Q&A about hearing loss in children
We ran a Q&A with Phonak and a team of leading experts in paediatric hearing care, to answer your questions on hearing loss in children and how to provide them with the best possible care and support. They also spoke about the new wireless 'Roger' device.
There are 45,000 children currently living in the UK with hearing loss and nine out of ten of these children are born to hearing parents with little or no experience of communicating with them, which can have a detrimental effect on the child's language development rate.
In order to help children with a hearing impairment to understand speech and communicate more clearly in the home environment, Phonak has just launched a groundbreaking new hearing system called Roger, which is set to significantly improve the child's speech and language development from an early age. The Roger Pen is a cutting-edge wireless microphone that allows hearing aid wearers to hear and understand speech more clearly in noisy environments and over distance. It works alongside the child's existing hearing aids and transmits the speech sound from the microphone directly to their ears.
Claire Benton - Clinical Lead for Paediatric Audiology within Nottingham Audiology Services
Claire has worked in the Children's Hearing Assessment Centre in Nottingham for 16 years and has been the Paediatric Clinical Lead since 2006. Claire sees children of all ages for assessment and habilitation and also specialises in seeing children with tinnitus, as well as those who have problems tolerating loud sounds.
Tony Murphy - Wireless Communications Specialist at Phonak UK
Tony is the go-to guy at Phonak when it comes to wireless technology. He's seen Roger develop from the word go and can provide detailed information on how it works, how it's different from anything else on the market and how it can benefit children with hearing loss.
Frank's seven-year-old sons Oliver and William were the first children to be fitted with Roger in the UK. Frank has been able to provide first-hand experience of the technology, along with information on how it has helped aid the learning and development of his children.
Questions and answers
Q. HypodeemicNerdle: My nine-year-old daughter wears a hearing aid for moderate hearing loss on one side. I would like to know what Roger is and how it could help my daughter.
A little bit more about Roger
- The Roger transmitter is simple, easy to use and contained in a discreet ‘pen’ shaped case which can be worn by the speaker or placed in the middle of a group, picking up speech from all around. It can also be used as a hand-held microphone, so the user can control who and what sounds they hear, as well as having the ability to connect to TVs, music or computer consoles.
- Roger is the most compatible system of its kind and works with virtually every behind-the-ear hearing instrument and cochlear implant.
- It is simple and easy to use – the microphone and receivers are activated with a single click and it will also automatically adjust to suit the environment that it is required in – there are no frequencies to programme or manage as is the case with previous devices.
A. Tony: It sounds as though your daughter's hearing aid may work well for amplifying all sound, allowing her to hear what she wouldn't be able to without it. However you may have noticed that in loud listening situations, such as at the park or in a restaurant where there is a lot of background noise, she still struggles to hear specific speech. Using Roger alongside her hearing aid will enable her to understand and pick up speech in the most difficult situations.
A. Frank: The Roger device really helps my sons Oliver and William in noisy environments and in public spaces. In the past, communicating with them when they are upstairs, when we're at the park or out for a meal in a loud restaurant was a constant task and almost impossible. However, since using Roger the difference has been amazing. For example, the boys both love bowling, but they really used to struggle there because of all the background noise. Since using Roger, this has completely changed – they are able to communicate with me so much better now and even comment that their hearing is better than mine! You can read more about our hearing loss journey here.
Q. TinyTwoTears: What is Roger, how does it work? How is it different from a radio aid?
My son has bilateral sensory neural moderate hearing loss. He has great pronunciation, is very good at phonics and reads very well but he struggles with knowing the direction of sound and finds it hard to concentrate in a group setting. He is six.
He was part of a study for radio aid use with preschoolers but freaked out when the radio aid was switched on. We haven't tried on since. How would Roger change my son's experience of sound?
A. Tony: You mention that your son has great pronunciation, is very good at phonics and reads very well but struggles with knowing the direction of sound and finds it hard to concentrate in a group setting. Using Roger alongside his hearing aids will help him to understand and pick up speech in the most difficult situations.
It is difficult to say why your son struggled with the radio aid he used in the past but I can say that Roger surpasses all other technology. It provides increased speech recognition compared to other devices, delivering a 54% superior performance versus its nearest competitor in terms of speech clarity. To find out more about Roger, visit here.
