Understanding the Role of Hearing Screening in Speech Assessment

Why Hearing Screening is Essential Before a Speech Therapy Assessment for Children

A hearing screening is an essential step before a speech therapy assessment for children. This is because hearing plays a crucial role in speech and language development, and any undiagnosed hearing loss can significantly impact a child’s ability to learn and communicate effectively. Understanding if there is a loss and the type and severity is important before starting speech therapy.

What Is a Hearing Screening?

A hearing screening is a quick test that can identify if your child needs further hearing testing. Hearing screenings produce a pass/fail result and will not give detailed information about your child’s hearing. If your child passes, then they show no signs of hearing loss. If they fail, then they should be referred for a hearing evaluation with an audiologist as soon as possible. 

Why Are Hearing Screenings Important?

97.9% of newborn babies in the United States have a hearing screening shortly after birth. It is important for children to have regular hearing screenings because some types of loss may not be identified during newborn hearing screenings (e.g., late-onset hearing loss, progressive hearing loss, frequency-specific loss, and minimal loss). Hearing loss can impact speech, language acquisition, and academic performance, so it’s important hearing continue to be monitored throughout childhood.

Hearing screening is mandated before any speech and language assessment because of how closely as well as in kindergarten/first grade, second, fifth, eighth, tenth/eleventh grade, and upon first school entry. Your individual state may have different hearing screening rules for school-age children. Hearing loss doesn’t have to be severe to impact a child’s ability to access the classroom fully. 

What to Expect From a Hearing Screening

An audiologist, nurse, pediatrician, trained teacher, or speech-language pathologist can screen your child’s hearing. They start by giving some basic instructions and practicing raising their hand when they hear a noise. Once wearing the headphones your child will be expected to raise their hand when they hear the tone that is played for 1-2 seconds.

What Is a Hearing Evaluation?

A hearing evaluation is a complete hearing test that is completed by an audiologist. A hearing evaluation provides more information on the type and severity of hearing loss, as well as possible treatment options for your child. If your child is found to have hearing loss, they may need special support in school.

What to Expect From a Hearing Evaluation

You will visit an audiologist in a clinic office or hospital to have a hearing evaluation done. The exam will be done in a sound booth. The audiologist will use an otoscope to look inside of your child’s ears. Then they will do tympanometry.

Tympanometry is a test to check how well your child’s eardrum is working. During the test, the audiologist will place a small earphone-like probe into each ear and use it to blow air into the ear canal. The device attached to the probe will show a graph called a tympanogram, which the audiologist will use to assess the movement of your eardrum. Tympanograms will help the audiologist determine if there is fluid in the middle ear, a hole in the eardrum, wax in the ear canal, or if the eardrum moves in the correct way.

The audiologist will then test your child’s hearing. Depending on your child’s age they may or may not wear headphones for this part of the test. Very young children will be taught to look at a toy or picture in response to a sound presented. Once kids are a bit older they may be asked to put a toy or ball in a bucket/peg in a peg board when they hear a sound. Finally, when kids enter school, they are simply asked to raise their hand or push a button when they hear a sound. 

The audiologist will review the findings of the hearing exam and if a hearing loss is found, the causes and effects will be explained. You’ll learn the type and severity of the loss and if hearing aids may be helpful to your child. 

Support for Children With Hearing Loss

Children with hearing loss may require special support, accommodations, or direct services like therapy with a deaf and hard-of-hearing specialist, special educator, or speech-language pathologist. There are very helpful supports and accommodations that schools and families can put into place that help children function better in their listening and learning environments.

Here are some example supports and accommodations a child with hearing loss may need to support their communication and learning:

Amplification

Hearing amplification, such as hearing aids, can provide many benefits for children with hearing loss. Here are some of the most significant advantages:

Improved speech and language development: When children can hear sounds more clearly, they are better able to develop speech and language skills. This can lead to improved communication and academic performance.

Better social interactions: Children with hearing loss can struggle with social interactions, but hearing amplification can help them participate more fully in conversations and social activities.

Enhanced safety: Children with hearing loss may not be able to hear important sounds, such as warning signals, sirens, and alarms. Hearing amplification can help keep them safe by allowing them to hear these sounds more clearly.

Increased confidence and self-esteem: With better hearing, children with hearing loss can feel more confident and secure in their abilities to communicate and interact with others.

Improved academic performance: Children with hearing loss may struggle in the classroom, but hearing amplification can help them hear instructions more clearly and participate more fully in classroom discussions and activities.

Better overall quality of life: By improving communication, social interactions, safety, confidence, and academic performance, hearing amplification can lead to a better overall quality of life for children with hearing loss.

Improved speech and language development: When children can hear sounds more clearly, they are better able to develop speech and language skills. This can lead to improved communication and academic performance.

Personal FM system

A personal FM system consists of a transmitter and a receiver. In a classroom setting, the teacher wears the transmitter (with a microphone), and the student wears the receiver (connected to the hearing device). The receiver makes the sound louder and sends it directly to the child’s ears. This makes it easier to hear in noisy places like classrooms.

Sound-field FM system

A sound-field FM system is a speaker-based system that uses a microphone to pick up the sound and transmit it wirelessly to a speaker system installed in the room. A teacher wears a microphone, and the sound is amplified around the room through the speaker(s). A sound-field FM system makes it easier for all listeners to hear the teacher and is a great accommodation for the entire class, not just the child with hearing loss.

Specialized seating arrangements

Children with hearing loss should sit close to their teacher. Another helpful seating arrangement in the classroom is facing children in a circle so they can see each other as they speak. You can also do this at home with a round dining table.

Flashing fire alarm (at home and at school)

A flashing fire alarm gives a visual aid to the child that the fire alarm is activated.

Repeat or rephrase information when necessary. For example, if another child asks a child a question the teacher or parent can rephrase or repeat the question before answering it.

Face the child when you are speaking to them so they can see your face and mouth well.

Move closely to the child when you are speaking to them

Provide gesture and facial expression to add more context to the auditory information.

You may be familiar with a well-known study by Albert Mehrabian where he examined the communication of emotions or attitudes (not all types of communication). He found only 7% of communication is based on words, while 38% is based on tone of voice and 55% on body language and facial expressions. It’s important you communicate to children who are deaf and hard of hearing by using clear body language and facial expressions.

Reduce noise and echo in the background

Hearing aides are wonderful but they amplify all sound, not just human voices. It can be hard for children to focus on speech when there is a lot of ambient noise in the background. It’s important to reduce background noise by turning off electronics, make sure windows and doors are closed, make sure loud machines are turned off.

Hard surfaces can distort the sound quality of incoming sound in hearing aides. It’s important to reduce echo in rooms with carpets, rugs, curtains on the windows, and padded walls when possible (sound proofing materials like cork boards are helpful).

Provide visuals and written information when possible.

Conclusion

Hearing screening is an important step before a speech therapy assessment for children, as it helps identify any undiagnosed hearing loss that could significantly impact their ability to learn and communicate effectively. Timely identification and support for hearing loss are crucial for children to access sounds in their life fully.