This is used to make an earmold that will fit the child exactly. As the child grows, new earmolds can be made and attached to the same hearing aid.

Making sure the hearing aid is working right

Your baby’s audiologist can show you how to keep the hearing aid clean and working. Here are a few things that he or she might talk about.

Whistling sounds
Babies and children outgrow earmolds quickly. If the earmold is too small, you will hear a whistling sound. That means that sounds from the hearing aid are leaking out. Sometimes you can adjust the earmold in your child’s ear and the whistling will stop. But if the whistling doesn’t stop after adjusting the earmold, it might be too small. If this happens, call your child’s audiologist for an appointment so he or she can check it. Your child might need a new earmold.

Listening to the sounds from a hearing aid
Your baby’s audiologist might give you a small listening tool (stethoscope) that is specially made for hearing aids. You can join the hook of the hearing aid to the tube of the stethoscope. Your audiologist will show you how it works.

Batteries
You can buy hearing aid batteries at drug stores, grocery stores, and many other stores. Most batteries have a small tab hooked to them. Take this off and put the batteries in the hearing aid following the instructions from your child’s audiologist or hearing aid instruction booklet. Your baby’s audiologist might also give you battery testers. These will help you know if the battery is still working.

Getting dampness (moisture) out of the hearing aid
Excess moisture can make your child’s hearing aid not work. Your baby’s audiologist can show you how to keep the hearing aid dry.

Keeping the hearing aids on your baby

Babies and young children sometimes take out their hearing aids, play with them, lose them, give them to pets, or put them in their mouth. Sometimes the hearing aids fall out and the baby doesn’t know to pick them up. This can be very frustrating for parents. Ask your baby’s audiologist for ideas about how to keep hearing aids on your child. Here are a few ideas. Your child’s audiologist may have others:

• Plastic rings — these can be used to keep hearing aids on a child’s ear. There are two loops which fit around the hearing aid and are connected to a larger loop which fits around the outer part of the ear.
• Attach to clothing — a cord can be attached to the hearing aid and then clipped to your child’s clothing.
• Shorter earhooks — an earhook is the part of the hearing aid that connects the hearing aid to the earmold. Shorter earhooks can make the hearing aid fit better and the hearing aids stay in place better.
• Double sided tape (wig tape) — this tape can be attached to the back of your child’s ear and to the hearing aid. You will need to change this tape often. Your baby’s audiologist can show you how to use the tape.

Keeping your baby safe

Batteries are very dangerous if swallowed. Hearing aids for infants and young children can come with a battery door lock. This lock does not let babies or young children remove the battery. An adult can lock and unlock this door using a small screwdriver.

Never let your baby or young child play with batteries. The batteries are small and can be swallowed.

Hearing aids, earmolds, and batteries should never be put in the mouth. Infants and children can choke on them.If any one of these are swallowed get your child medical care immediately by calling a doctor or taking your child to an emergency department.

Cochlear implants

A cochlear implant can help a person with severe to profound hearing loss. It gives that person a way to hear when a hearing aid is not enough. Unlike a hearing aid, cochlear implants do not make sounds louder. A cochlear implant sends sound signals directly to the hearing nerve. These signals go around parts of the inner ear (hair cells) that are not working right. A cochlear implant does not “cure” hearing loss, but does allow a person with hearing loss to make out sounds.

How does a cochlear implant work?
A cochlear implant has two main sections — the parts that are placed inside the ear during surgery, and the parts that are worn outside the ear after surgery. The parts outside the ear send sounds to the parts inside the ear.

How is a cochlear implant placed in the ear?
Surgery is needed to put in a cochlear implant. The surgery takes a few hours and general anesthesia is needed. Usually, children and adults getting a cochlear implant have to stay in the hospital one night after the surgery. It takes about 3 to 5 weeks for the skin over the surgery site to heal, but children usually return to normal activities in about 10 days.

If your child gets a cochlear implant, he or she will have to go back to the audiologist four to six weeks after surgery to have the cochlear implant turned on. After the cochlear implant is turned on, your child might need many more visits to make sure the cochlear implant is correctly adjusted.

Your doctors and audiologist may also recommend that your child get training with a speech-language pathologist. A speech language pathologist is a professional who is trained to know about how children learn and to teach children to learn speech and language. This training will help your child understand the new sounds that he or she hears with a cochlear implant.

Who can get a cochlear implant?
Adults and children can get a cochlear implant — even very young children and babies. A cochlear implant may be good for children and babies with severe or profound hearing loss that can’t be helped by a hearing aid. For more information on what a cochlear implant can do for your baby, please talk with your baby’s doctor or audiologist.

Illness Prevention

To prevent the possibility of illness, The Centers for Disease Control and Prevention (CDC) recommend that all persons who get cochlear implants have all their regularly-scheduled shots. For more information, please talk with your child’s doctor.

How can my child get a cochlear implant?
If you think you want your child to have a cochlear implant, your child will need to be evaluated to make sure he or she is healthy enough for surgery and will need to have his or her hearing levels checked.