A. Frank: Roger is brilliant because the microphones are multi-directional, so they pick up the most prominent sound (the speaker) and remove the unwanted background noise. This really helps in a group setting, like in a restaurant or at a busy dinner table, where we pass the microphone around or put it in the middle of us so William and Oliver can understand what everyone is saying. The access to sound is greater too as Roger removes the unwanted background noise and feedback that we used to find so unbearable with traditional radio aids.
Q. floradoors: My son (10) has mild hearing loss in his left ear which he's had since birth. Although we've had several consultations so far he hasn't needed a hearing aid but it did have an effect on his speech development when he was younger, although he's fine now. His primary school have been fantastic - he's always sat at the front of the class and the teachers have always been instructed to speak slowly as he does lip read to help compensate for his hearing problems.
He's going up to secondary school in September. It's a big school and although we'll obviously discuss with them about his hearing, it’s going to be difficult to make sure all the different teachers help him out (by sitting him at front of class etc.) Also I think the school will be much noisier than his current school. He's always been keen to avoid hearing aids but I'd be interested to hear more about the wireless Roger device and whether he'd be eligible for one.
A. Tony: I agree that he may struggle in his new school and Roger may be able to help but he will need hearing aids first. I would suggest you go back to your audiologist to discuss this further.
A. Claire: From the experience of families I see in clinic, it can be difficult for all the teachers across the different subjects to remember to make sure a child can hear them. It might be worth having a chat with your son about how he can manage his hearing loss more himself now he's going up to secondary school, he may come to his own conclusion that he would like to try a hearing aid, or he may be happy to make his needs known to the teachers depending on his confidence. He is likely to benefit from something like Roger, but whilst he doesn't wear a hearing aid this would not be possible.
It's a tricky time for any child coping with a new, bigger school. If he really isn't keen on having any form of hearing aid it might be worth letting him have a term at the new school then asking whether the local teachers of the deaf could visit and assess whether he is coping in the classroom - either the school or your local audiology team that monitors his hearing can arrange this. We have often been surprised just how well some children do cope, and either way it would put your mind at rest!
Q. zipzap: Both my children (five and eight) can hear but I worry about how well they are hearing things as they both have some problems pronouncing words correctly - it's becoming more evident from my eldest's spellings that there are lots of things that he's not only spelling them wrong, but if you read them phonically, they are phonically wrong too. Then when you get him to say the words he's supposed to be spelling, he's spelt them phonically correctly for the way he is saying them, which makes me wonder if this is how he is hearing them (for example, which led to an interesting conversation on the way to school this morning when he wanted an explanation for 'bawdy' - but was actually talking about 4-D).
So I guess my question is, if I know my children can hear (whisper 'who wants a biscuit' from the other side of the house and they are there), is there any way to monitor the quality of what they are hearing when there are potential indicators (ie the poor pronunciation of certain sounds) that there might be some problems with the hearing?
(I guess if it were eyesight that you were talking about, then I know my children aren't blind, and that they have reasonable sight as they can see words on a page to read them. But it's knowing if they've got the equivalent of mild long or short sightedness or a bit of a squint. It's easy enough to take the children to the opticians to get their eyes checked but you don't ever think of doing the equivalent for getting their hearing checked and it's not something you want to drag them to the doctor's for if there isn't a major problem.)
A. Claire: For your peace of mind I would ask your Doctor for a referral to your local audiology clinic for both your children - some audiology departments will take referrals directly from parents so it may be worth checking if this is possible too. Sometimes having problems with the pronunciation of certain sounds is an indicator of a hearing problem. For example the high frequency consonants such as f, th and s are fairly quiet in speech, so even a slight difficulty with hearing at the high frequencies can make it difficult to hear these and therefore you don’t know how to say them properly.
At the audiology clinic your children would have a hearing test that finds out the quietest sound they can hear at a range of frequencies from low to high. The audiologist would be able to tell you if the results meant they couldn’t hear particular parts of speech or if their hearing was all within normal limits. The test doesn’t take long and most children enjoy playing the game and taking part. In the audiology clinic they can also carry out some different tests that look at how well a child can discriminate similar sounding words, which can give you more information.
Q. cathpip: My son has a mild/moderate loss and is aided, he is in reception and uses radio aids which are superb "I can hear the teacher mummy, from across the room!" How is Roger different to a radio aid? Could it eventually replace radio aids? How would a child be deemed eligible? At the moment my sons radio aids are provided by the local authority, and hearing aids by the NHS, how would Roger be issued or would you have to fund it yourself?
A. Tony: The main differences between radio aids and Roger are as follows:
- How easy it is to use – radio aids are complicated to set up but with Roger there is no need to worry about this as it will tune automatically for you, adapting to each situation.
