By about 20 weeks of pregnancy, baby’s inner ear is fully developed. In other words, baby was born with a sense of hearing. By 23-24 weeks of pregnancy, baby starts hearing nicely.

There are 2 screening tests that may be used:

• Automated Auditory Brainstem Response (AABR)
• Otoacoustic Emissions (OAE)

Universal New-born Hearing Screening is a mandatory test to a check a baby’s hearing after birth, before leaving the hospital. If a baby is born at home, a hearing test should be completed before he or she is 1 month old. This enables definitive diagnosis by 3 months of age and effective intervention by 6 months of age as per the guidelines from JCIH Position statement, 2007 (https://www.pratidhwani.in/assets/resources/JCIH-2007-Position-Statement-Supplement.pdf) as well as Consensus statement by Indian Paediatric association, 2017 (https://www.pratidhwani.in/assets/resources/REC-00067.pdf)

Because the pathway of 8th vestibular nerve to the brain stem needs upto 3 months from the birth date to mature completely.

Many forms of hearing loss are genetic. They are hereditary and caused by gene mutations. Finally, gene mutations may cause several non-hearing related, hereditary conditions combined with a deformation of the inner ear, resulting in deafness at birth or later in life.

Risk factors for infant hearing loss include:

• Family history of hearing loss
• Low birth weight
• Birth defects that cause changes in the structure of the ear canal or middle ear
• Injury to or rupture of the eardrum
• Scar on the eardrum from many infections
• Exposure to certain toxic chemicals or medicines while in the womb or after birth
• Genetic disorders
• Infections the mother passes to her baby in the womb (such as toxoplasmosis, measles, or herpes)
• Infections that can damage the brain after birth, such as meningitis or measles
• Problems with the structure of the inner ear
• Tumors

Hearing and Language Milestones:

It is important to monitor your child’s speech and langugae development as well as responses to sound. The following provides a general guide to hearing and language milestones.

Birth to 3 months:

• Reacts to loud sounds.
• Quiets to familiar voices or sounds
• Makes cooing noises.
• Responds to speech by looking at speaker’s face

3-6 months:

• Turns eyes or head toward sounds
• Starts to make speech-like sounds
• Laughs and makes noises to indicate pleasure and displeasure

6-9 months:

• Babbles, “dada”, “mama”, “baba
• Shouts/vocalizes to get attention
• Will often respond to “no” and own name
• Responds to singing and music

9-12 months:

• Imitates speech sounds of others
• Understands simple words, eg “ball”, “dog”, “daddy”
• Turns head to soft sounds
• First words emerge

12-18 months:

• Appears to understand some new words each week
• Follows simple spoken instructions, eg “get the ball”
• Points to people, body parts pr toys when asked
• Continually learns new words to say although may be unclear

18-24 months:

• Listens to simple stories or songs
• Combines two or more words in short phrases eg “more food”

2-3 years old:

• Understands longer sentances
• Listens from a distance (in quiet)
• Follows directions that include 2-3 steps

3-4 years old:

• Processes complex sentence structures
• Retells longer stories in detail-5 or more sentances.

Milestone of speech development:

0 to 5 months:

• Vocalizes pleasure and displeasure sounds (laughs, giggles, cries, or fusses)
• Makes noise when talked to

6 – 11 months:

• Babbles (says “ba-ba-ba” or “ma-ma-ma”)
• Tries to communicate by actions or gestures
• Tries to repeat your sounds

12 – 17 months:

• Answers simple questions nonverbally
• Says two to three words to label a person or object (pronunciation may not be clear)
• Tries to imitate simple words

18 – 23 months:

• Correctly pronounces most vowels and n, m, p, h, especially in the beginning of syllables and short words. Also begins to use other speech sounds
• Says 8 to 10 words (pronunciation may still be unclear)
• Asks for common foods by name
• Makes animal sounds such as “moo”
• Starting to combine words such as “more milk”
• Begins to use pronouns such as “mine”

2 – 3 years:

