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Hearing Aids

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Hearing aids enable many children with impaired hearing to hear better and, for many, well enough to develop normal speech, language, social communication, and learning skills. Determining whether hearing aids will be helpful for a child depends upon the type, severity and configuration of the hearing loss, family involvement, and follow-up interventions, including speech and language therapy. For children with hearing impairment, the primary aim of hearing aid use is to enable them to hear and understand sufficiently to develop their own speech and language. Hearing aids vary in their ideal application, technology, size, cost, durability, and potential complications. If chosen and used appropriately, hearing aids can be effective in allowing normal development in the face of hearing impairment.

Assessment and Evaluation

Evaluation of pediatric patients should be performed by a pediatric audiologist, trained and experienced in assessing children. After hearing loss is confirmed, the pediatric audiologist will refer the child to an otolaryngologist for further medical assessment. Together the otolaryngologist and the audiologist will collaborate with the family to determine the rehabilitation needs of the child. After hearing aids or cochlear implantation, children often need the services of speech therapy and early intervention in order to fully maximize speech, language and listening skills. Children fit with hearing aids should be monitored closely by a pediatric audiologist and by early intervention specialists and other professionals to ensure the hearing aids are set appropriately and are providing the maximum benefit. In the first weeks and months following the fitting of amplification on children, the audiologist will see the child often and use several subject and objective measures to insure the hearing aids are set appropriately and that the family is comfortable trouble-shooting any problems.

Types of Hearing Loss

Hearing loss can be categorized by the part of the auditory system that is impaired and the severity of the impairment. There are three basic types of hearing loss: conductive hearing loss, sensorineural hearing loss, and mixed hearing loss.

Conductive Hearing Loss

Conductive hearing loss occurs when sound is not conducted efficiently through the outer ear canal to the eardrum and the tiny bones (ossicles) of the middle ear. Conductive hearing loss results in inability to hear faint sounds. Some causes of conductive loss can be corrected medically or surgically. For example, middle ear fluid or Eustachian tube dysfunction may be resolved with treatment of infection or placement of ventilating tubes. In some cases, absence of an outer ear or ear canal may be surgically repairable, but will likely require hearing aids for some time. Absence of the middle ear usually requires permanent use of hearing aids. In general, traditional hearing aids work well for conductive hearing loss. In some cases a surgically implanted or osseointegrated hearing aid is preferred.

Sensorineural Hearing Loss

Sensorineural hearing loss (SNHL) results from damage to the inner ear (cochlea) or to the nerve pathways from the inner ear to the brain. It is the most common type of hearing loss and usually cannot be medically or surgically corrected. SNHL reduces the ability to hear faint sounds; speech that is loud enough to hear may sound muffled or unclear.
Causes of SNHL in children include:
  • Illnesses, including CMV, bacterial meningitis
  • Drugs that are toxic to hearing
  • Hearing loss that runs in the family (genetic or hereditary)
  • Head trauma
  • Malformation of the inner ear
  • Exposure to loud noise
  • Eighth nerve lesions
  • Prematurity
Most traditional hearing aids are designed for SNHL.

Mixed Hearing Loss

Mixed hearing loss describes a condition where a conductive hearing loss occurs in combination with a sensorineural hearing loss (SNHL). Examples in children occur when a child has SNHL and also experiences conductive loss because of otitis media, causing hearing to be poorer than it was from the SNHL alone. Traditional hearing aids can be used with mixed hearing losses.

