Speech and Language Development in the Context of Hearing Loss

Some conditions affect part of the ear and interrupt the brain’s access to sounds. This results in hearing loss. Inconsistent or limited access to sounds impacts the development of spoken language. It can also result in difficulty learning and socializing.

Some children with hearing loss learn sign language, some learn spoken language, and some learn both. Children with hearing loss can have age-appropriate spoken language skills. This will depend on factors such as appropriate use of hearing technology, consistent exposure to spoken language, therapy services, and factors specific to your child (like other disabilities). Appropriate hearing technology is determined by an audiologist and may include:

• Hearing aids
• Devices that capture sound and transfer it through bone vibrations directly to the inner ear (Bone conduction hearing devices)
• Electronic devices that can help provide a sense of sound to a person with hearing loss (Cochlear implants)
• Technology that uses wireless radio frequencies to transmit audio signals to hearing aids (FM/remote microphone systems)

If your child has hearing loss, they will be best supported by a team of professionals. Here at Children’s Hospital of Philadelphia (CHOP), our team consists of audiologists, teachers of the deaf (TOD), speech-language pathologists (SLP), otolaryngologists (ENT) and other providers as needed. 

Hearing loss can be present from birth (congenital) or acquired. 

The degree of your child’s hearing loss determines the impact on their listening, speech and language skills. Without the use of hearing technology, your child may experience several symptoms:

If your child has mild hearing loss they may:

• Have difficulty understanding speech in noisy environments.
• Miss short words (an, the, of) and quiet consonant sounds (f, k, p, s, t).
• Miss grammatical word endings, such as past tense (-ed) and plurals (-s).
• Leave out certain sounds or words when speaking.
• Have reduced spoken language skills. This may include smaller vocabulary, shorter sentences and less use of grammar.

If your child has moderate or moderately severe hearing loss they may:

• Have difficulty understanding speech unless the speaker is close and talking loudly.
• Have more difficulty listening in noisy places.
• Leave out or substitute consonant sounds.
• Have significantly delayed or disordered spoken language skills.
• Be difficult for others to understand.

If your child has severe hearing loss they may:

• Find hearing difficult in all situations.
• Hear loud sounds, like a siren and a person yelling, but not understand what people say.
• Not develop spoken language or have significantly delayed or disordered skills.
• Be very difficult for others to understand.

If your child has profound hearing loss they may:

• Not hear loud voices or environmental sounds.
• Not develop spoken language.

If you notice these signs in your child, you can talk with their doctor. You can also schedule an audiological evaluation here at CHOP.

Audiologists test and diagnose hearing loss. SLPs assess the communication skills of children with hearing loss. Our SLPs at CHOP will support your child with hearing loss through speech-language-listening evaluations. This service does not replace the therapy your child is receiving through the county or school. It is a consultative service where we work together with you, your child and your child’s other medical providers. Your child’s other service providers are welcome to attend speech-language-listening evaluations.

The SLP completes an evaluation that assesses:

• Listening (auditory) skills
• Receptive language
• Expressive language
• Speech production
• Social
• Play
• Structure and function of the lips, tongue, jaw and palate (oral mechanism)
• Voice
• Sound vibrations in the throat, mouth and nose (resonance)
• Fluency

Our SLPs will also work closely with you and your family to:

• Provide information regarding hearing loss, typical speech and language development, and options for communication. This includes American Sign Language (ASL) and other visual-based communication systems.
• Teach activities that target auditory skill development.
• Model techniques to support language at home and in the community.
• Monitor your child’s progress over time and make recommendations.

Our SLPs use a team-based approach with the Center for Childhood Communication’s Audiology Department and Family Wellness Program. We work closely with your child’s providers to promote stable and consistent care. We follow your child for ongoing evaluations for as long as needed.

You may schedule the first speech-language-listening evaluation after a hearing loss diagnosis. These specialty appointment types can be scheduled at the following CHOP locations:

• Main campus in Philadelphia at the Buerger Center
• Specialty care locations in Abington, King of Prussia, Brandywine Valley and Princeton

Our SLPs will work together with your family to create goals for your child’s language skill development. Each child is unique and may have different needs. The therapy approach will depend on your child’s and your family’s specific needs.

Listening and spoken language therapy involves special techniques. These techniques are designed to help your child develop listening skills, which are needed to learn to talk. Listening skills develop across a hierarchy. Skills progress from detecting sounds, to noticing the differences between sounds and words, to recognizing words and phrases, to understanding sentences and conversation. As your child progresses through these levels, they will also learn to say sounds, words and sentences.

Listening and spoken language therapy is not always the most appropriate method for every child or family. American Sign Language (ASL) is a full language that can provide your child with hearing loss a complete and meaningful communication system. Many children use a combination of visual and auditory communication systems. There are also picture-based systems and touch-based systems. Our SLPs can support you in ensuring your child has consistent and effective access to language, in whatever form it may be.

Speech-language therapy sessions involve you, your child, their other caregiver(s) and our SLP. Sessions may be play-based or structured with tabletop activities. This will depend on your child’s needs and abilities. Sessions also include your child's interests and your family's culture. This leads to better engagement, relevance, learning and fun.