• Says around 40 words at 24 months
• Speech is becoming more accurate but may still leave off ending sounds
• Strangers may not be able to understand much of what is said
• Answers simple questions
• Begins to use more pronouns such as “you,” “I”
• Speaks in two to three-word phrases
• Uses question inflection to ask for something (e.g., “My ball?”)
• Begins to use plurals such as “shoes” or “socks” and regular past tense verbs such as “jumped”

3 – 4 years:

• Groups objects such as foods, clothes, etc.
• Uses most speech sounds but may distort some of the more difficult sounds such as l, r, s, sh, ch, y, v, z, th. These sounds may not be fully mastered until age 7 or 8
• Uses consonants in the beginning, middle, and ends of words. Some of the more difficult consonants may be distorted, but attempts to say them.
• Strangers are able to understand much of what is said
• Able to describe the use of objects such as “fork,” “car,” etc.
• Has fun with language. Enjoys poems and recognizes language absurdities such as, “Is that an elephant on your head?”
• Expresses ideas and feelings rather than just talking about the world around him or her
• Uses verbs that end in “ing,” such as “walking,” “talking”
• Answers simple questions such as “What do you do when you are hungry?”
• Repeats sentences

4 – 5years:

• Speech is understandable but makes mistakes pronouncing long, difficult, or complex words such as “hippopotamus”
• Says about 200 – 300 different words
• Uses some irregular past tense verbs such as “ran,” “fell”
• Describes how to do things such as painting a picture
• Defines words
• Lists items that belong in a category such as animals, vehicles, etc.
• Answers “why” questions

5 years:

• Engages in conversation
• Sentences can be 8 or more words in length
• Uses compound and complex sentences
• Describes objects
• Uses imagination to create stories

When baby:

• Doesn’t startle in response to a sudden loud sound
• doesn’t respond to sounds, music, or voices
• isn’t soothed by soft sounds
• doesn’t move or wake up at the sound of voices or nearby noises when sleeping in a quiet room
• by 2 months, doesn’t make vowel sounds like “ohh”
• by 2 months, doesn’t become quiet at the sound of familiar voices

Children that are having speech delay disorders could have the following characteristics:

• Speech mechanism in which speech is associated with hearing, motor speech and craniofacial malfunction
• Aspects in which the impairment is associated with the child’s intellectual, receptive, expressive and linguistic ability.
• Issues in which the impairment is associated with caregiver, school environment, and the child’s self behaviours such as aggression and maturity
• The many other causes of speech delay include bilingual children with phonological disorders, autism spectrum disorder childhood apraxia, Auditory processing disorder, prematurity, cognitive impairment and hearing loss.

The microphone picks up sounds and sends them to a small computer with an amplifier that makes the sound louder. The hearing aid will make some pitches of sound louder than others, depending on the shape and severity of the hearing loss. Your audiologist will connect the hearing aid to a computer program in order to adjust the sound for your child’s needs. After sounds are made louder, they go through the earhook – a small plastic piece that holds the hearing aid on over the top of the ear – to an earmold that is custom made for your child

A cochlear implant (CI) is a surgically implanted electronic device that provides a sense of sound to a person who is profoundly deaf or severely hard of hearing in both ears.

Children with hearing loss as young as 12 months old can be eligible for a cochlear implant. Experts recommend implantation as early as possible to expose children to sounds during the critical period of language acquisition. After implantation, they must undergo intense speech and language therapy in order to achieve the best possible outcome from the device.

Children are considered viable candidates when they:

• Have profound hearing loss in both ears.
• Get little or no benefit through the use of hearing aids.
• Are healthy and any medical conditions would not compromise surgery.
• Understand (when able), along with their parents, their role in the successful use of cochlear implants.
• Have support from family and an educational program that will emphasize the development of auditory skills.

Auditory-verbal therapy is a method for teaching hearing loss children to listen and speak using their residual hearing in addition to the constant use of amplification devices such as hearing aids, FM devices, and cochlear implant. Auditory-verbal therapy emphasizes speech and listening.

The Auditory Verbal approach stimulates auditory brain development and enables deaf children with hearing aids and cochlear implants to make sense of the sound relayed by their devices. As a result, children with hearing loss are better able to develop listening and spoken language skills, with the aim of giving them the same opportunities and an equal start in life as hearing children.