Please talk with your child’s doctor and audiologist to learn more about the process.

How can I pay for the cochlear implant?
A cochlear implant costs about $40,000 to $90,000. This includes:

• Visits to doctors and audiologists’ offices before the implant is put in.
• The cochlear implant itself.
• Surgery.
• Appointments needed to make sure the implant works correctly for your child.

This sounds like a lot of money but many insurance companies and state Medicaid programs help pay for the cochlear implant costs. Talk with your baby’s doctors and audiologist. They will tell you how to find out more.

What will my child’s hearing be like with the cochlear implant?
Each child’s hearing loss is different from the hearing loss of other children. So, please talk with your child’s doctor or audiologist. They know your child well and can give you a better understanding of what a cochlear implant can do for your child.

Other assistive devices

Besides hearing aids, there are other devices that help people with hearing loss understand sound.

FM systems are commonly used for babies and young children

An FM system is a kind of device that helps children with hearing loss. FM stands for frequency modulation. It’s the same type of signal used for radios. FM systems send sound from a microphone used by the person speaking to a baby wearing the receiver. This system is sometimes used with hearing aids. An extra piece is attached to the hearing aid that works with the FM system. This extra piece is called an “audio input boot”.

Normally, when a person speaking is not standing next to a baby with hearing aids, the baby might hear other noises in the room. These extra noises might not be a problem for a baby without hearing loss. But for a baby with hearing loss, speech and other noises get mixed together and make the speech difficult to understand. With FM systems, the person who is speaking wears a microphone that sends the speech right to the baby’s ears. This means the baby hears just the speech, without most of the unwanted noise.

Captioning

Many television programs, videos, and DVDs are captioned. Television sets made after 1993 are made to show the captioning. You don’t have to buy anything special. Captions show the soundtrack of a program on the bottom of your television screen. If you have your child watch children’s programs, you may want to turn on the captioning.

Other devices

There are many other devices available for children and adults with hearing loss. Some of these include:

• Telephone amplifiers
• Flashing and vibrating alarms
• Audio loops systems
• Infra red listening devices
• Portable sound amplifiers
• TTY (Text Telephone or teletypewriter)

Please ask you baby’s audiologist about these and other types of assistive listening devices

Definitions:

Mild Hearing Loss: A person with a mild hearing loss may hear some speech sounds but soft sounds are hard to hear.

Moderate Hearing Loss: A person with a moderate hearing loss may hear almost no speech when another person is talking at a normal level.

Severe Hearing Loss: A person with severe hearing loss will hear no speech of a person talking at a normal level and only some loud sounds.

Profound Hearing Loss: A person with a profound hearing loss will not hear any speech and only very loud sounds.

Audiologist: A professional trained to test hearing by performing audiology evaluations.

Earmold: An earmold is a plastic or silicone piece that is made to fit to a child's ear. The earmold has a short tube that is attached to the part of the hearing aid that sits behind the child's ear. The earmold sends sound from the hearing aid into the ear.

Speech Language Pathologist: A speech language pathologist is a professional trained to know about how children learn language and to teach children how to use speech and language.

FM System: An FM system is a kind of device that helps a person who is deaf or hard-of-hearing. FM stands for frequency modulation. It’s the same type of signal used for radios. FM systems send sound from a microphone used by the person speaking to a baby wearing the device. This system is sometimes used with hearing aids. An extra piece is attached to the hearing aid that works with the FM system. This extra piece is called an “audio input boot”.

Medications or surgery may also help make the most of a child’s hearing. This is especially true for a outer or conductive hearing loss, or one that involves a part of the outer or middle ear that is not working in the usual way.

One type of conductive hearing loss can be caused by a chronic ear infection. A chronic ear infection is a build-up of fluid behind the eardrum in the middle ear space. Ear infections are common for all children, including children who have a hearing loss. Even young infants can get them. If you think your child has an ear infection, it is important to take him or her to your child’s doctor. For a child with a hearing loss, an ear infection can lessen the hearing even more. Please talk about this with your child’s doctor, and your team.

Most ear infections can be treated with medication or with careful observation. If your child’s doctor finds an ear infection, he or she may prescribe one or more medications for your child to take. Infections that don’t go away with medication can be treated with a simple surgery that involves putting a tiny tube into the child’s eardrum to drain the fluid out.

Another type of conductive hearing loss is caused by a part of the outer or middle ear that did not form correctly while the baby was growing in the mother’s womb. There are several parts of the outer and middle ear that need to work together to send sound to the inner ear. If any of these parts did not form correctly, there might be a hearing loss in that ear. This problem can be improved and perhaps even corrected with surgery. An ear, nose, and throat doctor (otolaryngologist) is the health care professional who usually takes care of this problem.

Placing a cochlear implant is also a type of surgery.

After hearing about all these options and intervention services, you may be confused. You may be wondering “How do I make these plans and contact these people?”

One way to put all the intervention services together is through a program in your state called the Part C Program. This is a program for children — birth to three years of age — who have a developmental delay, or are at risk for one. The Part C Program is funded by the federal government, as part of the Individuals with Disability Act, (also called IDEA).

