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YOUR CHILD'S HEARING - What You Need to Know
by Tricia E Sullivan & Sue E. Ouellette

When a child is born with a cleft lip and/or cleft palate, there are obvious issues that need immediate attention. There may, however, be an associated problem that goes undetected - hearing loss. Children who have cleft palates are more likely to experience hearing loss than are other children. Although the kinds of hearing loss associated with cleft palate are often temporary and correctable through medication or surgery, more permanent forms of hearing loss can also occur. Hearing impairments can interfere with the development of speech and language, two of the major tasks of early childhood. For this reason, it is very important that hearing loss be detected and treated as early as possible. This article is intended to provide you with a basic information about hearing and hearing loss so that you can be an active partner in the treatment of your child.
The ability to hear occurs as the result of vibration and mechanical movements. Sound moves through the ear canal and travels up to the eardrum. The sound waves cause the eardrum to vibrate and send the sound to three small bones in the middle ear. This mechanical movement makes the third bone, the foot plate, move slightly in and out of a hole that leads to the inner ear. This movement causes fluid in the inner ear, or cochlea, to move. Vibration of the inner ear bends the tiny hair cells that line the cochlea. These cells in turn send a message along the nerves to the brain and that message is recognized by the brain as sound. Hearing loss can happen at any point along this complicated route and it is defined differently depending on where the problem occurs. A conductive loss occurs when there is a problem in the ear canal or middle ear. This type of loss can be corrected by surgery and/or medication and is treated by a physician. Examples include wax in the ear, a break in the connection among the three bones in the middle ear, and fluid in the ear, called otitis media.

Otitis media (fluid in the ear) is the most common kind of ear problem experienced by young children. It occurs most often in the first two years of life and decreases in frequency as the child gets older. Otitis media can occur with or without an infection; when there is no infection it may be called serious otitis media and when infection is present it is called purulent otitis media. Children with cleft palate experience otitis media more often than other children. Fifty to ninety percent of children with cleft palate will have episodes of otitis media in the first two years of life. Otitis media can affect children in many different ways. Some symptoms that may indicate a middle ear infection (purulent otitis media) include pulling or rubbing the ear(s), fever, being cranky or drowsy, and drainage from the ear. Some children have otitis media without symptoms; this may occur especially when there is fluid in the ear but no infection (serious otitis media). Behavioral observations may provide clues in this situation; for example, your child may not be responsive to your voice as he or she usually is. Parents are usually the first and best persons to notice when a child is having difficulty hearing for whatever reason.

The concern that professionals have about young children and otitis media goes beyond just hearing. When children have repeated episodes of otitis media, speech and language development can be affected. When a child's hearing fluctuates from day to day, the child may have difficulty learning new words and how to use them and/or learning to speak in a manner appropriate to his or her age. If your child has frequent ear infections or you are informed that he or she often has fluid in the ear(s) you will, of course, want to make sure your child has appropriate medical care. Your family physician may choose to treat otitis media through medication or may refer you to an otolaryngologist (ENT) to be evaluated for other types of treatment including a simple surgery (myringotomy) to insert tubes into the ears so that the fluid can drain. This procedure is done on an out-patient basis and is safe and painless. Your physician may also enlist the services of an audiologist, a professional who specializes in diagnosing and treating hearing loss, in order to monitor your child's hearing.

A second type of hearing loss occurs when there is damage to the inner ear or to the nerves that transmit sound from the ear to the brain. This type of permanent hearing loss is called a sensorineural loss and is usually diagnosed through hearing tests or special tests that measure how the brain receives and interprets sound waves. A third type of hearing loss is a mixed loss that combines some form of conductive (temporary) loss with some amount of a permanent, sensorilneural loss. Children with these types of losses may benefit from the use of a hearing aid and other special assistance available from an audiologist and other professionals.

It can be overwhelming enough to make decisions about the treatment of your child's cleft, but it is also important to safeguard your child's hearing since he or she is at a high risk for developing hearing-related problems. Children with cleft palates should be screened for hearing loss as soon after birth as possible, preferably before they go home from the hospital. If that is not possible, then hearing should be evaluated by a qualified audiologist within the first three months of life. As parents, you know your child best and the information that you provide to the audiologist is extremely important. You alone can give the audiologist examples of behaviors she or he may not see within the specific time spent with your child. Parents are the key to successful diagnosis and treatment and should be important members of the treatment team.

If you suspect that your child may have difficulty hearing, please have her or him evaluated as soon as possible. Hearing is the sense through which we learn about the world around us and the means by which we communicate with others. As such, safeguarding your child's hearing will ensure that he or she has the best possible start in life. Early intervention is the key to successful treatment. Your pediatrician or audiologist can provide further 
information or you may want to contact the American Speech-Language and Hearing Association (ASHA) at 10801 Rockville Pike, Rockville MD, 20852, or telephone ASHA at 800-638-8255.

-------------------Tricia Sullivan is a graduate student in Audiology at Northern Illinois University where Dr. Ouellette serves as Professor and Director of the Research and Training Center on Traditionally Undeserved Persons Who are Deaf.

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