- Its performance – conventional radio aids can be prone to annoying interference. In a research study, Roger delivered a 54% improvement versus its nearest competitor in terms of speech clarity, so if your son experiences any background noise or frequency disturbance with his existing radio aid that should completely disappear with Roger.
Roger is available in education but this is a slightly different system so although the performance is better, as you say it is funded by your local authority and therefore it is up to them to supply it.
The Roger pen though is now available for home use so if you find that your child is still struggling to hear outside of school in noisy environments then you may want to invest in a system yourself to use at home.
Q. MissBetseyTrotwood: My son has profound hearing loss in his left ear and normal hearing in his right. He uses a soundfield system at school but is not otherwise aided. He has had a speech and language delay and is very, very slowly learning to read. He's five but does struggle with phonics and hates school as he's starting to struggle to maintain friendships as he finds hearing the game in the playground difficult.
He also has vestibular hypofunction, something that I have struggled to find out much about since his diagnosis, even on the NDCS website. This has also impaired his ability to fit in as he can't really run like others his age.
So my questions are:
- Should his hearing be aided?
- If so, what would his options be?
- Is there anywhere I can find out more about vestibular hypofunction?
- What is Roger? Could it help a child like my son?
A. Claire: There are a number of options for aiding your son's hearing and there are pros and cons to all of them. One option would be to trial a type of aid called a CROS aid, this is where a microphone is worn on his left ear (where there is a profound loss) and what looks like a hearing aid on his right (good) ear. This does not amplify the sounds but just transfers the sounds from the left side into the right ear which can hear them. It means your son would be able to pick up sounds from all directions. The system we use in my department is very neat looking but we sometimes have a little difficulty keeping it on small ears. Also, it is becoming more common for children with one ear that has a profound loss to have an aid called a Bone Anchored Hearing aid (BAHA). This is initially worn on a band on the head but if successful this way you can have a small titanium screw implanted in the skull behind the ear. This picks up sounds on the side he can't hear and transmits them through the bone to the good inner ear on the other side.
Unfortunately, hearing in the playground is quite possibly the most difficult listening situation and all types of aid will struggle. However, this is exactly where a device like Roger could help. It only works alongside hearing aids though, so it is something to consider if he does get aided in the near future. You can find out more about Roger and how it could help your son here.
My advice in terms of next steps, however, would be to go back to your audiologist to discuss potentially being fitted with hearing aids first. It would then definitely be worth looking into a device like Roger to provide additional help in noisy situations.
You may also find the NDCS booklet on unilateral (one-sided) hearing loss helpful in giving more information on the options above.
Vestibular hypofunction is not my area of expertise and it's difficult to be precise without knowing more of your son's background and diagnosis. However, children born with hypofunction (whether one-sided or in both ears) usually compensate well. I would probably make sure he was doing lots of activity running around, football, if he's got a WiiFit, get him to do balance games for 20 mins a day and keep a record, and possibly get a physiotherapist involved to check his motor function.
(With thanks to Sam Lear, Clinical Scientist in Sheffield Children's Hospital who runs a paediatric balance service.)
Q. Pineapple10: I would love to hear more info about the wireless Roger aid and whether it could benefit my child (14) who has moderate 'cookie' loss in one ear (other ear is ok) and wears an aid which he is increasingly self conscious about.
A. Tony: If you have noticed that in loud listening situations, such as at the park or in a restaurant where there is a lot of background noise, your son still struggles to hear specific speech, then this is where Roger could help. Using Roger alongside his hearing aids will enable him to understand and pick up speech in the most difficult listening situations.
You have mentioned that your son is self-conscious about his hearing aid and although using Roger wouldn't specifically combat this as he would still need to wear it, Roger looks pretty impressive and more like a cool new gadget than a hearing instrument.
A. Frank: It sounds like Roger is definitely for him - cool but beneficial too. You still need the aid but the microphone would really help.
Getting Oliver and William to look after and service their hearing aids always used to be a constant task too, as well as making sure they remembered where they had left them. Not only is Roger effective, but they like the fact it's 'cool' and technical and they enjoy helping to set it up in the morning. You can read more about our hearing loss journey here.
Q. KepekCrumbs: Could it help adults with hearing loss too? I struggle with my hearing aids in my job sometimes. I get so tired with all the hard work listening is for me. I have to concentrate so much to hear.