You sign up for the Part C program by applying through an agency of the state where you live. The agency is different in each state. In many states, children with hearing loss will qualify for the Part C program. Please ask your team of professionals for more information on the Part C program in your state.

If your child qualifies, the Part C Program provides many services to your child and family. Professionals that work with the Part C Program:

• Look at the needs of your child and family
• Create an Individual Family Service Plan (IFSP)

Each family and child who uses this program is assigned a service coordinator. He or she will help the family put all the services together and help make or design an individual plan that makes the most of the child’s unique strengths and works with the child’s needs.

It’s all so overwhelming at first. Bianca, our resource coordinator, has been a lifesaver. We have a close relationship with all involved.” ~ Karen

Part C

An important part of the Part C Program is the Individual Family Service Plan (IFSP) . The family and the service coordinator together with the professionals who were involved in the multidisciplinary assessment meet to design the IFSP. This plan outlines all of the services, programs and equipment that a family and child will need for their child. This plan will also outline how the family will receive these services and equipment.

Services and equipment may include:

• On-going testing
• Hearing aids, assistive listening devices and cochlear implants
• Special instruction for communication
• School readiness
• Family support services

Even things such as transportation and childcare can be discussed and sometimes arranged.

This plan is family focused. The strengths and needs of the child and the concerns, resources and priorities of the family are important when making this plan. The plan is individualized. No two families will have the exact same IFSP. It is very important that the family works closely with the service coordinator and others to learn as much as possible about the intervention services in order to get the most out of their IFSP process.

Once the IFSP is done, the services and equipment that are written into the plan will begin, if they have not already done so. As time goes on, the parents, the service coordinator and other professionals will look at the IFSP to be sure that the child is getting the services needed. The IFSP will change as the child grows and his or her needs change. The service coordinator will meet with the family at least every 6 months to look at the IFSP and make necessary changes. A family can also ask for a reevaluation of the plan at any time to discuss their child’s progress and changes that they feel are needed.

Parents often find the Part C Program to be a helpful resource. If you have not already been referred to the Part C Program in your state, please ask one of the professionals that you are working with to tell you how to contact this program. You can also contact the office in your state that works with children with hearing loss and special needs.

Definitions:

Intervention services: are types of services available for children and their families. An intervention service might be:

• Meeting with a professional (or team) who is trained to work with children that have a hearing loss, and their families
• Working with a professional (or team) that can help a family and child learn to communicate
• Fitting a baby with a hearing device, such as a hearing aid
• Joining family support groups
• Other services available to children with a hearing loss and their families

Individual Family Service Plan (IFSP): An IFSP is a plan made for children who are deaf or hard-of-hearing. This plan is made by a child’s parents and a service coordinator. The plan outlines all of the intervention services and equipment that a family and child will need for the child and his or her hearing loss. This plan will also outline how the family will get these services and equipment. This plan is family focused — the strengths and needs of the child and family are very important when making this plan. Because each child has his or her own plan, no two plans will be the same. It is very important that the family works closely with the service coordinator and others to learn as much as possible about the intervention services available to them in order to get the most out of the IFSP process.

Service Coordinator: This is a professional that is assigned to help a family work through the IFSP (Individual Family Service Plan). Every family that takes part in this program is assigned a service coordinator. This professional works closely with the family to set up the services in the Part C program. The service coordinator talks with the family to learn about their concerns, resources, and priorities.

Intervention services: are types of services available for children and their families. An intervention service might be:

• Meeting with a professional (or team) who is trained to work with children that have a hearing loss, and their families
• Working with a professional (or team) that can help a family and child learn to communicate
• Fitting a baby with a hearing device, such as a hearing aid
• Joining family support groups
• Other services available to children with a hearing loss and their families

Hearing Aid: Hearing aids make sounds louder and clearer. Hearing aids are be worn by people of any age — including infants. Young babies with hearing loss can better understand sounds using hearing aids. This gives them the chance to learn speech skills right from birth.

There are many styles of hearing aids. They can help many types of hearing losses — mild, moderate, severe, and profound. Your baby’s audiologist will help you pick the best type for your baby’s hearing loss. A young child is usually fitted with behind-the-ear (BTE) style hearing aids because they adjust better on growing ears. Behind-the-ear hearing aids come in skin tone as well as many bright colors.

Mild Hearing Loss: A person with a mild hearing loss may hear some speech sounds but soft sounds are hard to hear.

Moderate Hearing Loss: A person with a moderate hearing loss may hear almost no speech when another person is talking at a normal level.

Severe Hearing Loss: A person with severe hearing loss will hear no speech of a person talking at a normal level and only some loud sounds.

Profound Hearing Loss: A person with a profound hearing loss will not hear any speech and only very loud sounds.

