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Financial Guide for Families of Children and Teens with Deafness and Hearing Loss

Hearing loss in children and teens can be misinterpreted as a learning or processing disability, or even as a behavioral issue. However, hearing loss is more common than you might think. The National Institute on Deafness and Other Communication Disorders found that 13% of children aged 12 or older have detectable hearing loss in both ears.

Research shows that one-third of children with undiscovered hearing loss may even end up having to repeat a grade by third grade, and additionally may have trouble developing communication skills. Personal devices such as earbud headphones have increased the risk of adolescent hearing loss, making it more important than ever to get your child’s hearing checked regularly. If your child has already been diagnosed with hearing loss or deafness, there are ways that you can seek support, both financial and interpersonal, to mitigate the effect hearing loss has on their life.

Symptoms of Infant Hearing Loss

Symptoms of hearing loss in infants include:

  • Not being startled by loud sounds;
  • Not turning toward sounds after they’re six months old;
  • Not saying single words like “mama” or “dada” by the time they’re a year old;
  • Turning their head if they see you, but not if you only call out their name;
  • Seeming to hear some sounds, but not others.

Symptoms of School-Aged Children Hearing Loss (five to 13)

Symptoms of hearing loss in school-aged children include:

  • Speech is delayed — this can look like unclear or unintelligible speech, difficulties learning new words, and trouble sounding words out.
  • Does not follow directions —  this can be misinterpreted as behavioral, however if this is a chronic occurrence both at home and at school, it may be a sign of hearing loss.
  • Asks for constant repetition of instructions or statements —  often saying “huh?” or “what?”.
  • Turns TV or personal device volume up too high, or sits too close to the TV.

Symptoms of Teen Hearing Loss (14 to 19)

Symptoms of hearing loss in teens include:

  • Turns TV or personal device volume up too high, or sits too close to the TV;
  • Lacks volume control in conversation —  either talking too loudly or too quietly;
  • Non-responsive to you when you speak in a conversational tone;
  • Constantly mentioning a whine, buzz, or ringing noise;
  • A sudden decrease in social interaction or classroom participation.

Causes of Hearing Loss

There are many causes of hearing loss in children and teens that may occur starting in the womb or take place any time into early adulthood. Some of these causes are congenital, while others are due to lifestyle.

Genetic Disorders

Genetic disorders are thought to cause 50% of all congenital hearing issues in newborns. These genetic disorders typically appear in the following ways:

  • Autosomal dominant: This occurs when one or both parents carries a dominant gene for congenital hearing loss, and typically suffers from hearing loss themselves. With this disorder, it is typically expected that the child will have some form of hearing loss.
  • Autosomal recessive: This occurs when both parents carry a recessive hearing loss gene. The likelihood that the child will inherit genetic hearing loss in these cases is less than 25%
  • X-linked factors: This occurs when the mother carries a recessive gene for hearing loss on the sex chromosome. In this case, it will be passed to male children, and not female children. This is an incredibly rare presentation of genetic hearing loss, accounting for 1% to 2% of syndromic and non-syndromic hearing loss.

Fetal Development Issues

Development in the womb can also be a cause of hearing loss or deafness. Prenatal infections or malformation of the head, ears, or face may impact a child’s ability to hear properly. It isn’t entirely understood why prenatal ear malformations occur, but they can occur due to inherited conditions, lack of blood supply to the area during development, or exposure to certain chemicals or medications.

Sound Exposure

Prolonged exposure to sounds above 70 decibels can cause hearing damage, and sounds above 120 decibels could cause immediate damage to your hearing. Activities such as concerts, loud music played from earbuds, and sporting events can cause hearing damage, most commonly in teens and young adults. If you or your teen is going to be exposed to loud sounds, make sure they have ear protection to mitigate hearing loss.

Otitis Media

Otitis media, infection of the middle ear, is one of the most common causes of hearing loss in children. About 75% of children experience at least one case of otitis media by their third birthday. The reason this ear infection is so common in children is that the eustachian tube, the passage between the middle ear and the throat, is smaller and more horizontal in young children, and therefore is more easily blocked and prone to infection. As children grow and the eustachian tube changes shape, these ear infections become less common.

