Navigating the Early Hearing Detection and Intervention (EHDI) Process
This page describes many options for audiological intervention. It is recommended that children with hearing loss have routine hearing screens. If families choose to use amplification devices*, they have access to different options and should follow up with an audiologist for device check ups. There is a wide variety of communication and treatment options available for your family to explore.
*Amplification includes the use of hearing aids, cochlear implants, and other devices intended to increase sound awareness.
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 (even if the family chooses not to use amplification devices). There are many different options for children with hearing loss and their families.
Why Is Screening Important?
Screening is a pass/fail test to determine if your child needs diagnostic testing.
What Does Screening Look Like?
Two different tests are available to screen for hearing loss in babies. Your baby needs to rest or sleep during both tests.
Otoacoustic Emissions (OAE) tests determine whether some parts of the ear respond to sound. During this test, a soft earphone is inserted into your baby’s ear canal. It plays sounds and measures an "echo" response that occurs in ears with normal hearing. If there is no echo, your baby might have hearing loss. Learn more.
The Automated Auditory Brainstem Response (AABR) (formerly known as BAER) test measures the auditory nerve and brainstem (which carry sound from the ear to the brain) for response to sound. Once your child has fallen asleep, sensors are placed on the skin behind the ears and on the forehead. A soft earphone is placed in or around the ear and different levels of clicking sounds and tones will be played. Our computer will measure your child’s response to those sounds. It will give us either a pass or fail for each ear. Learn more.
The Importance of Screening
If the results show that your baby may have hearing loss, make an appointment with a pediatric audiologist—a hearing expert who specializes in the assessment and management of children with hearing loss. This follow-up exam should be done as soon as possible, ideally by the time the baby is 2 to 3 months old. The audiologist will conduct tests to determine whether your baby has a hearing problem and, if so, the type and extent of that problem.
The pediatric audiologist may recommend that your baby visit a pediatric ear, nose, and throat (ENT) physician who specializes in conditions affecting the ear, known as a pediatric otologist. A pediatric otologist can determine possible causes of hearing loss and recommend intervention options. If your child has siblings, the audiologist or otologist may also recommend that their hearing be tested (CDC).
Outpatient Audiology Follow-Up Appointments
Following these steps can help ensure that your follow-up appointment is as seamless as possible:
- Wake your baby up early and keep them awake until you reach your appontment. It may be helpful to have someone with you to keep the baby awake.
- To create the best test environment, we ask that only the child recieving the test and one parent or guardian enter the test room.
- Bring a bottle, or if you breastfeed, plan to feed your baby when you arrive for the appointment.
- If your baby sleeps well in a carrier/car seat, please bring it with you.
- Do not use any lotion on the baby's head or ears on the day of the appointment.
Early Intervention
Early Intervention provides services to children (birth to age 3) who have hearing loss and/or additional developmental disabilities.
Early intervention staff use a coaching approach in order to help families and other caregivers support the child's learnign and development. Visits take place where the child feels comfortable: home, daycare, or even the park.
An evaluation takes place to determine what types of providers and services would most benefit the child. Some suggestions may include speech, occupational, feeding, and physical therapy. An early interventionist or teacher of the deaf may also work with the child. A service coordinator helps families and caregivers navigate scheduling and goals.
Get Connected to Early Intervention
Every county in Kentucky is divided into regions that serve various counties at a time. These are called Points of Entry (POEs). There are various providers in each region that can work with your child based on the services they qualify for, such as teachers, speech and language pathologists, occupational therapists, and more.
It's never too early to start Early Intervention. Therapists can teach parents how to best interact with their child to further their language development. Interventionists meet you where you are in your journey and are trained to work with children who are Deaf and Hard of Hearing and their families.
Family and Community Support
There are several groups in Kentucky that support families of children with hearing loss, as well as deaf adults.
- Kentucky Hands & Voices is a parent-driven, non-biased group committed to supporting families no matter how you choose to communicate. They believe that when parents are given all of the information and resources, they are able to make the best choices for their family. H&V waiting room
- Guide by your Side (Kentucky Hands & Voices)™ is a family support program that embodies the mission and vision of Hands & Voices™, which is to provide unbiased support to families with children who are deaf or hard of hearing. Guide By Your Side (GBYS) does this through specially trained parents of children who are deaf or hard of hearing. These parents work as “Guides” directly with families who have just learned of their child’s hearing loss, or who have older children and are in need of the unique support that comes from someone else who has walked this path.
Kentucky Commission for the Deaf and Hard of Hearing (KCDHH) is a group that provides effective and efficient leadership, education, advocacy and programs to eliminate barriers and to meet the social, economic, educational, cultural, intellectual and health and human services needs of deaf and hard of hearing Kentuckians.
KY Deaf Blind Project is a statewide support network for families of children with dual sensory impairments, or deaf-blind
The Impact of Deaf/Hard of Hearing Adults
The inclusion of DHH adults in the lives of families with children who are DHH can have a profound impact for everyone involved; child, parent, professionals and DHH adults. Trained DHH adults who act as mentors, guides or role models are
uniquely qualified to provide families with a positive and hopeful perspective from their day-to-day, real life experiences as a DHH person living in a hearing world. In sharing these experiences and insights, DHH mentors/guides/role models may be able to articulate what a young child cannot, which brings an important perspective and credibility to the team discussion of the child’s needs, extending
beyond academics.
Kentucky Hands and Voices hosts virtual and in-person events that give families the chance to interact with Deaf and Hard of Hearing (D/HH) adults. Hands and Voices recognizes the importance of D/HH individuals with diverse languages, modes of communication, ages, education, and life experiences in all aspects of the organization. This diversity provides a valuable resource to families with deaf and hard of hearing children, enabling them to interact with peers and adults who embrace the Hands & Voices philosophy of non-biased support.
