The effects of slight hearing loss are subtle, but may include difficulty in:

• hearing faint or distant speech (when a person is at a distance greater than three feet)
• hearing the fine distinctions in word sounds, such as the “s” sound in plurals, (lady vs. ladies) and possessives (Tommy vs. Tommy’s). Verb tenses might also be unclear (is vs. was, fill vs. filled).
• hearing in background noise, such as a noisy classroom or restaurant, or with the television on in the room
• following a fast-paced conversation
• picking up subtle conversational cues
• focusing on what the teacher is saying in the classroom

 Your child might experience problems like these:

• Your child might have difficulty in school when the classroom is noisy or if he or she is not seated close to the teacher.
• Your child might become fatigued in school from the increased effort it takes to listen.
• Your child might respond inappropriately if he or she has missed parts of a conversation.

Some things you can do to help your child in the classroom:

• You can make sure your child’s teacher knows about your child’s hearing loss.
• Your child should sit close to the teacher where good eye contact is possible.
• If your child has one ear that hears better, that ear should be on the side closer to the teacher.
• Your child might benefit from a soundfield or personal FM system. In these systems, the teacher wears a microphone which transmits either to a headset worn by your child, or to speakers in the classroom. In both cases, the teacher’s voice is amplified so that it is more easily heard above the background noise of the classroom.

Here are the categories of hearing loss, and how you can expect your child to hear speech. 

 
This diagram shows the categories of hearing loss - the further towards the bottom of the graph, the more severe the hearing loss. A few speech sounds are also plotted, indicating the approximate frequency (pitch) and intensity (loudness) of each sound.  the speech sounds are plotted at levels of loudness if they were spoken in average conversational loudness in a quiet environment.

Speech sounds differ in terms of frequency (pitch) and intensity (loudness). Vowel sounds such as 'a', 'e', 'i', 'o' and 'u', tend to be lower in frequency (pitch) and louder in intensity. Consonants such as 's', 'p', 't', 'sh', 'k', and 'f' tend to be higher in frequency (pitch) and softer in intensity. How much hearing loss your child has will determine how he or she will be able to hear normal conversational speech.

Normal hearing (0-15dB): Your child will likely be able to detect and discriminate all speech sounds even at very quiet levels.

Slight (20-25dB) and Mild hearing loss (25-40dB): Your child might have difficulty hearing faint or distant speech and have difficulty in group environments. Your child will likely be able to hear sounds at close distances and in quiet environments.

Moderate (40-55dB) and Moderately-Severe hearing loss (55-70dB): Your child might have difficulty detecting and discriminating consonants (e.g., the s, sh, th, ch, f, k, and p sounds) and might rely on combined clues from several sounds, words, and patterns of speech to understand what is said.

Severe hearing loss (70-90dB): Your child might be able to identify environmental sounds; he or she might be able to discriminate vowels but will likely have difficulty discriminating consonants.

Profound hearing loss (90-105dB): Your child will likely only hear loud environmental sounds and feel vibrations.

Children often have hearing loss that is a combination of different levels for different pitches. An example is a mild hearing loss in the low pitches and a severe hearing loss in the high pitches.

Follow Up - Recommended Next Steps

Untreated hearing loss can have significant negative effects on speech and language development.

Early intervention services (or early communication support services), medical treatment and/or hearing devices can significantly minimize the negative effects of hearing loss. Use of sign language, hearing aids or other hearing devices are usually needed for permanent hearing loss. 

You should work with your audiologist and other professionals to be sure to get appropriate treatment and a follow-up plan for your child’s hearing loss.

There are many strategies you can use to enhance your child’s listening skills. In addition, there are specific changes that can be made to the home environment to make listening easier for your child. 

A unilateral hearing loss affects your child in several ways:

• Hearing in background noise: Important sounds, such as the speech of your child’s caregiver, are not as clear and are harder for your child to hear when there is other noise in the background.
• Finding or localizing a sound: Most children find it difficult to tell where a sound is coming from when they do not have the same hearing in both ears.
• Language development: Children learn to speak by saying what they hear. If your child does not hear speech clearly, it may be more difficult for your child to develop clear speech.
• Hearing soft sounds: Soft voices and voices that are far away may be more difficult for your child to understand.

Speech and Language Development

Children learn to talk by listening to those around them. Some children with a unilateral hearing loss may experience some difficulties learning new words or pronouncing all words clearly. A recent study looked at children with unilateral loss at age 3 and found that only the children with severe or severe to profound unilateral loss were having difficulty. This type of outcome is similar to other research studies on the subject.

Ask your care team for some strategies that help your child to develop good listening skills. This is called auditory training. 

There are some things that you can do to modify your environment so that it is easier for your child to hear you:

• Reduce or remove sources of background noise such as televisions and dishwashers. Move away from sources of noise that you can’t reduce.
• Position your child so that the ear with normal hearing is directed toward the sound you want the child to hear.
• When you are talking to your child, get close. Get even closer when you are in a noisy environment.

There are some communication strategies that you can use to ensure that your child hears you:

• Speak clearly to your child on the side where his/her hearing is normal.
• Avoid shouting as it will actually add distortion to your speech, making it even harder to understand what you are saying.
• Rephrase rather than repeat sentences that are not understood.
• Use visual cues (facial expressions, gestures).
• Speak clearly (not too loud or too soft; not too fast or too slow).
• Use appropriate facial expressions and body language.
• Have visual aids on hand (pictures, books, toys).
• Get your child’s visual attention before speaking.
• Be sure there is good lighting when you are speaking to your child.

Amplification options:

A hearing aid may be helpful depending on the nature of your child’s hearing loss. Your audiologist will be able to tell you if a hearing aid will help your child.

For school-aged children, there are a few assistive listening devices that may be helpful. For example, sound-field or personal amplification systems can help a child to hear better in the classroom. In these systems, the teacher wears a microphone which transmits either to a headset worn by your child, or to speakers in the classroom. In both cases, the teacher’s voice is amplified so that it is more easily heard above the background noise of the classroom.

Here are some sources of health care support for your child’s hearing loss:

• Visit an otolaryngologist (ENT) if middle ear fluid or infections are present.
• Have your child’s hearing tested on a regular basis, as recommended by your audiologist.
• Arrange classroom observation and consultation with a speech and language pathologist or hearing resource teacher in your child’s school district.
• Ask your early interventionist for some strategies that help your child to develop good listening skills. This is called auditory training.

As your child’s parent, you are part of a team. Your partners are your health care provider, your audiologist, and your early interventionist who is familiar with hearing loss and auditory skill development. Your team can check to see if the unilateral hearing loss has an impact on speech and language learning.