A. Claire: Yes! The Roger system is very adaptable and equally as suited to adult use as it is for children. It may be worth investigating whether you could get funding for it through the Access to Work scheme. You can find out more about Roger and how it could help you to hear over noise and distance here.
Q. bordellosboheme: My son has moderate bilateral high frequency hearing loss.
- What are the main causes?
- How can I best help him to develop speech (he is two)?
- How is it likely to affect him socially?
A. Claire: There are many causes of hearing loss, sometimes even after investigation we don't find out the cause. It is worth talking to your audiologist or ENT Consultant about seeing your local Paediatrician. Children diagnosed with a permanent hearing loss should all be offered aetiological (cause of hearing loss) investigations.
Making sure your son uses his hearing aids well is likely to help him to develop speech as these should give him access to the high frequency sounds. Even at two years being mindful of background noise is useful as it can really make it difficult to hear speech clearly. Ask your local Speech and Language Therapist for advice.
Most of all, make communication fun for your son! The National Deaf Children's Society (NDCS) and the Ear Foundation are both charities which can offer advice and information about getting good communication with your son.
As to how it will affect him socially, that's trickier as all children are different. Building his confidence with good hearing aid use and good communication skills will help. It can also be helpful for children to know others with hearing aids so they don't think they are the only one who wears them.
Q. scarfaceace: Could the Roger device help somebody who is completely deaf in one ear and who has no nerve responses at all (due to a childhood ear infection)?
A. Claire: Yes, it is possible to wear the Roger connected to an i-Sense device in your good ear and you would get the benefits of reducing the background noise. Please also see the options outlined above for MissBetseyTrotwood.
Q. BrigitBigKnickers: We have the Dynamic FM MLXi receivers with Inspiro transmitters and Digimaster 5000 SF systems in our classes. How is the Roger system different?
A. Tony: The main differences between radio aids and Roger are as follows:
- How easy it is to use – radio aids are complicated to set up but with Roger there is no need to worry about this as it will tune automatically for you, adapting to each situation. The microphone and receivers are activated with a single click and it will automatically adjust to suit the environment that it is required in – there are no frequencies to programme or manage as is the case with previous devices. It will automatically adjust for group work or individual use so you no longer need to be concerned with complex operation.
- Its performance – conventional radio aids can be prone to annoying interference. In a research study, Roger delivered a 54% improvement versus its nearest competitor in terms of speech clarity, so any background noise or frequency disturbance that may be an issue with existing radio aids should completely disappear with Roger.
- The cost and accessibility of the technology –this type of technology has largely been limited to schools in the past, but Roger is now widely available for home use too, where some parents may find that communicating with their child out and about in noisy hearing situations such as the park, in restaurants or in the car may be particularly difficult.
The sound field system will be upgradable but you will need to check if your inspiro can be upgraded too (if it's an inspiro premium then you will be able to upgrade it). Your MLxi will not work with Roger, but if you can upgrade your inspiro it can broadcast on FM soundfield and Roger at the same time.
Q. Queenmarigold: My daughter has high frequency loss due to carboplatin. She finds it impossible to hear when there is background noise. I would love to hear more about your hearing aid.
Can you also advise, is moderate hf loss a candidate for hidden aids? If I find a way to pay privately in future, bullying worries me.
A. Tony: Roger isn't a hearing aid but a system that works with hearing aids to help you hear over noise and distance. From what you have said it does sound as though Roger would be a great solution for your daughter as you've mentioned that she really struggles to hear when there is background noise. You have mentioned that you are worried about bullying and although using Roger wouldn't specifically combat this as she would still need to wear the aids, Roger looks pretty impressive and more like a cool new gadget than a hearing instrument. It is also compatible with almost every hearing aid so if you do decide to go down the route of in-the-ear aids then Roger could still work. To find out more about Roger, visit here.
A. Claire: Your daughter's loss may be suitable for in-the-ear hearing aids, but I would recommend finding a private provider who specialises in children's hearing aids in order to do this. There are various in-the-ear models that are suitable for children, but you should talk these options through with an audiologist first as it often depends on their age and circumstances.
I would talk to your daughter's Teacher of the Deaf about your concerns about the possibility of bullying; they can offer a lot of support in school. Also, get in touch with the National Deaf Children's Society for advice and support on the subject. Developing your daughter's confidence around her hearing loss is also really important.
Q. EverythingIsTicketyBoo: I would like to know some more details of this Roger, is he suitable with all hearing aids, what about cochlear implants? And how does it differ from a normal radio aid?
