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First Steps A Parent’s Guide to Childhood Hearing Loss Photo credit http://www.hearing.siemens.com 1 Table of Contents Welcome! Page 3 What is newborn hearing screening? Pages 4-5 What are the signs of hearing loss? Pages 6-7 How do I read an audiogram? Pages 8-11 What are the types of hearing loss? What are hearing tests for children? Pages 12-14 Pages 15-16 What’s a hearing aid? Pages 17-18 Professionals to Help You Pages 19-20 MN/National resources for hearing loss Pages 21-23 2 Welcome! My name is Pam Reynolds-Klocke, and I am an audiologist in the Twin Cities area of Minnesota. I have been practicing as an audiologist for 12 years. I graduated from the University of Utah with a masters degree in Audiology in 2001. I am currently working on my Doctor of Audiology degree (AuD) through AT Still University. This website is intended to be a resource for children newly diagnosed with hearing loss and their families. I was diagnosed with a unilateral, mild to profound mixed hearing loss in my left ear at age 3. Back when I was young, newborn hearing screening programs didn’t exist. Thankfully, I had a very attentive nursery school teacher who noticed that I was never able to hear someone whisper in my left ear during the game of Telephone. I was diagnosed a few weeks later. There were many challenges growing up with hearing loss, but I learned a lot along the way. It also inspired my career choice in audiology so that I could help others with hearing loss. There is so much technology available now to help children with hearing loss, and there is also tons of information to help educate parents and family members about the impact of hearing loss. I’ve tried to consolidate that into this website, as well as some links to give you more information. Please feel free to send any comments or questions! I hope this information will help you on your journey. Pam This information is general only. It is not intended to be a replacement for a thorough medical and audiological exam. 3 What is newborn hearing screening?? Photo credit http://www.embell.co.uk Thanks to technology, we can actually diagnose hearing loss within hours of a baby's birth! Most states require all babies to have a hearing screening before leaving the hospital. This is an important first step in identifying babies with hearing loss. The sooner babies are diagnosed with hearing loss, the sooner intervention can begin, and the more normal the baby's speech and language development will be. Did you know? According to the American Speech-Language and Hearing Association, 3 out of every 1000 babies delivered will be diagnosed with hearing loss. How is this testing done? There are two ways in which newborn hearing screening is done. The first test is called an otoacoustic emissions (OAE) test. A small earphone is placed in each of the baby's ears. The earphone contains a tiny microphone and speaker. First, a series of tones or clicks come into each ear from the speaker. If tiny sensory cells in the inner ear, called outer hair cells, are working correctly, a small sound is actually emitted from the ear and is recorded by the microphone. The loudness of these sounds is then compared to normative data in a computer program that show us if these sounds are within the range of normal. Here is an example of what a passing distortion product otoacoustic emissions test for the left ear looks like. The OAEs are in blue, the noise levels are in green. Photo credit http://www.bradingrao.com For more information on otoacoustic emissions, here is a website for you to check out. http://www.asha.org/public/hearing/Otoacoustic-Emissions/">here</a>. 4 The second test is called an automated auditory brainstem response (AABR) test. Small sticky electrodes are placed behind the baby's ears and on the forehead. Small earphones with a tiny speaker are inserted into the baby's ears. Soft tones or clicks come into each ear from the speaker, and the electrodes pick up the auditory nerve's response to these sounds, which are recorded as waveforms. These waveforms are compared to normative data in the computer to see how soon they occur after the stimulus and how large they are. Here is an example of an ABR tracing. The major waveforms are numbered. The top graph has waveforms that are more robust and also occur close together in time, which suggests that the patient was being tested with a higher intensity sound. As you look at the other waveforms, you can see that they gradually diminish in height and are occur farther apart in time. This occurs when softer level stimuli are used. When the intensity of the sound gets below a person's threshold of hearing, the waveforms are either absent or very delayed. Photo credit http://www.dizziness-and-balance.com For more information