Assistive Listening Devices: There are many devices that can help children and adults with hearing loss. You can talk to your audiologist about which one (or ones) is best for your child. Some of these devices include:

• Hearing Aids
• Cochlear Implants
• FM Systems
• Captioning
• Telephone amplifiers
• Flashing and vibrating alarms
• Audio loops systems
• Infra red listening devices
• Portable sound amplifiers
• TTY or TDD (Text Telephone or Telecommunications Device for the Deaf)

It’s never too early to start thinking about helping your baby learn language. Without extra help, children with hearing loss have problems learning language. These children can then be at risk for other delays.

Families who have children with hearing loss often need to learn special skills to help their children learn language. These skills can be used together with cochlear implants, and other devices that help children hear.

Many parents look for help in learning to use these special skills. There are several programs that can help parents and children, each emphasizing different language learning skills. Here are the five programs, and the skills that are sometimes included in each of them:

Auditory-Oral: The auditory-oral program teaches babies and young children who are deaf or hard-of-hearing to use whatever hearing they have. They also use lipreading (speechreading) and gestures to understand and use spoken language. This program includes building blocks such as Natural Gestures, Listening, Speech (Lip) Reading, and Speech.

Auditory-Verbal: The auditory-verbal program teaches babies and young children who are deaf or hard of hearing to use their amplified residual hearing or hearing through electrical stimulation (cochlear implants) to listen, to understand spoken language, and to speak. This program includes building blocks such as Listening and Speech.

Bilingual: This program teaches babies and young children who are deaf or hard of hearing two languages, American Sign Language (ASL) and the family’s native language. (for example, English or Spanish). ASL is usually taught as the child’s first language and English (or the family’s native language) is taught as the child’s second language through reading, writing, speech, and use of residual hearing. This program also teaches respect for Deaf and hearing cultures. This program also includes building blocks such as Finger Spelling and Natural Gestures.

When most people hear the word “language” they think of languages such as English, Spanish, or other spoken languages. However, there are other languages such as American Sign Language (ASL), which are visual languages.

Cued Speech (Building Block): Cued Speech (sometimes called “cueing”) is a building block that helps children who are deaf or hard-of-hearing better understand spoken languages. Many speech sounds look the same on the face even though the sounds are different. For instance, the words “mat”, “bat”, and “pat” look the same on the lips and mouth. When “cueing” English, the person communicating uses eight hand shapes and four places near the mouth to help the person looking tell the difference between speech sounds.

Total Communication: The Total Communication program teaches babies and young children that are deaf or hard-of-hearing to use a combination of building blocks to communicate in the English language. Most Total Communication programs use some form of Simultaneous Communication (speaking and signing at the same time). This program includes building blocks such as Conceptually Accurate Signed English (CASE), Finger Spelling, Listening, Manually Coded English (MCE), Natural Gestures, Speech (Lip) Reading, and Speech.

You will need to choose which language (or languages) and which building blocks you want for your child.

These five programs use a mixture of different approaches and skills.

You as a parent can look at these programs and choose the skill — or set of skills — that will help your child communicate. Some parents choose a single program because that’s what works best for them. Other parents choose skills from two or more programs because that’s what works best for them. You can also talk to your team of health care professionals about which program or programs will give your child the most success.

Because these skills are used to build language, we are going to call them” building blocks”. Learning language is like stacking building blocks on a platform. The language is the platform and the skills are the building blocks. A family can pick and choose the building blocks that work best for their child and family.

“Building Blocks” refers to the different skills that parents can use to help their child learn language. There are many types of building blocks, and a family can pick and choose the building block (or blocks) that work best for their child and family. The following is a list of many commonly used building blocks.

• Conceptually Accurate Signed English (CASE)
• Cued Speech
• Finger Spelling
• Listening / Auditory Training
• Manually Coded English (MCE)
• Natural Gestures
• Speech
• Speech Reading (Lip Reading)

After learning a child has a hearing loss, some parents may have feelings of surprise, shock, confusion, anger, and even guilt. You may feel differently than other parents who have a child with a hearing loss. If you share parenting with a spouse or partner, each of you may feel differently about your child’s hearing loss. Other children in the family may also feel differently about their brother or sister than you do.

Families are sometimes troubled by this. It is normal to have different feelings. Your family might want to talk to someone who is trained to help families learn about and share their thoughts and feelings. This person might be a counselor, social worker, clergy, teacher, service coordinator, or any other person that the family feels comfortable with.

Remember, it is common for families to take time to learn about and adjust to their child’s hearing loss. Most families develop positive, healthy views about their family and their child’s future. Often, it just takes time.

As you go through the decision-making process, you will be gathering information to learn more about options for your child. From what you already know — and from the information provided in this CD-ROM — you might be ready to start making some decisions.

However, many families will want to learn more about their options. In fact, you will probably continue to gather information as your child grows, your family changes, and the choices of options and what professionals recommend changes over the years.

Think of gathering information as a journey.

Good places to start include:

• Professionals.
• Support networks.
• Adults who are deaf and hard-of-hearing.
• Other parents.
• Spending time with children who are deaf or hard-of-hearing and their families.
• Reading information on the Internet, books, pamphlets, and brochures.

Never forget — you make the final decision on what is right for your child.