Auditory Neuropathy Spectrum Disorder

Auditory Neuropathy Spectrum Disorder (ANSD) is a specific form of hearing loss defined as a problem in the transmission of sound from the inner ear to the brain that makes sound disorganized when it reaches the brain. ANSD is most commonly diagnosed by the presence of normal or near-normal Otoacoustic Emissions (OAEs) but the absence of normal middle ear reflexes and severely abnormal or completely absent auditory brainstem response (ABRs). Variability or absence of responses to behavioral testing is also an indication of ANSD. Because of the wide variability in auditory performance, the term Auditory Neuropathy Spectrum Disorder (ANSD) was adopted in 2008.
Children presenting with this hearing loss may have sporadic windows of hearing or near normal hearing and at other times may not respond to sound at all. The children that do respond to speech will often will have difficulty distinguishing one sound from another and trouble understanding speech clearly. In some cases, ANSD causes only mild hearing difficulties and is only a problem in noisy situations. In the majority of cases, however, it leads to significant hearing loss. The causes of ANSD are unknown, but children who are born prematurely or have a family history of the condition are at higher risk for it. Symptoms can develop at any age, but most kids with ANSD are born with it and diagnosed in the first months of life. As ANSD becomes better understood, it is diagnosed more frequently and now accounts for about 10% to 15% of cases of hearing loss. Due to that variability in auditory performance, habilitation recommendations are based on speech and language development and can range from audiological monitoring to hearing aid fitting and cochlear implantation.

Degree and Severity of Hearing Loss

The degree or severity of hearing loss is described by the threshold of loudness at which sound can be heard, in ranges of decibels – mild hearing loss (26 to 40 dB HL), moderate hearing loss (45 to 60 dBHL), severe hearing loss (65 to 85 dB HL), and profound hearing loss (91+ dB HL).
The configuration or shape of a hearing loss refers to its degree and pattern across frequencies (tones), as illustrated in a graph called an audiogram. For example, the configuration of a hearing loss might show good hearing in the low tones and poor hearing in the high tones. Some hearing loss configurations are flat, indicating the same amount of hearing loss for low and high tones.
The degree and configuration of hearing loss are factors the audiologist considers when selecting and recommending hearing aids.

Other Descriptors of Hearing Loss

Other descriptors associated with hearing loss are:
  • Bilateral versus unilateral.
  • Symmetrical versus asymmetrical, depending on whether the degree and configuration of hearing loss are the same in each ear.
  • Progressive versus sudden hearing loss – progressive means that hearing loss becomes worse over time. Sudden means hearing loss that happens quickly, which should prompt immediate medical attention to determine its cause and treatment.
  • Fluctuating versus stable hearing loss.
A progressive or sudden hearing loss will require a hearing aid that is capable of providing more amplification as the hearing loss becomes worse. The best hearing aid for a fluctuating hearing loss will provide different levels of amplification to accommodate the fluctuation.

Styles of Hearing Aids

The type, degree and configuration of hearing loss will determine which style of hearing aid may work best for the child, with smaller models generally suited for less significant losses and larger styles suited for any degree of hearing loss, including severe and profound.

Behind-the-ear (BTE) Aids

different models of behind the ear hearing aids
All parts of the aid are contained in a small plastic case that rests behind the ear and is connected to an earmold by a piece of clear tubing. The behind-the-ear (BTE) hearing aid is the type most commonly recommended for infants and young children for a number of reasons:
  • It accommodates various earmold types.
  • The earmold detaches and can be easily remade as the child grows.
  • The earmold is easy to handle and clean.
  • Parents and caregivers can easily do a listening check and make adjustments.
  • It accommodates a wide variety of hearing losses.
  • It can be made with direct audio input or a telecoil, so it can be used with other listening devices.
  • The earmolds are made of a soft material that is safer and more comfortable for tiny ears.

Behind-the-ear Aid, Open Fitting

A small plastic case rests behind the ear, and a very fine clear tube runs into the ear canal. Inside the ear canal, a small, soft silicone dome or a molded, highly vented acrylic tip holds the tube in place. These aids offer cosmetic and listening advantages and are typically used for adults and some older children as well.

In-the-ear (ITE) Aids, In-the-canal (ITC), and Completely-in-the-canal (CIC) Aids

photo of infant wearing Hearing aid
All parts of the aid are contained in a shell that fills in the outer part of the ear (as shown) or are partly or completely fit into the ear canal (CIC). They are the smallest aids available and offer some cosmetic and listening advantages. These are most often not appropriate for children as their ears are too small or growing rapidly, requiring frequent changes in size.

Other Types of Hearing Aids

There are also special hearing aids built to handle very specific types of hearing loss or circumstances:

CROS Hearing Aids

CROS hearing aids route sounds coming to one ear over to the other ear. These devices are for use by individuals who have no hearing in one ear. In special cases, hearing aids can be built into eye glasses for individuals who need that type of fitting.