on automated auditory brainstem response testing, here is another website to help you. http://emedicine.medscape.com/article/836277-overview Both of these tests can take only minutes with a quiet, sleeping baby! The result of both tests will either be a PASS or REFER for each ear. If your infant has a REFER result, prompt follow-up should be scheduled for a more thorough evaluation. Keep in mind that OAE and AABR are not truly hearing tests. They both test different parts of the auditory system and to some extent they can give us clues about the child's hearing loss. However, behavioral hearing testing is necessary to know for sure the type and degree of hearing loss a child has. See more about this under the "Hearing testing for children. 5 What are the signs of hearing loss? photo credit http://www.sheknows.com Although newborn hearing screening helps us to diagnose hearing loss at birth, many times hearing loss can happen later in the child’s development. It’s important for parents and family members to be aware of the signs that your child is not hearing normally. Here are some of the behaviors to look for if your child is not hearing well. Delayed speech and language: Children learn language by listening to the people around them and emulating what they hear. If they are unable to hear the different sounds of speech normally, they will be slower to learn sounds and words. Talk to your pediatrician or audiologist if you have concerns about your child’s language development. To be sure your child is achieving the normal speech and language milestones expected for his age group, visit http://www.asha.org/public/speech/development/chart.htm or ask your audiologist for more information. Saying “what” all the time: Hearing loss causes us to miss some of the softer consonant sounds of speech which make it difficult to tell words apart. Children that are missing speech sounds may ask parents or teachers to repeat what they’ve said or may repeat things back to others incorrectly. Not startling or localizing to environmental sounds: If your baby doesn’t startle when a door slams shut, doesn’t seem to notice a dog barking, or doesn’t respond to voices or music in their environment, there may be some cause for concern. Difficulties in school: Children that aren’t able to hear well will have difficulty in a classroom environment, especially one with an open floor plan, group (“pod”) classroom design, or if they are sitting far away from the teacher. Background noise situations, like the cafeteria, gym class or during classroom group work, are usually very challenging for children with hearing loss. Lower grades in reading, spelling or phonics may also indicate a problem. If your child complains of difficulties hearing in certain classes or if the child’s teacher voices concerns, it’s a good idea to get the child’s hearing checked out. 6 Intuition: A parent’s intuition that something is wrong should never be disregarded. You know your child the best out of everyone. If you notice that your child seems to speak and sound different from other kids, alerts unusually to environmental sounds, seems disconnected from conversation or doesn’t seem to be responding well to simple requests, have your child’s hearing evaluated. It’s far better to have things evaluated now and find out hearing is normal than to wait and discover hearing loss later. Note: Keep in mind that there can be other reasons unrelated to hearing loss for some of the behaviors above. For example, children may have delayed speech and language with perfectly normal hearing, or may have a learning disability that might be impacting academic progress. It’s always better to have a professional evaluate your child to rule out hearing loss as the cause of these issues. For more information on signs and symptoms of hearing loss, visit http://www.pamf.org/hearinghealth/facts/children.html 7 How do I read an Audiogram? photo credit http://www.en.wikipedia.org The Audiogram When your child has a hearing test, the test results will be displayed on a graph called an audiogram (see above). This graph will show the softest sound levels each ear can hear sounds of different pitch. The softness or loudness of the sounds presented are graphed from top to bottom. This is measured in deciBels hearing level (dBHL). If your child responds to sounds at very soft levels, the marks will be closer to the top of the graph. If there is hearing loss, the marks will be made further down on the graph. The further down the marks are, the more hearing loss there is. The American Speech-Language Hearing Association (ASHA) defines the different levels of hearing loss as follows: Photo credit http://www.pedsent.com Normal hearing: -10dBHL to 25dBHL Mild hearing loss: 26 dBHL to 40 dBHL. Moderate hearing loss: 41 dBHL to 55 dBHL. Moderately