Your child will grow and your family will change. Decisions that may have been good for your child as an infant may not be the best for your child as a toddler. This includes how your child learns to communicate. As your child grows older, you may find that you need new language and communication plans to meet your child’s changing needs. As he or she becomes an adult, your child may wish to make his or her own changes. Some families will change more often than others. Decision-making is a process just as your child’s growth is a process.

As you gather information and make decisions, you will meet people who have strong opinions. Some of these opinions might come from well-meaning relatives, friends, other parents, professionals, deaf and hard-of-hearing adults, or even the media. These opinions may seem to favor the choices you have made for your child. Or these people might offer opinions about communication strategies that you may wish to consider for your child. However, these opinions may go against your decisions about services and programs that you have chosen.

Many parents question their own decisions when this happens. You are making the choices for your own child and family. Others’ opinions may be a good way to gather information about different services and programs, but please remember that your decisions about your child’s future are the ones that matter.

Sometimes you may have decided on services or programs for your child that may not be available in your area. For example, you may have decided that you would like your toddler to learn to use a certain set of communication building blocks, or learn a certain language. But your community may not offer teaching of these building blocks and languages to infants and toddlers.

You can tackle this problem in many different ways. You can talk with your child’s service coordinator (or another member of your child’s team of professionals) about setting up a program in your community that will teach these skills. As you might expect, this approach can take a lot of time and effort, but can be worth the work. You can also choose to move to a community where the services are offered. Or you may wish to choose a different service or program. Talking with other parents and with professionals can give you more ideas.

Definitions:

“Building Blocks” refers to the different skills that parents can use to help their child learn language. There are many types of building blocks, and a family can pick and choose the building block (or blocks) that work best for their child and family. The following is a list of many commonly used building blocks.

• Conceptually Accurate Signed English (CASE)
• Cued Speech
• Finger Spelling
• Listening / Auditory Training
• Manually Coded English (MCE)
• Natural Gestures
• Speech
• Speech Reading (Lip Reading)

Even though American Sign Language (ASL) is not a building block, it is sometimes used together with one or more building blocks.

Service Coordinator: This is a professional that is assigned to help a family work through the IFSP (Individual Family Service Plan). Every family that takes part in this program is assigned a service coordinator. This professional works closely with the family to set up the services in the Part C program. The service coordinator talks with the family to learn about their concerns, resources, and priorities.

Parents of young babies are experts at communicating with their babies long before their babies learn to talk or to understand what their parents are saying to them! All of us have seen parents making funny faces for their babies. When a father makes a silly face for his baby, at first the baby might look surprised, but then will break into a wide smile, or giggle and wiggle his or her arms or legs. In the same way, communication also happens when a mother rocks her baby after a feeding, holds the baby close and gazes into her little one’s eyes.

Communication can include touch (such as rocking and holding your baby), vision (facial expressions, eye contact), gestures, and sound. Extending your arms to your infant shows that you are about to pick him or her up. Other ways of communicating include smiling, laughing, hugging, kissing, and letting your baby keep you in sight. Your physical and visual contact with your baby tells him or her that you are there and everything is safe.

Many babies with hearing loss have some hearing (residual hearing) and can partially hear voices, especially if the person talking is very close. So try speaking to your baby while holding him or her close. But don’t shout. Simply talk the same way you would talk to other babies. Your baby might be very interested in looking at faces and will begin to understand that your face and mouth are sending important messages. So make sure that you often talk to your baby when he or she is able to see your face.

Some things to remember when communicating with your baby:

• Hold your baby close so that he or she can focus on your face.
• Position your baby so that you are often within sight.
• Try to minimize background noises so that your child can use the hearing he or she has to the best of his or her ability.
• Use good lighting. Be sure that the room is not too dark or the lights too bright. You don’t want your baby to be squinting into the light.
• Make eye contact often.
• Imitate the movements and sounds your baby makes, then wait for him or her to repeat them.
• Work on communicating with your child during activities that you both enjoy.
• Take time to communicate with your child many times throughout the day.
• Give you and your child some quiet time. If your child becomes fussy, he or she may be overwhelmed by all of the communication!
• And most importantly, ENJOY the time you and your child spend together.

These are some suggestions for you while you are exploring and beginning to build communication and language for your baby. Please, talk with your baby’s health care professionals for more communication ideas.

Hearing plays an essential role in communication, speech and language development, and learning. Even a small amount of hearing loss can have profound, negative effects on speech, language comprehension, communication, classroom learning, and social development. Studies indicate that without proper intervention, children with mild to moderate hearing loss, on average, do not perform as well in school as children with no hearing loss. This gap in academic achievement widens as students progress through school.

An estimated 12.5% of children and adolescents aged 6–19 years (approximately 5.2 million) and 17% of adults aged 20–69 years (approximately 26 million) have suffered permanent damage to their hearing from excessive exposure to noise.