Eyeglass Aids

Hearing aids and glasses were combined in the 1950s but are no longer seen as viable options in most cases.

Disposable Hearing Aids

Young child on parent's lap wearing a Baha bone conduction hearing aid
Cochlear™ Americas, © 2009 Cochlear Americas
Disposable hearing aids have a non-replaceable battery. These aids are designed to use power sparingly, so that the battery lasts longer than those used in traditional hearing aids. Disposable hearing aids aim to minimize maintenance (battery replacement, aid adjustment, and cleaning). To date, two brands of disposable hearing aids are available. Both are digital, but they are used in very different ways. One is a BTE hearing aid that is bought online and worn like any other BTE device. When it runs out, the user replaces it with a new one. The other requires a professional to implant it deep in the ear canal and to remove and replace it when the battery runs out. Disposable hearing aids are not recommended with children.

Bone Conduction Hearing Aids

Bone conduction hearing aids use a headband and a bone vibrator for individuals who have no ear canal or outer ear. These devices bypass the outer and middle ear and directly stimulate the cochlea or inner ear. This is often the only alternative for children born with a permanent conductive hearing loss, such as atresia of the ear canal, or chronic draining otitis media that precludes fitting a hearing aid.

Osseointegrated Hearing Aid

illustration of a bone-anchored aid behind someone's ear
Cochlear™ Americas, © 2009 Cochlear Americas
A relatively new innovation is the osseointegrated hearing aid (bone anchored), which is implanted in the skull. This device has three parts: a titanium implant, an external abutment, and a detachable sound processor. Currently the FDA approves bone anchored devices for children age 5 and older.

Middle Ear Implants

Middle ear implants are hearing systems implanted in the space behind the eardrum that mechanically vibrate the middle ear structures. This device has two parts: an external portion and an implanted portion. Middle ear implants are used when a conductive hearing loss results from permanent damage to or the absence of the ossicles.

Cochlear Implants

A cochlear implant provides direct electrical stimulation to the auditory (hearing) nerve in the inner ear. Children and adults with a severe to profound sensorineural hearing loss who cannot be helped with hearing aids may be helped with cochlear implants. The cochlear implant does not result in “restored” or “cured” hearing. It does, however, allow for the perception of the sensation of sound. Children as young as 6 - 9 months of age have received cochlear implants, and the potential exists for successful implantation at younger ages.

It is generally agreed that the best child candidates for cochlear implant are those who:

  • Have profound hearing loss in both ears
  • Have had limited benefit from hearing aids
  • Are healthy and have no medical conditions that would make the surgery risky
  • Are involved (when able), along with their parents, in all the steps in the process
  • Understand (when able), along with their parents, their role in the successful use of cochlear implants
  • Have (when able), along with their parents, realistic expectations for cochlear implant use
  • Are willing to be actively involved in their habilitation/rehabilitation
  • Have support from their educational program to emphasize the development of auditory skills

Use & Care

Families and children should be familiar with the following components of a hearing aid.

Batteries

  • Zinc air cell batteries are used in virtually all current-day hearing instruments. They are activated by removal of a tab which allows air to enter the battery and they have excellent shelf life when stored properly (approx. 2-3 years). These replaced mercury and silver oxide batteries. They are available in all sizes (675 to 5A) and high-power. Cost is ~ $1.00 per battery
  • All hearing aid batteries are toxic. Keep them stored in a safe place away from children and pets. A swallowed battery is a medical emergency and the individual needs medical attention immediately. Call your local emergency number or the national Poison Control Center at 1-800-222-1222.