A. Tony: Yes, the Roger Pen is compatible with virtually every hearing aid and cochlear implant, which is one of the main differences between Roger and existing radio aids. Its other main differences are how easy it is to use and the level of performance that it offers (see answers outlined above for BrigitBigKnickers).
Q. isitme1: My niece has recently been diagnosed with some type of hearing loss. They aren't sure if she's fully deaf now or if she has some hearing remaining in one ear, one ear is fully gone. She's under a year old and her newborn hearing was fine. We are waiting for her to see the specialists.
What's the best way we can help her live a 'normal' life? Where do we start with all of this as nothing has been discussed? Will this device you have mentioned be available to her by NHS?
A. Claire: It can take time to get a complete picture of a child's hearing loss at this age. Hopefully your niece's audiology team will be able to give her parents and the family more information about her hearing loss and the management they are suggesting very soon. For more support I would strongly recommend contacting the National Deaf Children's Society (NDCS) - their freephone helpline is 0808 800 8880. Your niece should also be supported by an Early Years Teacher of the Deaf. Although using a technology such as Roger may be beneficial in the future, as your niece is under a year old she is probably a little young at the moment for this, so it is important to first get a good idea of her hearing loss to ensure she has the most appropriate hearing aids fitted. Please be reassured that many children with a hearing loss are out there enjoying very 'normal' lives - the NDCS can even help put your family in touch with some of them when you are ready.
A. Tony: As Claire mentions, Roger may be part of the solution at some stage and could probably help, but it is worth getting aids fitted first and discussing further options such as Roger with her audiologist down the line.
You may also be interested in an initiative called 'Listen & Talk As One'. It's a collaboration between Phonak (manufacturers of the Roger device), Chear (leaders in the field of private paediatric audiology in the UK) and spoken language specialists Auditory VerbalUK (AVUK) which aims to enhance speech and language development in children and babies that have a hearing loss. Visit the Listen & Talk As One website for more information on how they can help.
Q. ShoeWhore: My son had glue ear and I am now told may have permanent mild hearing loss - my niece has just been told the same thing. I'd like to know when this new aid might be appropriate and if it could help him in the longer term if he needs it. At the moment he is happy wearing his hearing aid but he got upset at a concert last week as he said it was too loud and hurting his ears. He's six.
A. Tony: The Roger system works with your child's hearing aids to help him hear more speech over a lot of background noise and distance, so it could help him hear better in different situations.
A. Claire: As Tony mentions, if you notice your son is struggling to hear in noisy situations even when he's wearing his hearing aids, the Roger system would be worth looking in to. In terms of the aids hurting his ears at a recent concert, it may just be worth checking with his audiologist whether his aid is set up correctly if he has had some discomfort with loud sounds. Sometimes this can just be the amount of noise being confusing and a little overwhelming at a concert rather than the loudness, but it definitely needs checking out.
Q. confusedofengland: I have a question regarding hearing. My son is nearly three. He has had three hearing tests over eight months and at each one they have found fluid in his ears (in the springtime one they found fluid in both ears, in the summertime one just in one ear, then in the winter one in both ears again). Is this glue ear? They also said he did not comply sufficiently with the tests to show whether or not his hearing was affected, although I believe the tests they were using were too advanced for him (I would say his understanding is delayed). He also has a fairly severe speech delay, which is causing me concern.
We are going to ENT tomorrow to have him looked at again. At what point, if at all, is anything likely to be done about the fluid in his ears? And what could be done? I know it causes him discomfort because he often pulls at his ears, and I also believe it causes some hearing loss as he can repeat sounds but not words, so it seems like he is not hearing thing clearly enough to copy them.
A. Claire: Yes, it does sound like Glue Ear – which is a term used to describe when there is fluid behind the ear drum that is staying around for a while. Hopefully you have more information after your ENT appointment. There are several options available but usually it's helpful to have an idea of any hearing problems too before deciding on which is the best. One option is grommets, which involves a short surgical procedure. Grommets are small ventilation tubes placed in the ear drum to prevent the fluid from forming. If there is a hearing loss another option is a temporary hearing aid to use whilst the fluid is there. Some parents also opt to watch and wait for a few months to see if the fluid goes by itself. Not all options are possible, for example the guidelines for when grommets are used are fairly strict. If testing has been unsuccessful again it may be worth requesting an appointment with the paediatric audiology team if this hasn’t already happened.
For more information on Roger technology, visit www.hearingadvisor.co.uk.