Hearing loss can result from damage to structures and/or nerve fibers in the inner ear that respond to sound. This type of hearing loss, termed “noise-induced hearing loss,” is usually caused by exposure to excessively loud sounds and cannot be medically or surgically corrected. Noise-induced hearing loss can result from a one-time exposure to a very loud sound, blast, or impulse, or from listening to loud sounds over an extended period.

Preventing Noise-Induced Hearing Loss

Hearing loss caused by exposure to loud sound is preventable. To reduce their risk of noise-induced hearing loss, adults and children can do the following:

• Understand that noise-induced hearing loss can lead to communication difficulties, learning difficulties, pain or ringing in the ears (tinnitus), distorted or muffled hearing, and an inability to hear some environmental sounds and warning signals
• Identify sources of loud sounds (such as gas-powered lawnmowers, snowmobiles, power tools, gunfire, or music) that can contribute to hearing loss and try to reduce exposure
• Adopt behaviors to protect their hearing:
  • Avoid or limit exposure to excessively loud sounds
  • Turn down the volume of music systems
  • Move away from the source of loud sounds when possible
  • Use hearing protection devices when it is not feasible to avoid exposure to loud sounds or reduce them to a safe level
• Seek hearing evaluation by a licensed audiologist or other qualified professional, especially if there is concern about potential hearing loss

American Sign Language (ASL): ASL is a visual language. It is a complete language. It is much more than making gestures or “pictures in the air.” ASL has its own vocabulary and grammar that is different from English. Signs and sentences in ASL are made using handshapes (for example, a pointing handshape, or the fingers spread out to show the number 5), moving the hands and arms (for example, in a straight line, or bouncing), and different facial expressions (for example, frowning or raising your eyebrows). You can share feelings, abstract ideas, and make jokes using ASL. You can take ASL classes and start teaching your baby even while you are still learning it yourself.

Assistive Listening Devices: There are many devices that can help children and adults with hearing loss. You can talk to your audiologist about which one (or ones) is best for your child. Some of these devices include:

• Hearing Aids
• Cochlear Implants
• FM Systems
• Captioning
• Telephone amplifiers
• Flashing and vibrating alarms
• Audio loops systems
• Infra red listening devices
• Portable sound amplifiers
• TTY or TDD (Text Telephone or Telecommunications Device for the Deaf)

Audiologist: A professional trained to test hearing by performing audiology evaluations.

Audiology Evaluation: A complete hearing evaluation performed by an audiologist . The evaluations include:

• A test that will tell the audiologist how your baby’s outer and middle ear are working.
• A test that measures how your baby reacts to sounds.
• A test that checks the ears’ response to sound.
• A test that checks the brain’s response to sound.

The audiologist will ask you questions about your baby’s health, hearing loss in you family, and how well you think your baby hears.

Auditory nerve: (Hearing nerve) This nerve carries electrical signals from the cochlea in the inner ear to the brain.

Auditory-Oral: The auditory-oral program teaches babies and young children who are deaf or hard-of-hearing to use whatever hearing they have. They also use lipreading (speechreading) and gestures to understand and use spoken language. This program includes building blocks such as Natural Gestures, Listening, Speech (Lip) Reading, and Speech.

Auditory-Verbal: The auditory-verbal program teaches babies and young children who are deaf or hard of hearing to use their amplified residual hearing or hearing through electrical stimulation (Cochlear Implants ) to listen, to understand spoken language, and to speak. This program includes building blocks such as Listening and Speech.

Auditory Training / Listening: Many children who are deaf or hard-of-hearing have some amount of hearing. This is called residual hearing . Some parents of a child with residual hearing may choose to use a building block called listening (auditory training). This building block is often used together with assistive devices such as Hearing Aids and Cochlear Implants .

Automated Auditory Brainstem Response test (AABR): This test that measures the brain’s response to sound using electrodes.

Bilateral Hearing Loss: A hearing loss that affects both ears.

Bilingual: This program teaches babies and young children who are deaf or hard of hearing two languages, American Sign Language (ASL) and the family’s native language, (for example, English or Spanish). ASL is usually taught as the child’s first language and English (or the family’s native language) is taught as the child’s second language through reading, writing, Speech, and use of residual hearing . This program also teaches respect for Deaf and hearing cultures. This program also includes building blocks such as Finger Spelling and Natural Gestures.

Building Block(s): “Building Blocks” refers to the different skills that parents can use to help their child learn language. There are many types of building blocks, and a family can pick and choose the building block (or blocks) that work best for their child and family. The following is a list of many commonly used building blocks.

• Conceptually Accurate Signed English (CASE)
• Cued Speech
• Finger Spelling
• Listening / Auditory Training
• Manually Coded English (MCE)
• Natural Gestures
• Speech
• Speech Reading (Lip Reading)

Even though American Sign Language (ASL) is not a building block, it is sometimes used together with one or more building blocks.

Centers for Disease Control and Prevention (CDC): CDC is recognized as the lead federal agency for protecting the health and safety of people — at home and abroad. CDC’s Early Hearing Detection and Intervention (EHDI) program provides information about children and hearing loss and answers some commonly asked questions. Information about the state EHDI programs is also available.