Microphone(s)

  • Omnidirectional (omni) - have one port of entry for inputs and equal sensitivity to inputs from all directions; currently, most manufacturers offer an omni-directional microphone option in all styles including canal styles.
  • Bidirectional - Not used very often

Other Components

  • Receiver - converts electrical energy into acoustic energy
  • Amplifier - amplifies the acoustic signal before it enters the ear canal

Types of Hearing Aid Circuitry

Analog

  • Representation of sound by electrical current
  • “Older”, more conventional technology

Digitally Programmable

  • Analog components programmed/adjusted by an external digital source (computer)

Digital

  • Both the audio circuit and the additional control circuits are fully digital.
  • Hearing aid programmed with an external computer temporarily connected to the device. Fully digital hearing aids can be programmed with multiple programs that can be invoked by the wearer, or that operate automatically and adaptively. These programs reduce acoustic feedback (whistling), reduce background noise, detect and automatically accommodate different listening environments (loud vs soft, speech vs music, quiet vs noisy, etc.), control additional components such as multiple microphones to improve spatial hearing, transpose frequencies (shift high frequencies that a wearer may not hear to lower frequency regions where hearing may be better), and implement many other features. These programs can be determined on an individual basis for each patient.

Cleaning Your Hearing Aid

Keeping your hearing aids in good working order prevents many future problems. To clean your aid you will need a wax pick, brush, and hearing aid blower. If not included with your hearing aid, they can be purchased from an audiologist or vendor.
After removing the hearing aid from your ear, remove any wax from the ear mold or tubing with the hearing aid pick and wipe the exterior of the aid and mold with a soft cloth. These should be done daily.
Clean the battery compartment by removing the battery and gently brushing interior. Replace battery and close the casement.
Earmolds can be removed from the aid by first locating the end of the tube where it connects with the ear hook; then twist and pull gently. Using warm water and mild soap, wash the earmold, then rinse with clean water. Place the blower on the end of the tube and squeeze. This should force water out of the tube. Allow to dry overnight before reconnecting to ear hook.

Moisture

Moisture is a major cause of hearing aid failure, resulting in circuitry problems and distortion. Moisture gets into the hearing aid primarily through condensation from the warm moist environment of the inner ear. If possible, avoid wearing your hearing aid in wet, humid or steamy conditions or during strenuous exercise.
If moisture droplets are seen in hearing aid tubing, disconnect the tubing gently from ear hook and, with a hearing aid blower, blow air through the tubing to force out moisture and then allow it to dry overnight. With in-the-ear models, the only way to combat moisture is to remove them and allow them to dry out.
Never put your aids in a conventional or microwave oven to dry or leave them in direct sunlight. Excessive heat may melt plastic components and microwaves will destroy all of the electronic components.
Special moisture-dispersing tubing or “Dry Aid” kits are available and may be worth trying if moisture problems recur.

Hearing Aid Checks

Hearing aid checks should be performed daily. Parents or teachers can perform checks for young children; school-age children should be taught to perform checks and, when competent, perform them independently.
First, check the exterior of aid for any cracks, holes or tears. Remove the battery and test with a hearing aid tester. After reinserting or replacing battery, close the compartment completely. Turn the O-T-M switch to “off” (O) position. Turn the volume to the lowest setting and turn the switch to the “microphone” (M) position. Put one end of a hearing aid stethoscope into the ears of a hearing person and say several vowel and consonant sounds. None should be distorted. Once the hearing aid has been checked and verified to be working properly, place it in the ear and listen for feedback. If feedback is present, remove the aid. Cover the opening of the canal in earmold with thumb. If you still hear feedback, there is a problem with the aid. If not, it means the earmold was not fitted tightly, which could be a sign of a bad fit.
Ear wax is the normal way that the ear protects the ear canal and ear drum (tympanic membrane). Most peoples’ ear canals clear wax without help. A hearing aid can impede this process resulting in wax build-up behind the earmold, which can damage a hearing aid. It can also cause hearing aid feedback—an extremely high-pitched whistling sound—and reduce hearing effectiveness by blocking sound.
No one should try to remove ear wax themselves. Using a swab or any object in the ear canal can push the wax back further and cause it to become impacted, which can cause pain and further hearing loss. Current guidelines from the American Academy of Otolaryngology—Head and Neck Surgery Foundation recommend that individuals with hearing aids have their ears cleaned professionally twice a year.

