JRI's Pediatric Rehabilitation Department offers a range of pediatric evaluation and therapy services for children with hearing loss. The recent advent of universal hearing screenings has greatly improved the identification and care of children with suspected hearing loss. Children may also develop hearing problems from conditions such as chronic ear infections, meningitis, and some inherited forms of hearing loss. 

For children with a greater degree of hearing loss, the effects may be noticed very early. But for children with milder hearing impairments, the effects may be far less noticeable, including lack of attentiveness, daydreaming, delayed development of speech and language skills, poor academic performance, and listening to the television at a higher volume than others.

JRI's pediatric audiology specialists use hearing tests with techniques and activities designed to appeal to infants and young children. Our team evaluates all parts of the hearing mechanism with behavioral and objective test measures to help provide a complete assessment of the child's hearing. If hearing loss is identified, detailed explanations and recommendations are provided.

If a routine hearing evaluation does not provide adequate information on a child's hearing, electrophysiological testing may be recommended.
 

• The Otoacoustic Emissions test measures an acoustic response that is produced by the child's inner ear (cochlea). Although not a substitute for a behavioral hearing test, it can provide information on the presence or absence of cochlear function.
   
• The Brainstem Auditory Evoked Response test detects electrical activity in the cochlea and auditory pathways in the brain. Although not a substitute for a behavioral hearing test, it can provide useful information on the child's hearing.

Newborn Hearing Screening/Otoacoustic Emissions (OAE)

The JFK Johnson Rehabilitation Institute (JRI) and our affiliate JFK Medical Center are committed to the early identification of hearing loss in children. A universal hearing screening program has been in place since 1996 at the JFK Medical Center, where the goal is to test all newborns prior to discharge. The otoacoustic emissions (OAE) test is used to evaluate the integrity of the outer hair cells of the cochlea. If the patient does not pass the test at birth, follow-up testing as an outpatient is used to diagnosis the hearing loss as early as possible. Intervention can then be initiated so that the child's learning is not delayed.

Hearing Aids

Children's hearing aids come in all shapes, types and sizes. JRI's audiologists are familiar with all available hearing aid options, so they can help families choose hearing aids that are compatible with their specific physical and amplification needs. For infants and children, the selection of hearing aids poses unique challenges. The ears of children are softer and smaller than those of adults and change in size over the first few years of life.

When choosing amplification, it is important to enhance the child's ability to understand speech. Two important factors contribute to this: recognizing the distinct letters in the words heard and hearing in the environment one is in. Background noise (such as in a restaurant) can make it difficult to understand the right sounds in words.

Hearing aids with digital technology offer better understanding of speech in more challenging listening situations. Instead of using traditional electronic components, digital hearing aids use a digital sound processor to translate sounds into a digital signal. This signal can be enhanced without distorting the sound - ensuring that the sound quality is as crisp and clear as a CD.

Counseling and Education

Because educating patients is one of our primary concerns, JRI offers free hearing aid education classes to our pediatric patients and their families. These classes review the impact hearing loss has on a child's life as well as on his or her family; review strategies that can enhance communication between hearing-impaired people and their loved ones; and ensure that patients can effectively care for their hearing aids.

Balance Program

Dizziness, loss of balance and lightheadedness are frequent reasons parents may seek medical attention for their children. Because dizziness is not a disease, but a symptom that indicates a problem may exist somewhere in the body, it has many causes.

In most cases, the problem is related to a change in the child's vestibular system (the parts of the inner ear and brain that help control balance, eye movements and body orientation). Vestibular disorders are common and can affect people of all ages, including children. It is estimated that more than 90 million Americans will complain to their physicians about dizziness at least once during their lifetime. Regardless of the cause, early detection improves chances for a complete recovery.

In addition to dizziness, the most frequently reported symptoms of vestibular disorders are vertigo, nausea, and unsteadiness or imbalance while walking. Other symptoms may include increased sensitivity to noise and bright light; headaches; muscular aches in the neck and back; and problems with vision, thinking and memory.

Tests developed in recent years have enabled physicians to diagnose some vestibular disorders in children that previously could not be documented. All of these tests are painless and most children tolerate them well. 