severe hearing loss: 56 dBHL to 70 dBHL Severe hearing loss: 71 dBHL to 90 dBHL Profound hearing loss: 91dBHL + 8 From left to right on the graph are the different frequencies or pitches that are tested. This is measured in Hertz (Hz). Think of frequencies like musical notes. They are graphed from low pitch to high pitch from left to right on the graph, just like the keys are set up on a piano. Low frequency hearing loss: 250 Hz to 1000 Hz. Mid-frequency hearing loss: 1000 Hz to 4000 Hz. High frequency hearing loss: 4000 Hz to 16000 Hz. ASHA also discusses other terms you may hear when discussing an audiogram: Unilateral/bilateral: One ear/both ears have hearing loss Symmetrical/Asymmetrical: The ears hear the same/the ears hear differently Progressive hearing loss: The hearing loss is getting worse Fluctuating hearing loss: The hearing loss can be better and worse at different times Sudden hearing loss: The hearing loss happened very quickly Reading the audiogram When you first see an audiogram, you will notice many colors and symbols on the graph. Each of these marks is important. Every audiogram should have a key on the page to help you understand what you are seeing. If your child was tested in soundfield, these responses are written on the audiogram as an S (for soundfield) or NB (for responses to narrow band noise). Responses for air conduction (AC) hearing (when your child wears earphones) and bone conduction (BC) hearing (when your child wears a bone conduction vibrator) are shown on the graph. Remember that air conduction tests the outer, middle, inner and neural parts of the ear. Bone conduction tests only the inner and neural parts of the ear. 9 Here’s an audiogram showing hearing for the right and left ears. Photo credit http://www.siemens.com The right ear’s responses are shown in red. AC responses: o BC responses: < The left ear’s responses are shown in blue. AC responses: x BC responses: > Masking If the ears hear very differently from each other, or if there is a conductive/mixed hearing loss, the audiologist will use a technique known as masking. Because the inner ear is actually part of the skull, if you present a sound loud enough, both cochleas will actually respond to the sound, making it hard to tell which ear hears what. Masking will be used when: *air conduction testing shows a difference of 40dB or more between the hearing levels in each ear at each frequency *bone conduction testing shows a 10 dB or more difference between air and bone conduction levels in each ear at each frequency To use masking, the audiologist will initiate a noise in the better hearing ear that sounds like static. This will keep the better ear busy listening to the noise, ensuring that only the poorer ear will be responding to the tones. If masking is used, there are different symbols to show this on the audiogram. Right ear will be shown in red Masked AC: triangle Masked BC: [ Left ear will be shown in blue Masked AC: box Masked BC: ] 10 Photo credit http://www.phaseseminars.com Here is an audiogram showing that masking was used to test the left ear, since it is worsehearing than the right ear. The loudness limits of an audiometer are not without a ceiling. If your child has a very severe hearing loss, you may see marks made at the very bottom of the graph with downward arrows coming from them. These marks indicate that hearing loss is so severe that the audiometer was not able to produce a sound loud enough for your child to hear. Here below is an audiogram depicting these symbols in the mid to high frequencies in both ears. Photo credit http://www.raisingdeafkids.org 11 What are the types of hearing loss? photo credit http://www.soundonsound.com How the hearing system works This is a drawing of the different parts of the ear. The outer ear comprises the pinna (the outside flap of the ear) and the ear canal (external auditory canal). Sound waves are funneled down the ear canal to the middle ear, which consists of the tympanic membrane (eardrum), tympanic cavity (middle ear space), the Eustachian tube and the ossicles (three tiny bones in the middle ear space). The inner ear consists of the bony, fluid filled spaces of the snail shell-shaped cochlea (the sense organ of hearing) and the semicircular canals (the organs of balance). Sound waves move the eardrum and the ossicles like a chain, and the last ossicle moves back and forth into a small opening in the cochlea, creating a small wave that travels through the fluids of the cochlea. All along the cochlea are tiny sensory cells that respond to different frequencies of sound. Depending on the sound that is heard, the wave sent from the middle ear into the cochlea will reach the corresponding place along the cochlea, stimulating the little sensory cells in that area. When these cells are excited, they send electrical signals to the auditory nerve, which travel along the nerve to the brainstem and the brain, where these impulses are translated into information about sound, speech or the body’s position in space. Visit http://www.youtube.com/watch?v=0jyxhozq89g for a great animated YouTube video showing how the ear works. The types of hearing loss There are many types of hearing loss. The type of hearing loss your child may have depends on the part of the ear that is affected. The five types of hearing loss are conductive hearing loss, sensorineural hearing loss, mixed hearing loss, neural hearing loss and auditory processing disorder. 