“Knowledge about what a child who is deaf or hard of hearing could become and the things s/he could accomplish, can dramatically alter the sequence of the process of grieving.”
Communication OptionsOne of parents' biggest fears when they find out their child has hearing loss is that their child will not be able to communicate. The good news is, there are many options to explore including speech, sign language, cued speech, and other non-verbal options. Every family and child is unique, and this choice is very personal.
Treatment Options
Audiological Intervention
What is an Audiologist?
Audiologists are health care professionals who test, diagnose, treat and manage hearing loss and balance disorders in people of all ages. An audiologist holds either a master’s (MA, MS) or a doctoral level degree in audiology (AuD, PhD, ScD), completes a fellowship or externship year, and is licensed to practice state by state. Some audiologists only work with children and are called pediatric audiologists. If a child is diagnosed with hearing loss, the family follows up regularly with the audiologist to monitor the hearing loss, the child’s communication development, and the hearing devices, if used. Regular adjustments to the hearing device(s) may also be necessary to meet the child’s needs. Audiologists also support families by connecting them with local resources. Click on the following links for more information about audiologists: What Is an Audiologist - American Academy of Audiology, Audiologist and ENT Referral Guide - American Speech-Language-Hearing Association
Types of Hearing Devices: - Traditional Hearing Aids: For small children, these are worn behind the ear and are attached to an earpiece custom made for the child. The sound from the hearing aid is based on the child’s hearing loss. The sound travels from the hearing aid, through the earpiece and into the child’s ear canal.
- Bone Conduction hearing aids use vibration to deliver amplified sound to the ears. The vibration cannot be felt by the user. The device can be worn on a softband or implanted. They are programmed based on the wearer’s hearing loss.
- Cochlear Implant(s) are devices surgically implanted in the inner ear that stimulate the hearing nerve directly. Signals that are created by the implant are sent from the hearing nerve to the brain where they are recognized as sound. They are programmed based on the wearer’s hearing loss.
- FM Systems /Remote Microphones send sound to a hearing device to help make sounds clearer in noisy environments (ex: a classroom setting).
Otolaryngology/Otorhinolaryngology Services
What is an ENT?
An ENT is a doctor that specializes in treating conditions of the ear, nose and throat. The ENT can treat a wide range of conditions including hearing loss, ear infections, balance disorders and tinnitus.
Why would I see an ENT?
Patients who have been diagnosed with any type of hearing loss are referred to an Ear, Nose and Throat Specialist. ENT Specialists examine the ears for any medical conditions, including those that may affect a person’s hearing. They also try to determine the cause of a patient’s hearing loss, often by ordering bloodwork and imaging (CT scans and/or MRIs). Medical clearance from an ENT is required before a patient under the age of 18 can be fit with hearing devices. A medical clearance statement says that the patient does not have a medical condition that would keep them from using or benefiting from a hearing device. The ENT will work with the audiologist and patient to determine the best type of hearing device. If a cochlear implant or implanted bone conduction device is the best option, they will be the doctor who does the surgery.
Diagnostic Testing:
What is diagnostic testing?
If your baby has failed a screening test, they should be referred for diagnostic testing with an audiologist. These tests show if a hearing loss is present and how much sound your child can hear.
Types of Diagnostic Tests
- Auditory Brainstem Response (ABR): The ear is made up of three parts - the outer, middle, and inner ear. The auditory brainstem response (ABR) test tells us how the inner ear, called the cochlea, and the brain pathways for hearing are working. You may also hear it called an auditory evoked potential (AEP). The test is used with very young children or others who cannot complete a typical hearing test. The test is typically completed with the child asleep. Sensors are placed on the skin behind the ears and on the forehead. A soft earphone is placed in the ear and different levels of clicking sounds and tones will be played. The computer will measure the brainwave response to those sounds. The audiologist will measure the quietest sounds that cause a response to determine if a hearing loss is present, and if so, how much.
- Otoacoustic Emissions (OAE): The OAE test is a test of the inner ear, or cochlea. There are hair cells in the inner ear that respond to sounds by vibrating. The vibration produces a very quiet sound that echoes back out of the ear. These vibrations are the otoacoustic emissions. If you have normal hearing, you will produce OAEs. If your hearing loss is greater than 25–30 decibels (dB), you will not produce these very soft sounds. The measurement of the OAEs can be affected by an issue like a blockage or fluid in the ear. If there is an issue, the sound sent into the ear may not reach the inner ear loud enough to cause the vibrations or it may weaken the OAEs so much that they cannot be picked up by the equipment.
- How is the OAE test done? A small earphone, or probe, is placed in the ear. The probe puts sounds into the ear and measures the sounds that come back. You do not need to do or say anything during the test. The person doing the test can see the results on the equipment screen.
- Tympanometry: Tympanometry is a test used to check the health of the middle ear and is not a test of hearing. It gives information about the eardrum (tympanic membrane) and the movement of the tiny bones in the middle ear (ossicular chain). It can also help identify if there is any fluid in the middle ear, holes in the eardrum or blockages in the ear canal. A small probe is placed in the ear to complete this test.
- Behavioral Testing:
- Visual Reinforcement Audiometry (VRA): VRA uses visual rewards, like a toy or video, to encourage children to respond to the test sounds. When they turn correctly to the sound, they are rewarded with seeing a toy or video. This test can be completed with the sound coming through speakers or headphones. VRA is most often used for testing hearing in children ages 6 months to 3 years old.
- Conditioned Play Audiometry (CPA): CPA is used mostly with preschool and slightly older children. The child is taught to play a listening game like putting a toy in a bucket or giving a high five when a sound is heard through a speaker or headphones. The child may also be asked to point to a body part or a specific picture, or to repeat a simple word to test their speech understanding.