In some cases, the hearing loss caused by otitis media is temporary and clears up as children age, and are less prone to fluid blockage. However, recurrent otitis media can cause damage to the eardrum, the bones of the ear, and even nerve damage, resulting in more permanent sensorineural hearing loss.

Hearing Detection and Intervention

Early detection is crucial in cases of childhood hearing loss. The earlier you detect hearing loss, the earlier you can intervene and prevent more permanent hearing damage from occurring. The easiest way to detect hearing loss is with a hearing screening. There are several types of hearing screenings, including:

  • Pure tone testing: This test measures the ability to hear tones at different pitches and volumes.
  • Bone conduction testing: This is a type of pure-tone test that measures your inner ear’s responses to sound.
  • Acoustic reflex testing: This type of test measures your middle ear’s muscle contractions. This is typically used to identify your type of hearing loss, once hearing loss has been established.
  • Auditory brainstem response (ABR): This test, typically performed on newborns, is used to determine if you have a specific type of hearing loss called sensorineural hearing loss. Sensorineural hearing loss affects your ability to hear soft sounds and especially loud sounds, and occurs when there is damage to the inner ear pathway to the brain.
  • Speech testing: This test is used to measure the softest level of speech that you can hear, as well as your ability to separate speech from background noise. It is typically performed in a busy environment.
  • Tympanometry: This test measures the responsiveness of your eardrum to air pressure, and can help determine if hearing loss or impairment is due to wax or fluid buildup, and even detect inner ear tumors.
  • Otoacoustic emissions (OAEs)Otoacoustic emissions are the vibrations of hair follicles in the cochlea. By using a probe with a speaker to disturb the hairs and measure emissions, this test can determine whether there is blockage or damage to the cochlea. This test is also often performed on newborns.

What Is the Cost of Hearing Screening?

The cost of hearing screenings depends on several factors, including the type of screening, where you’re getting screened, and your level of insurance coverage. If you or your child gets a hearing screening from a pediatrician or audiologist, a hearing test may cost up to $250 without insurance. If you have insurance, annual pure-tone hearing tests are often covered by your insurance at no cost to you. More in-depth screenings, such as OAEs, may incur more costs due to specialized equipment.

For newborns, hearing tests are typically administered as part of the infant wellness check that occurs within the first few weeks of birth.

For school-age children, many public schools may administer vision and hearing tests. These screenings may be done by the school nurse or a visiting audiologist. However, the conditions under which these tests are done are not the same as the conditions that exist in a doctor’s office, so you may see discrepancies between tests if you get your child screened later in a doctor’s office.

The Cost of Hearing Treatments

The cost of hearing loss treatments varies wildly by the type of treatment. Treatments for hearing loss include:

Surgery

For hearing loss that is caused by malformation of the inner or outer ear, corrective surgery may be a treatment option. The price of corrective surgery will vary on the procedure and the surgeon.

Outer ear surgery, such as reshaping the ear or removing barriers to the inner ear, costs around $3,220, according to 2019 statistics from the American Society of Plastic Surgery. Inner ear surgery, such as a stapedectomy, had an estimated lifetime cost of $19,417.95. These figures may vary depending on your doctor and your insurance coverage.

Implants

Cochlear and brainstem implants, as well as bone-anchored hearing aids, can be a good option for children with profound hearing loss. A cochlear implant does not make sound louder, like a hearing aid, but rather sends sound signals directly to the hearing nerve.

A brainstem implant bypasses the inner ear and hearing nerve altogether, and stimulates the hearing receptors in the brain directly.

Bone-anchored hearing aids are different from traditional hearing aids as they are surgically implanted, and treat hearing loss through bone conduction, rather than amplifying sound into the inner ear.