12 photo credit http://www.illinoissoundbeginnings.org Conductive hearing loss (CHL): Conductive hearing loss occurs when there is a problem with the outer or middle ear. CHL causes a weaker signal to travel to the normal inner ear resulting in hearing loss. The above graph shows a conductive hearing loss in the left ear. The air conduction results are the blue Xs. The bone conduction results are the blue >s. Note that the BC results are closer to the top of the graph! The hallmark of conductive hearing loss is normal hearing with bone conduction and hearing loss with air conduction. This occurs because bone conduction does not test the affected middle ear! Sometimes this type of hearing loss can be corrected or improved with surgery or medical intervention. Common causes of conductive hearing loss include: Holes in the eardrum (perforations) Fluid in the middle ear (otitis media) Disconnection or stiffening of the middle ear bones The stapes getting stuck in its opening to the cochlea (otosclerosis) Sensorineural hearing loss (SNHL): Sensorineural hearing loss occurs when there is a problem with the inner ear. In this case, the signal from the other and middle ear gets to the cochlea at the correct level, but because of damage to the sensory cells of the inner ear, the cochlea cannot stimulate the hearing nerve normally to get the signal to the brain. The above graph shows a high frequency sensorineural hearing loss in the left ear. Here, the AC and BC results are the same, because the cochlea is tested by AC and BC testing. This type of hearing loss is generally permanent and cannot be corrected or improved with surgery or medical intervention. Common causes of sensorineural hearing loss in children include: 13 Medication interactions Family history of childhood hearing loss Head trauma Different diseases or syndromes photo credit http://www.illinoissoundbeginnings.org Mixed hearing loss (MHL): Mixed hearing loss is a combination of both conductive and sensorineural hearing loss and indicates a problem with the outer/middle ear and the inner ear. In this case, the middle ear will send a weaker signal to the inner ear through air conduction, and in combination with that, the inner ear will also be unable to stimulate the auditory nerve normally because of damage to the inner ear. Some of the bone conduction responses may be normal or close to normal, depending on what is affected in the middle ear. The above graph shows a mixed high frequency hearing loss in the left ear. In the lower frequencies, bone conduction is close to normal, but as the frequency increases, the bone conduction gets worse and matches up with the air conduction results. Neural hearing loss (NHL): Neural hearing loss occurs when there is a problem with the nerve transmission of sound from the cochlea to the brain. In this case, the outer, middle and inner ears may respond normally, but because of damage to the auditory nerve or anywhere along the neural pathway to the brain, the signal that gets to the hearing part of the brain is altered. A neural hearing loss can have almost any type of audiogram (normal to profound), normal middle ear function, normal otoacoustic emissions, but will generally have decreased speech understanding scores, elevated or poor acoustic reflexes and abnormal auditory brainstem response testing. Auditory Processing Disorder (APD): Think of auditory processing as what the brain does with what it hears. There are two parts to hearing: detection and comprehension. Some children can have normal detection of sounds (ie. a normal audiogram) yet still have trouble understanding speech, especially in background noise situations or if the speech signal isn’t ideal. These children can also have trouble following directions or staying organized. An auditory processing disorder will most likely have a normal audiogram, tympanograms, reflexes, OAEs and ABRs, but may show poorer than expected speech test scores. There are several special tests that can be performed to help diagnose an auditory processing disorder. Ask your audiologist if you have concerns about auditory processing disorder with your child. 