Cochlea: The cochlea is in the inner ear. It’s a snail-shaped tube that is filled with fluid and has tiny hair cells. Sound that comes into the cochlea moves the hair cells back and forth. This turns sounds into electrical signals that are sent to the brain through the auditory (hearing) nerve.

Cochlear Implants: A cochlear implant is a surgically placed device that can help a person with severe to profound hearing loss. It gives that person a way to hear when a hearing aid is not enough. A cochlear implant sends sound signals directly to the hearing (auditory) nerve.

Conceptually Accurate Signed English (CASE): Conceptually Accurate Signed English (CASE) is a building block that people who are deaf or hard-of-hearing and people who are hearing use together to communicate. Sometimes it’s called PSE or Pidgin Signed English. CASE is a building block that people who use American Sign Language (ASL) and English in the form of Manually Coded English (MCE) mix together. CASE can change based on the skills of the people using it.

Conductive Hearing Loss: Hearing loss caused by something that stops sounds from getting through the outer or middle ear.

Cued Speech (Building Block): Cued Speech (sometimes called “cueing”) is a building block that helps children who are deaf or hard-of-hearing better understand spoken languages. Many speech sounds look the same on the face even though the sounds are different. For instance, the words “mat”, “bat”, and “pat” look the same on the lips and mouth. When “cueing” English, the person communicating uses eight hand shapes and four places near the mouth to help the person looking tell the difference between speech sounds.

Cued Speech (Program): This is a program that teaches babies or young children that are deaf or hard of hearing how to use Cued Speech. This program includes language building blocks such as Cued Speech and Speech (Lip) Reading.

Earmold: An earmold is a plastic or silicone piece that is made to fit to a child’s ear. The earmold has a short tube that is attached to the part of the hearing aid that sits behind the child’s ear. The earmold sends sound from the hearing aid into the ear.

Family Support: Family support is anything that helps a family. This help may include advice, information, helping a parent understand the options available, having the chance to get to know other parents that have a child with hearing loss, finding childcare or transportation, giving parents time for personal relaxation, or just a supportive listener.

Finger Spelling: Finger spelling is a building block that uses hands and fingers to spell out words. Hand shapes stand for the letters in the alphabet. Finger spelling is used with many other building blocks; it is almost never used by itself.

FM Systems: An FM system is a kind of device that helps a person who is deaf or hard-of-hearing. FM stands for frequency modulation. It’s the same type of signal used for radios. FM systems send sound from a microphone used by the person speaking to a baby wearing the device. This system is sometimes used with Hearing Aids . An extra piece is attached to the hearing aid that works with the FM system. This extra piece is called an “audio input boot”.

Geneticist: A professional that is trained to know about genes and the medical conditions that might be related to genetics. This includes hearing loss.

Hearing aids: Hearing aids make sounds louder and clearer. Hearing aids are be worn by people of any age — including infants. Young babies with hearing loss can better understand sounds using hearing aids. This gives them the chance to learn Speech skills right from birth.

There are many styles of hearing aids. They can help many types of hearing losses — mild, moderate, severe , and profound. Your baby’s audiologist will help you pick the best type for your baby’s hearing loss. A young child is usually fitted with behind-the-ear (BTE) style hearing aids because they adjust better on growing ears. Behind-the-ear hearing aids come in skin tone as well as many bright colors.

Individual Family Service Plan (IFSP): An IFSP is a plan made for children who are deaf or hard-of-hearing. This plan is made by a child’s parents and a service coodinator. The plan outlines all of the intervention services and equipment that a family and child will need for the child and his or her hearing loss. This plan will also outline how the family will get these services and equipment. This plan is family focused — the strengths and needs of the child and family are very important when making this plan. Because each child has his or her own plan, no two plans will be the same. It is very important that the family works closely with the service coordinator and others to learn as much as possible about the intervention services available to them in order to get the most out of the IFSP process.

Inner Ear: The inner ear is made up of the snail shaped organ for hearing (called the cochlea) and the nerves that go to the brain.

Intervention Services: Intervention services are types of services available for children and their families. An intervention service might be:

• Meeting with a professional (or team) who is trained to work with children that have a hearing loss, and their families
• Working with a professional (or team) that can help a family and child learn to communicate
• Fitting a baby with a hearing device, such as a hearing aid
• Joining family support groups
• Other services available to children with a hearing loss and their families

Lip Reading: Lip reading (or speech reading) is a building block that helps a child with hearing loss understand Speech. The child watches the movements of a speaker’s mouth and face to understand what the speaker is saying. About 40% of the sounds in the English language can be seen on the lips of a speaker in good conditions — such as a well-lit room where the child can see the speaker’s face.

Listening / Auditory Training: A deaf or hard-of-hearing child may still have some hearing. This is called residual hearing . Some parents of a child with residual hearing may choose to use a building block called listening (auditory training). This building block is often used in combination with other building blocks and assistive devices such as Hearing Aids and Cochlear Implants .

