Paediatric Programme

More information

Brief overview

The New Zealand Government provides hearing screening for all newborns in New Zealand through The Universal Newborn Hearing Screening and Early Intervention Programme.

 

Some children are born with a hearing loss, and others develop a hearing loss later on.

 

There are varying levels of hearing loss. For an overview of hearing loss in New Zealand, visit The National Foundation for Deaf & Hard of Hearing.

 

Many children receive adequate benefit from hearing aids; however, a cochlear implant should be considered for children who do not receive adequate benefit from hearing aids.

Suspecting a hearing problem


Usually it is parents or primary caregivers who are the first to suspect something is wrong with a child’s hearing. This may be due to the lack of response from the child when a parent speaks to the child from across a room, or even a lack of response to other unexpected sounds such as a door slamming. Others might become concerned if their child appears reluctant to speak or gets to an age where they seem behind their peers when communicating.




What should you do?


It is never too early to take the first step and talk to your talk to your GP or another Health Professional, such as an Audiologist, Hearing Therapist or ENT Specialist, about your concerns. They are trained to know about children’s development, including the age at which children should be starting to speak and communicate. It is likely they will refer your child for a comprehensive hearing test. If you continue to have concerns and your child is not referred, keep pushing for your child to have a comprehensive hearing test by an Audiologist.




Assessing a hearing problem


Hearing tests for children are painless, even for very small babies, and are an effective way to work out if a child has a hearing loss and, if they do, the extent of that loss. A hearing test measures a child’s ability to hear sounds of different volumes (loudness) and pitch (high and low sounds). These measurements are recorded on a graph of a child’s hearing called an audiogram.

Hearing loss can be defined as mild, moderate, severe, or profound based on the extent of the hearing loss.

The majority of children diagnosed with a hearing loss have a mild to moderate hearing loss and many need a hearing aid rather than a cochlear implant.

If an Audiologist or other Health Professional feels your child may benefit from a cochlear implant, they can refer your child to the paediatric cochlear implant assessment programme for an assessment.




Eligibility and Assessment


Eligibility for a Cochlear Implant depends on a multitude of factors.

Your child will be assessed by a multidisciplinary team including an Ear, Nose, and Throat Surgeon, Audiologists and an Auditory-Verbal Therapist.

The length of time required for the assessment will vary for each child, depending on age, previous hearing aid use, and language development.

Following the assesment, the results will be explained and the assessment team will discuss with you whether a Cochlear Implant is appropriate for your child.

If a Cochlear Implant is appropriate, you will be made aware of the commitment required of your family to ensure your child benefits as much as possible.

You will learn that the operation itself is only the first step.

The second step is much more involved, and requires your continued support to help your child learn to listen and speak. An Auditory-Verbal Therapist will work with you and your child to achieve this goal.




Surgery


A two to three-hour operation under general anaesthetic is required to insert the Cochlear Implant.


A small amount of the child’s hair is shaved before surgery and there is a small scar behind the ear, which is almost invisible when the hair regrows.

It is common for the ear to stick out a little after surgery, but this eventually settles down.

The area where the implant package has been placed is slightly prominent, but it is unusual to have any significant swelling in this area.

After surgery, a child stays overnight at Gillies Hospital in Auckland – with their parent in the same room – and goes home the next day.

Sometimes it may be possible to return home the same day. Details of surgery are explained during the assessment process.

There is mild discomfort for up to a week after the surgery.A child is prescribed antibiotics for a few days after surgery in order to reduce the risk of infection, and parents are told to keep a close eye on the wound to make sure it doesn’t swell up or become red, which can be a sign of infection.

Dissolvable stitches are usually used so that a child does not need to get these removed.

Further follow-ups with the surgeon are carried out shortly after surgery and again at a few months later.




Switch-on


Shortly following surgery, the speech processor is switched-on.

The ‘switch-on’ involves careful programming of the speech processor to ensure the cochlear implant provides the right sound levels for the child.

This is termed ‘MAPping’. The child will return again the next day for continued ‘MAPping’ and will typically require 10 appointments within the first year for further refinement.

Generally speaking, after one year, the levels are stable and the child will be seen either once or twice a year, depending on age. Each child’s progress is monitored carefully.




Habilitation


This is the process of teaching a child with hearing loss to match sound to meaning.

Young children will begin with a clean slate' and learn to listen and match the sound to meaning in the same way a newborn baby does.

If the child or teenager has already developed language prior to getting a cochlear implant, habilitation will help them to acquire what they have missed while they had compromised access to sound.

It is important to ensure a child receives as much benefit from the implant as possible.

The Hearing House and Ko Taku Reo are joint providers of habilitation services for the northern region.

After surgery, a child embarks on extensive therapy to meet their communication potential.

It is recognised that children will achieve best if the family are given regular intensive guidance at therapy sessions to enable them to work daily on listening targets in the home.

Auditory-Verbal Therapy uses the child’s access to sound to learn to listen and speak.

This works by accelerating the natural way a child would develop language, and requires the family to be the main teacher of their child’s language.

The ultimate aim of Auditory-Verbal Therapy is for the child to speak as clearly and naturally as their hearing peers — and ideally, to attend a mainstream school by the time they are five.

Most children attend therapy with their parents or carers once a week for an hour, even if they are babies.

Each week, parents/carers are given new sounds or words to focus on with their child at home and the Auditory-Verbal Therapist works closely with children and families to maximise opportunities to learn to listen and speak.

Those who interact with the child regularly, such as grandparents, guardians, and other caregivers (such as preschool teachers) are also encouraged to help the child learn to listen and speak by understanding their language goals.

Over time they will attend less regularly, but this first period is important to try and catch up on auditory stimulation the child missed out on before they got their device.

Children aged five and over

Receive habilitation services from Ko Taku Reo and audiology services from The Hearing House.

Ko Taku Reo has a residential facility and core school in Auckland, ranging from preschool to students who are preparing for tertiary study or the workforce.

They also operate classes in satellite units for students in mainstream schools and have responsibility for managing Resource Teachers of the Deaf (RTDs).