14 What are hearing tests for children? photo credit http://www.blogs.babycenter.com You may wonder how hearing is tested in children. There are several different methods that are used. The testing selected is usually based on several factors such as a child’s developmental age, agility, dexterity, and attention span. Whether it’s speech or frequency specific stimuli, sounds are presented at softer and softer levels until we see that the child is able to hear the sound 50% of the time (called a hearing threshold). The most common testing that is performed are discussed below. Tympanometry: Also commonly called a pressure test, tympanometry tests the function of the tympanic membrane (eardrum) and the ossicles (the three tiny bones of the middle ear). A small earpiece is inserted into the ear canal, and a small pressure change is introduced into the ear. This pressure change moves the eardrum and the ossicles back and forth, and their movement is recorded in the computer, creating a graph that shows the outer ear canal’s volume and the degree of movement caused by the pressure change. A normally functioning middle ear system will reveal a graph that looks like a circus tent, showing eardrum/ossicle movement. An abnormal tympanogram would appear as a flat line. If there is fluid or another obstruction in the middle ear space, or a hole in the eardrum, the eardrum and ossicles can’t move. Behavioral observation audiometry (BOA): This testing method is used with infants from birth to six months. Newborns are obviously unable to respond conventionally to sound, but research has shown that when a sound is heard, children will cease sucking activity while nursing or using a pacifier, and then will resume sucking after the sound stops. This testing can be conducted in sound field (inside a soundproof booth using speakers) or using earphones. The audiologist will present sounds while observing the infant’s sucking behavior. Testing with earphones allows ear-specific testing, while sound field testing only tests the better hearing of the two ears. Visual reinforcement audiometry (VRA): This testing method is used with children aged six months to 36 months. A child is seated in their parent’s lap inside a sound booth. Decreasing sounds or speech are presented through speakers or earphones and the child is conditioned to look in the direction of a reinforcing toy whenever he hears the sound. The toy is then lighted or animated only when the child looks. While sound field testing using two speakers can give us some information on localization, it still does not test each ear individually. Conditioned Play Audiometry (CPA): This testing method is used with children aged 3-5. The child is conditioned to do a play task (putting a block in a bucket, adding a peg to a 15 peg board, clapping their hands, etc) when they hear a sound. Earphones are preferred for this testing. Children over age 5 can generally be tested using conventional hearing test methods, such as raising a hand or pressing a button when a sound is heard. Did you know? Children with hearing loss in one ear and normal hearing in the other ear, or low frequency hearing loss in one ear and high frequency hearing loss in the other ear, can all show normal sound field hearing test results, so ear specific hearing testing is very important! Speech testing: It’s important to know how soft the child is able to hear speech and language. There are several kinds of speech testing. Younger children (ages birth-3 years) will generally respond to speech sounds (/ba/, /sh/ and /s/ or conversational speech) presented from earphones or speakers. Children ages 3-5 can point to corresponding body parts or pictures on a board when they hear a word spoken through the earphones. Older children over age 5 can either repeat two syllable words (called spondees) to get a speech reception threshold (SRT) or can repeat a list of words at a standard level slightly above their hearing thresholds, called word discrimination testing. OAEs and ABRs (discussed in the first section for newborn hearing screening) can also be used with older children to help pinpoint the part of the hearing system that is not working normally. See this section for a review of what these tests are and what they measure. 