July 24, 2000 -- Veronica Miller was only 1 year old when her mother, Laura, first began to worry about her hearing. Veronica didn't seem to respond when her parents called out her name. And she rarely babbled or made baby talk like other kids her age. But her pediatrician said some children start to recognize speech patterns slower than others; he advised the family to wait and see what happened in a month. A month later, the doctor repeated the same advice. Frustrated, Miller took the girl to an audiologist for a hearing test and found out Veronica's hearing was profoundly impaired in both ears.
"I couldn't believe it," said the East Meadow, N.Y., mother. "I was in total denial. She always seemed like such a happy baby. It just kind of tricked us."
Many parents with hearing-impaired infants share Miller's experience -- they are simply unaware that their new baby can't hear. In fact, hearing impairment is the most common birth defect in the United States, striking three of every 1,000 babies born here. Yet at a time when new technologies can make a profound difference in a hearing-impaired child's ability to hear, only 35% of newborns receive a simple hearing test before they leave the hospital. The result: Most children who have a hearing impairment aren't diagnosed until they reach 30 months, a delay that can have lasting consequences.
Early Connections in Tiny Brains
"When a baby is born, it responds to auditory stimulation by making connections within the brain," says Karl White, PhD, director of the National Center for Hearing Assessment and Management (NCHAM) at Utah State University. "These connections are essential for language development, and if this doesn't happen within the first few months of life, it may never happen the way that it should." The longer you wait, the more damage there will be to the child's ability to process language, says White.
Prompt detection and treatment, on the other hand, can make a huge difference. When Miller's second child Samantha was born, she insisted that the girl receive a hearing test before leaving the hospital. Samantha was found to be almost completely deaf in one ear and was fitted for her first hearing aids before she was 1 month old.
In contrast, older sister Veronica didn't receive her first hearing aids until shortly after her first birthday. They failed to improve her hearing significantly, so when she was two, she received a cochlear implant -- a tiny electronic device that is surgically implanted in the inner ear. It stimulates the auditory nerve, sending sound signals straight to the brain.
Veronica is now 6, and while her hearing is normal, her speech skills have tested at one to two years behind her peers. Samantha, on the other hand, is now just over a year old and is blurting out words like an 18-month old. "That's the difference early detection can make," says Miller. "Veronica missed out on those first two years, and those years are so important."
Advances in Treatment
Most people don't realize that today's hearing aids are so effective that in all but the most serious cases, people with hearing impairments can be made to hear as well as anybody else, says White. Cochlear implants can be used in cases where the child's own cochlea (the nautilus shell-shaped organ in the inner ear that translates sound into vibrations the brain can interpret) is so damaged that hearing aids simply won't work. With the help of these advances, both of the Miller girls are now hearing at or above normal levels despite being born nearly deaf.
Having two hearing-impaired children in the same family is not unusual. While some hearing problems are caused by environmental conditions like ear infections, the vast majority are caused by congenital defects. And though 90% of children with hearing impairments are born to parents with no hearing problems at all, once a couple has a child with hearing problems, the odds are one in four that subsequent children will have similar problems, according to NCHAM researchers. And that, says Laura Miller, is why she pushed so hard to have Samantha's hearing tested.
A Screening for Every Child
Advocates for the hearing-impaired argue that every child should have the same chance Samantha got. "Our goal is to see that every child gets a screening at birth," said Elizabeth Foster, director of the National Campaign for Hearing Health, a Washington, D.C.-based group that promotes awareness of hearing issues. "Every day that goes by when a child's hearing problem is not identified is a day that is lost for auditory and verbal development."
Unlike hearing tests for older children, which require the child to respond to a sound by raising a hand, hearing tests for infants measure vibrations produced by the cochlea. (The infant tests are painless.) If the vibrations are weak, further computer-aided testing can measure the baby's brain activity in response to noise, confirming the diagnosis of a hearing impairment. While the basic screening test cost as much as $600 per child 20 years ago, today's equipment has brought that figure down to about $40. "It is now feasible to test every child when they're born," says White. "The tests are accurate and inexpensive."
So why aren't all infants being tested? White blames the delay on the current health care climate, where expenses are often considered before patient needs. "Hospitals are looking to cut procedures out, not to add new ones," he says. But despite the slow pace of change, White is optimistic. With urging from both the medical community and the government, more and more hospitals are making infant hearing screenings a standard procedure.
"If left undetected and untreated, a hearing disability will have a significant impact on language development," says Foster. "That's why we have to identify these kids within the first six months. If it goes undetected after that, their speech levels will probably test below normal almost indefinitely. Parents shouldn't have to go through the heartache of late identification of these problems."
Thanks to advances in testing and treatment, the Miller household --with two vocal little girls running about -- is anything but silent now. But that's just fine with mom Laura; she wouldn't want it any other way.
Will Wade, a San Francisco-based writer, has a 5-year-old daughter and was the co-founder of a monthly parenting magazine. His work has appeared in POV magazine, The San Francisco Examiner, and Salon.
