The type and frequency of therapy needs to be determined by a formal speech and language evaluation with a qualified speech-language pathologist. This determination should be made based on the total needs of the patient, not just their hearing needs.

There are specialists who are trained to work with children with hearing loss. Depending upon the communication modality chosen by the family (i.e., spoken language, cued speech, manual communication, total communication), this will have a direct impact on the type of therapy the child should receiver.

For a child under one year of age, we need to be considering how best to support that child’s caregivers, whether that be their parents, grandparents or another caregiver. The caregivers need to become empowered to model appropriate language, and to utilize skills practiced in therapy at home with the child for the best possible outcomes.

Teaching the caregivers to become their child’s first therapist, and coaching parents how to become that is critical for the outcomes of any child, regardless of communication modality.

Partnering with parents and caregivers is what will ultimately determine the potential for success in whatever therapy is recommended. 

Treatments for unilateral hearing loss has a long history of a variety of options from nothing to cochlear implants.  We know that children with unilateral hearing loss are more likely to have difficulty in school, making them more susceptible to poor performance and repeating grades.  Earliest intervention is most ideal. 

Candidacy for a cochlear implant depends on how well/poorly the person is understanding words as well as taking into consideration how long the hearing loss has been present with and without treatment.  Auditory deprivation, how long a person goes without hearing, will impact with how well a person does with a cochlear implant, and should be minimized to get the best outcome possible.  Talk to your audiologist to get more details on your child’s specific situation.  When treating unilateral hearing loss with a cochlear implant, recipients typically report an overall sense of completeness, a significant reduction in listening fatigue, hearing sound/people on the implanted side of their body, and an improvement in understanding speech in background noise.  While those benefits superficially may seem not-so-important, they actually significantly improve patients’ quality of life and overall function. 

There are other non-surgical treatment options for unilateral hearing loss that could be considered.  A CROS (contralateral routing of signal) device is a system where a person wears a microphone that looks like a hearing aid on the affected ear, then the signal is routed from the hearing impaired side to another device worn on the side with normal/better hearing.  Another non-surgical option would be a bone conduction device that is worn behind the affected ear attached by either a sticker or worn on a headband.  The speech signal is sent to the cochleae via bone conduction and the ear with the better cochlea is going to hear it.  The CROS and the bone conduction devices do not stimulate the affected cochlea directly, but do provide awareness of sound on the affected side. There are advantages and challenges that should be considered in counsel with your audiologist. 

An important non-surgical consideration would be an FM system in the classroom and other challenging listening environments. The teacher wears a microphone then the speech is sent to a receiver that is either worn on the unaffected ear, or amplified at a desktop speaker or a classroom amplification system. An FM system provides a better listening environment that helps children overcome the background noise.

Treatment options vary across individual needs and should be considered directly with your audiologist to get the best outcomes possible.  

It can be overwhelming as a caregiver trying to navigate options available to help your child hear better, and understanding the impact of unilateral hearing loss can sometimes be more difficult for teachers and family members because the child has better hearing in the ear without hearing loss. Over time, the child will start to develop compensatory strategies for their hearing, and their brain will form around this absence or reduced sound from one side.

When a person has hearing in both ears, both of their auditory nerves on the right and the left gather information from the world of sound around them. Without the same access to the sound signal from each ear, our brains have half as much information for us to process. What that could mean is that we have to work extra hard in order to be aware that someone is talking to us on the side we don’t hear well out of. It could also mean that we get tired easier, as we’re having to work harder to understand with half the amount of sound information. This could also mean that we don’t know where exactly a sound is coming from. If there is a siren, we would expect this person to hear the siren with the ear that hears better, but without both ears working together, we don’t know exactly where to look for that siren. We’re missing information to help us complete the sound picture.

We also know that when we miss sound information, we may miss a joke from a friend, laugh at the wrong time, or incorrectly hear something that was said. This can contribute to social issues for a developing child with their peers. This can also impact a child’s ability to hear the teacher as they move around an educational space, like a classroom or a cafeteria. In the case where there is significant hearing loss, it is a good idea to try a traditional hearing aid, at least for a little while, in order to determine if using this device helps improve some of the difficulties described above. In some cases, people do see improvements, but in others we may start to consider alterative options that could help more.

A cochlear implant is another option in the continuation of hearing healthcare. A cochlear implant can help provide more information to the left ear, the ear with more hearing loss, than perhaps the hearing aid could. This may help give your child more of a complete picture of the sound world around him. Essentially, we’re trying to open the left ear window, so that his brain can receive sound information from the left side better. The hearing aid maybe helped by opening the window slightly, but the cochlear implant may have the possibility of fully opening that left listening window and helping the brain to get as much information as possible. When we do this, the brain starts getting signals from both the right hearing nerve and now the left hearing nerve.