16 Professionals to Help You It takes a village to help a child with hearing loss, and there are many people who will help you and your child along your journey. Here is a list of some of the professionals you may meet or work with. Otolaryngologist: An otolaryngologist is an ear, nose, and throat specialist. They have an MD degree. He or she will look in your child’s ears to rule out any medical problems that could be causing the hearing loss, which sometimes can be corrected surgically or with medication. They also provide medical clearance for your child to wear a hearing aid, which is required by the FDA before a fitting can take place. Audiologist: An audiologist is a specialist in hearing and balance disorders. They have a masters degree in audiology (MA or MS) or a Doctor of Audiology degree (AuD). They perform hearing evaluations and counseling on test results. They are also specialists with amplification (hearing aids, cochlear implants, etc) and assistive listening devices. They will recommend and fit appropriate amplification to your child. An Educational Audiologist works for the school system. He or she will help monitor your child’s progress in the classroom and will ensure amplification is working correctly. Speech-language Pathologist: A speech-language pathologist is a specialist in speech and language disorders. They have a masters degree in speech-language pathology (MA or MS). If your child has hearing loss, he or she may need help learning and practicing the specific sounds of speech, even after a hearing aid or cochlear implant has been fit. They will provide therapy for your child if needed and will also follow their progress to ensure that important developmental milestones are being met. Special Education Specialist: A special education specialist is a certified teacher in your school or school district who works with children with special needs. He or she will be responsible for working with you on your child’s academic placement and progress. They will also help to create an Individualized Education Plan (IEP) if special services or accommodations are necessary for your child in school. This plan will be updated annually as your child gets older. They will also work with your child’s classroom teachers once your child is mainstreamed to ensure they are meeting goals set for them. 17 Genetic Counselor: Certain genes in the human genome can sometimes cause hearing loss. A genetic counselor has a master’s degree (MA or MS) in genetic counseling. They will look at your family history and the type of hearing loss your child has. They will explain how genetics can cause hearing loss and what is involved in genetic testing. They will help you decide if this testing is right for you. After testing is complete, they will review the results with you and discuss your options. Your child’s pediatrician and classroom teacher are also important parts of the team! 18 What’s a Hearing Aid? Hearing aids are very small electronic devices that we can wear to help us hear better. They come in a variety of shapes, sizes and colors, and can do many different things. Here you can learn a little bit about them. What do hearing aids look like? photo credit http://www.lakesideaudiology.com There are many different styles of hearing aids. Since children’s ears are still growing and developing, the style that is likely to be recommended for your child is a behind-the-ear style, otherwise known as a BTE. These are shown in the top row of the picture above. This unit sits back behind your child’s ear and connects into the ear using either a custom-made plastic earpiece called an earmold or a small slim plastic tube and soft plastic dome. BTEs come in many fun colors and some even have fun patterns on them or come with stickers so your child can decorate them. Custom hearing aids are hearing aids made from an impression of your child’s ears, so that the housing of the hearing aid is custom made. These are shown in the bottom row of the picture above. They fit inside the ear rather than behind the ear. They come in several styles and sizes. Custom hearing aids are generally not recommended for smaller children because their ears continue to grow until adolescence and would need many costly shell remakes to keep the fit current and secure. Hearing aids that do not fit securely can cause problems like feedback (whistling), discomfort, or even possible loss of the hearing aid. How do hearing aids work? photo credit http://www.illinoissoundbeginnings.org A hearing aid has three electronic parts: a microphone, an amplifier, and a receiver. First, the microphone picks up the sounds in your child’s environment. The microphone sends this signal to the amplifier, which is controlled by a computer chip. When your child is fit 19 with a hearing aid, the hearing aid is connected either wirelessly or with a small wire to the computer. The audiologist enters your child’s hearing loss into the computer, and based on their hearing test, the computer chip decides how much each frequency should be turned up. The chip tells the amplifier what sounds to increase, and this amplified signal is then sent to the receiver. The receiver is a tiny speaker that puts the amplified sound into the ear. Some hearing aids have volume controls on them, so that your child can turn the sound of the hearing aid up or down themselves. Some have program switches