Manually Coded English (MCE): Manually Coded English (MCE) is made up of signs that are a visual code that stand for the words of the English language. Many of the signs (hand shapes and hand motions) in MCE are borrowed from American Sign Language (ASL) . But unlike ASL, the grammar, word order, and sentence structure of MCE are similar to the English language.

Medical Home: A medical home is not a building, house, or hospital. It’s a way of seeing that all children get good health care services. A medical home is set up when one professional takes care of a child and makes sure he or she gets all needed services.

Middle Ear: The middle ear is made up of the eardrum and three small bones (ossicles) that send the movement of the eardrum to the inner ear.

Mild Hearing Loss: A person with a mild hearing loss may hear some speech sounds but soft sounds are hard to hear.

Mixed Hearing Loss: Hearing loss that includes both a conductive and a sensorineural hearing loss.

Moderate Hearing Loss: A person with a moderate hearing loss may hear almost no speech when another person is talking at a normal level.

Natural Gestures: Natural gestures — or body language — are actions that parents normally do to help children understand a message. For example, if a parent wants to ask a toddler if he or she wants to be picked up, the parent might stretch out their arms and ask, “Up?” For an older child, a parent might motion with their arms to call him or her to come inside the house. Or, a parent might put their first finger over their mouth and nose to show that the child needs to be quiet.

Newborn Hearing Screening (also see Screening): An initial hearing check for newborn babies is usually performed while the mother and baby are still in the hospital, either in the nursery or in their mother’s room. Hearing screening is easy and is not painful. It takes a very short time — usually only a few minutes.

Ophthalmologist: A physician that is trained to know about and treat conditions related to the eyes.

Ossicles: The chain of three tiny bones in the middle ear (malleus, incus, stapes).

Otoacoustic Emissions (OAE): a test that measures the ear’s response to sound.

Otolaryngologist: A physician who specializes in conditions related to the ear, nose and throat.

Outer Ear: The outer ear is made up of the parts we see (pinna), the ear canal, and eardrum (tympanic membrane).

Part C Program: (Infant and Toddler Services) One way to put together early intervention services is through a program in your state called the “Part C program”. This is a program for children from birth to 3 years of age who have or are at risk for a developmental delay (a lag in development). This sometimes includes children with hearing loss. Please ask your child’s health care provider for more information.

Pediatric Audiologist: An audiologist trained to give audiology evaluations to babies and young children.

Pinna: (Auricle) This is the part of the ear that we see on each side of our heads. It is a part of the outer ear. The pinna collects sound and sends it down the ear canal to the rest of the ear.

Post-lingual Hearing Loss: Hearing loss that happens after a child learns to talk.

Pre-lingual Hearing Loss: Hearing loss that happens before a child learns to talk.

Professional: For this CD-ROM, a professional is a person who has special training in health and education and works with children and families.

Profound Hearing Loss: A person with a profound hearing loss will not hear any speech and only very loud sounds.

Residual Hearing: This refers to the amount of hearing a child with hearing loss has, despite their hearing loss.

Screening (Newborn Hearing Screening): An initial hearing check for newborn babies, usually performed while the mother and baby are still in the hospital, either in the nursery or in their mothers’ room. Hearing screening is easy and is not painful. It takes a very short time — usually only a few minutes.

Sensorineural Hearing Loss: Hearing loss that occurs when there is a problem in the way the inner ear or hearing nerve works.

Service Coordinator: This is a professional that is assigned to help a family work through the IFSP (Individual Family Service Plan). Every family that takes part in this program is assigned a service coordinator. This professional works closely with the family to set up the services in the Part C program. The service coordinator talks with the family to learn about their concerns, resources, and priorities.

Severe Hearing Loss: A person with severe hearing loss will hear no speech of a person talking at a normal level and only some loud sounds.

Speech: Speech is a skill that many people don’t think about. But speech is a building block . It helps build language. Parents can choose to have their children use this building block for communicating — that is, expressing themselves.

Speech is often used in combination with Hearing Aids , Cochlear Implants , and other assistive devices. Since this building block is used by the children to express themselves to other people, one or more other building blocks must be used to help the child understand others.

Speech-Language Pathologist: A speech language pathologist is a professional trained to know about how children learn language and to teach children how to use speech and language.

Speech Reading: Speech reading (lip reading) is a building block that helps a child with hearing loss to understand speech. The child watches the movements of a speaker’s mouth and face, to understand what the speaker is saying. About 40% of the sounds in the English language can be seen on the lips of a speaker in good conditions — such as a well-lit room where the child can see the speaker’s face.

Total Communication: The Total Communication program teaches babies and young children that are deaf or hard-of-hearing to use a combination of building blocks to communicate in the English language. Most Total Communication programs use some form of Simultaneous Communication (speaking and signing at the same time). This program includes building blocks such as Conceptually Accurate Signed English (CASE) , Finger Spelling , Listening, Manually Coded English (MCE) , Natural Gestures, Speech (Lip) Reading, and Speech.

Tympanic membrane: The eardrum

Unilateral Hearing Loss: Hearing loss affects only one ear.