In some cases, there may be an anatomical reason why a cochlear implant may not work well. That is usually something that the team working with your child can help determine with radiology and imaging. We want to make sure that the cochlear implant is a good option by checking to make sure that the inner ear, or the cochlea, and the auditory nerve on the left are able to receive a cochlear implant, and that a cochlear implant could successfully deliver information to the left hearing nerve. In the case that the left cochlea or hearing nerve cannot receive a cochlear implant, there are other nonsurgical options in the continuum of hearing healthcare. Some may include a sound rerouting system. There are systems that can pick up sound on the left side of the head, and move it to the right inner ear and right hearing nerve with technology. This could be a CROS system or a bone conduction system. These systems serve to help give the child more awareness of sound by putting a microphone on the ear that doesn’t hear as well, and then moving that sound to the better hearing ear. This helps to fill in some of the picture that is missing but works differently than a cochlear implant.

Another technology option that may be helpful is technology known as a remote microphone system. All of these can be explored with your speech language pathologist, audiologist and your ear, nose, and throat physician in order to determine what will work best for your child, your family, and the communication and listening goals you’ll develop.  There may be other team members that you work with that help you to refine those communication and listening goals. What is important to remember is that you have choices, and your child has options to help them hear the amazing world of sound around them easier. The hope would be that each of these options would serve to improve overall quality of life, improve access to sound in all listening situations, and to help reduce how hard your child has to work in order to hear well.

Development in children happens so rapidly. They are like sponges, soaking up all of the available information to them from day 1. When babies are born, they are born with 20 weeks of listening experience while in the womb. When they go through their first year of life, they make connections based on the information their brains receive. Vocabulary development starts to occur with listening experiences. This vocabulary development plays an integral role in spoken language development, overall communication, and academic achievement. Something to keep in mind is that sponges can only soak up what is available to be absorbed. When a child is diagnosed with hearing loss, the brain is not receiving information from the auditory system in the same way that a child with normal hearing would. In other words, the access to language in an auditory format is cut off, and that child’s brain cannot make listening connections, and cannot form vocabulary and spoken language development connections. Because the child is not hearing the information from the world around them, their brain does not have the ability to absorb it and make new connections. Essentially, they are sponges without access to any hearing and cannot soak that up. So, their brain will organize itself around the information it does receive. The longer their brains go without this information, the more difficult it will be to reorganize their brains later. We then start to enter somewhat of a language crisis as we don’t have access to hearing. Waiting makes this journey to language, hearing, vocabulary, and academic achievement harder in the long run. This will also require that more assistive services are required. These services may include longer time in speech and language therapy, delay or lack of academic achievement, use of other communication systems such as sign language, social developmental delays compared to peers with normal hearing or appropriate intervention. 

Putting off the decision to implant your child may offer you some temporary relief from making such an important decision, but delaying surgery and intervention will have serious consequences on your child’s speech and spoken language development and the ripple effects on their education and other development.  Neural plasticity allows a young child with no other medical conditions to adapt to a cochlear implant very early on, but it also limits cochlear implant benefit if delayed, much like how neural plasticity makes it easier for a young child to learn a second language where it is more difficult for adults.  Repeated research shows that the younger a child is implanted the sooner they will achieve speech and language skills that match their typical hearing peers.  Earlier implantation will also allow your child to begin school at typical ages and maximize their educational potential. 

Using hearing from both ears offers a lot of benefits, whether it is with two cochlear implants or one cochlear implant and a hearing aid.  Your audiologist will help you determine what may be the right solution for you.  If you do get one cochlear implant, wearing a hearing aid in the non-implanted ear is usually a strong recommendation regardless of the degree of hearing loss.  Hearing from both ears gives you a sense of fullness, or completeness of sound which reduces listening effort and enhances auditory input.  You will find it is easier to understand speech in background noise and to localize to sound sources. If the hearing loss is so profound that a hearing aid does not provide much benefit, but you can’t get a cochlear implant yet, you should still wear a hearing aid to keep that ear stimulated which will make it easier to adapt to sound if/when you do get a cochlear implant.

A cochlear implant is an amazing tool that helps people with significant hearing loss have access to sound, both for environmental information and for communication purposes. Some people have a cochlear implant in one ear and have the ability to continue to wear a hearing aid in the opposite ear. If you have hearing thresholds in the ear that does not have the implant, a hearing aid may be something that you benefit from. The hearing aid can help to balance the sound you receive from the cochlear implant that is electrical, with more natural acoustic information. Many cochlear implant recipients express that if they are able to wear both the cochlear implant and a hearing aid, that the sound quality is fuller, more balanced, and that it helps their overall ability to hear. We hear better with two ears, and we are “wired” to do that. When we stimulate both ears, either with two hearings, two cochlear implants, or a cochlear implant and a hearing aid, we access binaural processing cues that aid in our ability to understand the world of sound around us. These cues can help us understand where sound is coming from, which can help us know where safety signals are originating and where meaningful communication is happening. It can also help us to know where noise is in space, so that we can better manage those complex listening environments and use our brain to filter the meaningful binaural cues. Listening fatigue is a real issue for people with hearing loss. Being able to maximize sound in each ear can really help reduce some of that listening load and make listening more enjoyable and overall, a better experience. Hearing loss impacts our ability to interact with the world of sound around us, and this can be taxing for those that experience it. When we are able to help both ears hear their best, cochlear implant recipients can worry less about how taxing a complex listening situation is and improve their quality of life by being able to better understand and process sound around them.