Costs & Funding

The cost of a single hearing aid can vary from $500 to $6,000 or more, depending on the level of technology and whether fitting fees are included. Most private US health care providers do not provide coverage for hearing aids for adults, but some, including many state Medicaid programs, cover hearing aids for children. Health Savings Accounts or HSAs should cover the costs. Some school districts may conditionally cover the cost and use of hearing aids. Less expensive hearing aids can be found on the internet or in mail order catalogs but some of these use poorly made sound amplifiers and are not recommended. The cost of hearing aids is a tax-deductible medical expense for those who itemize medical deductions.
Diagnostic audiology evaluations may be performed with a physician’s written order and include procedures used to determine hearing aid assessment and other appropriate diagnostic tests. Hearing aids and cochlear implants require prior authorization and must meet eligibility requirements of Medicaid. Children should be evaluated for hearing aids by a pediatric audiologist who can monitor the child’s response to the hearing aids and insure that they fit appropriately. In many states, before a hearing aid can be fit on a child, an otolaryngologist must provide medical clearance in the form of a prescription. This is to ensure that treatable causes of hearing loss have been assessed.
The life of a hearing aid depends on many factors, including care. In many cases a hearing aid can last up to five years or longer. Some insurances will not authorize hearing aids more than once every five years unless the hearing loss has changed significantly and the current aids are no longer appropriate. Many pediatric providers recommend hearing aids from companies that are pediatric-friendly and offer extended warranties for loss and damage. There are also private insurance companies that offer insurance plans that cover loss and damage of hearing aids and other assistive devices for a fee.

Resources

Information & Support

For Professionals

American Academy of Audiology
Resources for professionals who test, treat, and provide care to the deaf or hard of hearing.

American Speech-Language-Hearing Association
Information for professionals working in audiology, speech-language pathology, and the speech and hearing sciences. Advocate for people with communication disabilities.

For Parents and Patients

Family Voices
A national, nonprofit, family-led organization promoting quality health care for all children and youth, particularly those with special health care needs. Locate your Family-to-Family Health Information Center by state.

Hearing Aid Choices and Tips (My Baby's Hearing)
From a program of the Boystown National Research Hospital, answers to common questions about choosing and using hearing aids for children and tips for how help children with them; note that the content is covered over 6 pages addressing specific aspects.

The HIKE Fund, Inc.
Hearing Impaired Kids Endowment Fund, supported by Job’s Daughters International, provides hearing devices for about 100 children a year who have hearing loss and whose parents are unable to meet this special need financially.

Hear Now Program
The Hear Now Program of the Starkey Hearing Foundation is a national program providing assistance, to those permanently living in the US, to acquire hearing aids through an application process. All applicants must meet the program's financial criteria. Hear Now works with licensed practitioners in the applicant's area.

AUDIENT Alliance for Accessible Hearing Care
For individuals whose income is above the government's established poverty levels, but who still find it difficult to afford quality hearing care.

Oticon Pediatric Hearing Aids
Oticon is a reputable manufacturer of pediatric hearing devices.

Miracle-Ear Childen's Foundation
Miracle-Ear Children's Foundation provides free hearing aids and services to children from low-income families.

Phonak Pediatric Hearing Aids
Phonak is a reputable manufacturer of pediatric hearing devices.

Cochlear Americas Baha Hearing Aids
Cochlear Americas is a leading manufacturer of bone-anchored hearing aids (BAHA).

Alexander Graham Bell Association
One of the oldest and most comprehensive organizations focused on pediatric hearing loss, including information on how to find a provider, funding sources and information, scholarships, and a family support section.

Services for Patients & Families in Rhode Island (RI)

For services not listed above, browse our Services categories or search our database.

* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.

Studies

Clinical Trials Related to Hearing Aids in children (clinicaltrials.gov)
Studies looking at better understanding, diagnosing, and treating this condition; from the National Library of Medicine.

Authors & Reviewers

Initial publication: April 2011; last update/revision: January 2018
Current Authors and Reviewers:
Authors: Nancy Hohler, AuD, MBA
Jeanne Raney, MA, SLP
Reviewers: Natalie Allen, RN
Jennifer Goldman, MD, MRP, FAAP