where programs for hearing better in different environments can be accessed. Some examples of different listening programs are for hearing better in background noise, watching TV or hearing well on the telephone, or accessing an FM program for a classroom. Many times in younger children hearing aids will be ordered without these features or have them disabled. This is to prevent the child from unknowingly turning the hearing aid off, turning it too loud or too soft, or choosing the wrong program for the wrong environment. Some will also have special battery doors that are child-proof so that the child cannot get to the battery and accidentally eat it or lose it. 20 MN/National Resources for Hearing Loss Photo credit http://www.infanthearing.vihsu.org.au As a parent of a child with hearing loss, you may sometimes feel alone and overwhelmed, uncertain of what to expect for your child’s development and academic growth and how you can help them. There are many supportive resources in Minnesota and nationwide for children with hearing loss and their families. Whether it’s learning about hearing loss, securing services for your child, or finding financial or emotional support, all of these resources can help or point you in the right direction. Hearing Loss Resource Center 709 University Ave, West St. Paul, MN 55104 (651)245-2435 TTY (651)265-2779 Toll free (866)857-2329 http://www.familysupportconnection.org/ This is a non-profit organization that provides help and support for deaf or hearing impaired children and their families. The HLRC is supportive of hearing and Deaf culture. They offer a lending library of support materials and connect families of newly-diagnosed hearing impaired children with other families of previously diagnosed children who can answer questions and offer assistance. Help Me Grow (651)201-3641 http://www.health.state.mn.us/divs/fh/mcshn/ecip.htm A program through the MN Dept of Health, Help Me Grow is an early intervention program for infants and toddlers with hearing loss. This organization can help get qualifying children the crucial services they need to thrive, such as speech therapy, PT and OT. Audiology services, assistive technology, and family counseling are just some of the options available. To see if your young child qualifies for these services, you can contact MDH directly or visit their website for eligibility information. 21 MN Deaf and Hard of Hearing Services Dept of Human Services Administration Building 540 Cedar St, St. Paul, MN 55164 (651)431-5940 http://www.health.state.mn.us/divs/fh/mcshn/ecip.htm With 6 locations to serve you throughout MN, the DHHS program provides educational materials, online trainings, and information on ASL interpreter services and the MN Telephone Equipment Distribution Program to provide captioned phones for the hearing impaired. Information on emergency preparedness for our volatile MN weather is also provided. Click here to find the location closest to you. University of Minnesota Hearing Aid Bank (612)626-0946 Once hearing loss is diagnosed, it’s important to fit children with hearing aids as soon as possible so they won’t fall behind on speech-language and auditory development. The Hearing Aid Bank is a fantastic resource for families who want to fit their children with temporary amplification while evaluating their options to purchase permanent hearing aids. This agency provides reconditioned hearing aids that can be used for 6 months. Northern Voices An Oral School for the Deaf 1660 W County Road B Roseville, MN 55113 (651)639-2535 http://www.northernvoices.org Northern Voices is a school that works exclusively with hard of hearing/deaf children from birth to 2-3rd grade. Their goal is to help children with hearing loss gain the skills they need to be in a mainstreamed school with their same-age peers. They work on speechlanguage and cognitive skills and give families critical information about their child’s education and future. Here are some great websites for national organizations to help you learn more about hearing loss. American Speech-Language and Hearing Association 2200 Research Boulevard Rockville, MD 20850-3289 (800)638-8255 http://www.asha.org/public 22 Alexander Graham Bell Association for the Deaf and Hard of Hearing 3417 Volta Place, NW Washington, DC 20007 202-337-5220 (Voice) 202-337-5221 (TTY) http://listeningandspokenlanguage.org/ Boys Town National Research Hospital 555 N. 30th Street Omaha, NE 68131 402-498-6511 (Voice) http://www.babyhearing.org/ National Institute on Deafness and Other Communication Disorders National Institutes of Health NIDCD Information Clearinghouse 1 Communication Avenue Bethesda, MD 20892-3456 800-241-1044 (Voice) 800-241-1055 (TTY) [email protected] Visit my website at http://www.firststepshl.wordpress.com for more information. 23