Hearing Aids

Hearing aids are a non-surgical treatment option. The aids are small electronic devices that you wear in or around your ear that can amplify or change sound. Pediatric hearing aid costs can vary widely, as with most health technology, but recent estimates put them between $1,000 to $6,000 per aid. Hearing aids for kids may actually be a more expensive option than surgery in the long run because they need to be replaced every three to five years.

Does Health Insurance Cover Treatment for Hearing Loss?

If you have private healthcare, your coverage will vary from carrier to carrier, and even from plan to plan. Most hearing screenings are covered by health insurance, but you’ll need to consult your insurance provider about the coverage of further treatment.

Government health insurance, such as Medicare and Medicaid, also varies by the type of hearing treatments they cover. For Medicare, Medicare Part B covers diagnostic screenings if your pediatrician orders a hearing test based on symptoms or suspicion of a deeper problem, but does not cover hearing aids or further treatments. Medicare Part C, or Medicare Advantage Plans, can cover diagnostic hearing screenings and the cost of hearing aids.

For Medicaid, the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program is included in coverage for children from infancy to the age of 21. The program includes diagnostic tests and screenings, hearing aid evaluations, and medically necessary hearing aids and accessories.

Medical treatment of any kind can be expensive even with insurance, so when discussing treatment and treatment costs, you may want to see if any of your child’s medical expenses are tax-deductible. Other financing options for treatment include:

Communication Options

There are many communication options available to you and your child, even if your child has significant hearing loss or total deafness. Depending on their age, your child may still use spoken English to communicate with others, but may recognize or use any of the following when being communicated with:

  • Sign language: This could be American Sign Language (ASL), Signing Exact English (SEE), Manually Coded English (MCE), or others. Sign language can assist children of all ages, including toddlers, who are hard of hearing or need assistance communicating.
  • Fingerspelling: Also called the tactile alphabet, fingerspelling involves using the finger to draw letters on the hand of the person they are trying to communicate with. This can be especially useful for young children transitioning into sign language.
  • Natural gestures: Natural gestures are body language cues where the meanings are universally understood in our culture. For example, if you’re asking your child to be quiet, you might put a finger to your lips. These gestures can help assist children who are hard of hearing with understanding your intent, without need to hear you fully.
  • Cued speech: Cued speech is a combination of speech and hand motions positioned near the mouth to give the eyes and ears similar input. Cued speech can be useful for varying degrees of hearing loss, when speech can still be understood, but the assistance of hand motions helps the individual process meaning and intent.
  • Interpreters: Interpreters can be a great resource for public spaces with a lot of noise, or where your child may need to communicate with many people, such as the classroom or extracurriculars, like summer camps. Interpreters may be provided by your school as a part of their individualized education program (IEP), or you can contract them independently.

Resources for Teens and School-Age Children

As a parent of a child with hearing loss, there are ways that you, along with your child’s teacher, can support them in the classroom. One of these ways is an individualized education program (IEP).

An IEP is a learning plan that your child’s teacher can put together that includes and caters to a child’s specific needs. This could be sitting up front in the classroom to reduce background noise, having an interpreter in the room, or having one-on-one learning with an aid during specific times of the day. An IEP can be completely customized to your child’s needs, and can be maintained all the way through high school to ensure that they are getting the right tools to supplement their learning.

There are also foundations for school-age children and teens with hearing loss that offer low- or no-cost educational opportunities, such as:

Private ASL tutoring and one-on-one learning may also be beneficial for you or your child depending on their needs.

Resources for College Students

If you are a college student living with hearing loss, it’s incredibly important to understand how to manage medical debt. This is essential both in the case that you age out of your parent’s coverage, or that you are uncovered yourself.

Some universities offer low-cost student health insurance options or include them in the price of tuition, which can be a great temporary solution. It’s important to note that colleges must comply with federal Americans with Disabilities Act (ADA) regulations and provide reasonable accommodations to students in need.  Additionally, there are many scholarships and grants available to students with hearing loss.

Additional Family Support Resources

Support resources for families with children that have hearing loss or deafness include debt help, financial assistance, socialization support — for both kids and parents — and government resources.

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