• Electronystagmography (ENG) is the standard for measuring the vestibular system using infrared video recording of eye movements. This allows comparison of the function of each inner ear. During the ENG procedures, the child is asked to do a series of tasks related to eye movements. Eye movements will also be recorded as you move through head and body positions. The final portion of the test is conducted with cool and warm air flowing into the ear canals. For most individuals, there is minimal discomfort during the procedure. Some experience slight sensations of nausea and, on rare occasions, vomiting.
   
• The Rotary Chair Test provides another means of assessing the inner ear. The child sits in a computer-driven chair that rotates gently back and forth at several acceleration rates as specialized video goggles with infrared cameras measure eye movements.
   
• Computerized Dynamic Posturography (CDP) is a noninvasive procedure used to assess the child's daily functional balance and stability under changing support surfaces and visual environments. As the child stands on a platform secured by a harness, he or she is exposed to various situations where either the platform or visual surroundings will move in vestibular, visual or somatosensory conditions. 
   
• The Audiometric (Hearing) Test evaluates the child's hearing status. Both the hearing and motion-sensing parts of the inner ears may be affected by the same disease.
   
• Brainstem Evoked Auditory Response (BSER/ABR) testing allows assessment of the child's entire auditory pathway up through the brainstem. Electrodes are placed on the scalp or forehead and on or behind the ears. A series of sounds are presented through an insert earphone. As the electrodes pick up electrical energy produced by the auditory nerve, a computer averages the responses and produces a waveform that shows the response from the inner ear to the auditory nerve. There is no discomfort. The child need not do anything but relax and not move around. In fact, many patients drift off into natural sleep.
   
• Vestibular Evoked Myogenic Potential (VEMP) testing provides information about the child's saccule (an inner ear balance organ) and the inferior vestibular nerve. It is based on a reflex that occurs between the saccule and a muscle in the neck.
   
• Electrocochleography is used to identify an inner ear condition called cochlear hydrops (also known as Meniere's disease). Electrodes are placed on the child's scalp or forehead and on or behind the ears. A series of sounds are presented through an insert earphone. As the electrodes pick up electrical energy produced by the auditory nerve, a computer averages the responses and produces a waveform that shows the response from the inner ear to the auditory nerve. There is no discomfort. The child need not do anything but relax and not move around. In fact, many patients drift off into natural sleep.

Treatment for pediatric balance disorders varies according to the diagnosis. The problem may arise from the tiny mechanisms inside the ear or the "circuitry" in the brain that links the eyes and ears together in order to maintain balance. Treatment may include vestibular rehabilitation and balance retraining with a physical therapist; medication; diet changes; and, in rare cases, surgery.

(Central) Auditory Processing Disorders

What the ears "hear" and what the brain interprets as being heard may not be one and the same.  Some people have difficulty making sense out of what the ears pick up, even though the hearing in both ears may be normal. This difficulty in "processing" may show itself in many ways, such as finding it hard to hear someone talking against background noise, or a problem remembering what was heard just a short while ago. Children with processing problems may appear to be distracted, daydreaming or just not "tuning in."  Their grades may suffer as a result.

JRI's licensed, certified audiologists can provide a comprehensive evaluation for children and adults suspected of having central auditory processing disorder, using at least nine separate tests. Particularly for school-aged children, testing can often target specific areas of processing difficulty in both auditory memory and selective attention. If problem areas are identified, detailed recommendations and referrals are provided. 

Tinnitus Management

Many people experience noises (especially ringing) in the ears. For some, this tinnitus can interfere with sleep, relaxation and concentration, becoming a source of annoyance and anxiety. In very rare instances, tinnitus may be associated with a disease that demands medical attention. In the majority of cases, however, the cause is unknown and the tinnitus sufferer may be told simply to "live with it."  Tinnitus is extremely common, but each individual's ability to deal with it is different.

JRI's certified, licensed audiologists are trained in the Jostreboff method of "Tinnitus Retraining Therapy." This method is used to help identify the nature of the tinnitus and offer recommendations and assistive devices that may help relieve the child's over-perception of tinnitus. Hearing testing, counseling, and even hearing aids and sound generators may also be offered.

Swim Molds, Noise Protectors, Musician's Plugs and Earmolds for Personal Listening Devices

JRI offers a wide range of custom-made products for children in a variety of colors and styles. These products can be used with the phone or personal listening devices.