Sound Waves

Your baby can hear with one ear—an important asset to protect. However, three key factors might affect their hearing during their life.

Ear wax

The ear naturally produces wax (or cerumen) to protect the ear canal. Typically, the ears clean themselves. The wax and dirt move away from the eardrum to the opening of the ear canal, where you can remove the wax with a damp cloth. However, sometimes wax builds up and blocks sound from reaching the eardrum. This can make it harder for your child with UHL to hear well. A wax build-up in young children is usually only noticed during routine ear examinations at the doctor or audiologist.

Ear drops that soften the wax are available from the pharmacy, which may be all that is needed to remove the wax. Always consult your family doctor (GP) if you’re concerned.

For more information on managing ear wax, visit: Ear Wax Management 

Do not insert any foreign objects into the ear canal!

Avoid using ear candling which is both ineffective and dangerous.

Ear infections

Ear infections are common in young children and can cause temporary hearing loss and impact on speech development and learning.

Ear infections can occur in the outer ear (otitis externa) or the middle ear (otitis media). Outer ear infections are usually painful and may cause fever. In contrast, middle ear infections can lead to fluid build-up behind the eardrum, affecting the child’s hearing. 

Otitis media with effusion or ‘glue ear’ occurs when fluid remains trapped behind the eardrum. A child with glue ear may have no symptoms, but the doctor can see the fluid during an ear examination. If the fluid remains in the middle ear for a long time or returns frequently, it can affect hearing.

Preventing ear infections

You can reduce your child’s risk of ear infections.

• Immunise against pneumococcal disease. Pneumococcal infections are a major cause of otitis media. Vaccination for pneumococcal disease is part of the routine immunisation schedule for babies at 2, 4 and 12 months old (3 doses total) and is free for all Australian children.
• Practice good hand hygiene to prevent the spread of the germs that cause colds and flu.
• Avoid exposing your child to cigarette smoke, as it increases the risk of ear infections¹⁵.

Treating ear infections

Mild infections can often be managed with pain relievers like paracetamol. However, consult your family doctor if your child has a high fever, severe earache, or persistent ear discharge.

If you are worried about your child’s hearing, arrange an appointment with your family doctor. Your doctor will examine your child’s ears and should be able to tell if glue ear is present. If there is any pain or sign of infection, your GP may prescribe antibiotics. Your GP may want to wait to see if the glue ear clears up by itself before referring your child to an ENT specialist.

For more information on glue ear, visit: Glue Ear: A Guide for Parents

Noise

Noise-induced hearing loss is becoming more common, especially due to loud leisure activities. It’s important to understand that the effect of noise on hearing is cumulative – factors like frequency of exposure, duration, and intensity can cause damage over time. 

Protecting you and your child from noise

Lead by example! Children learn from observing their parents, so you should always use safe listening practices.

• Educate your child from the early years on the importance of ear protection.
• Always wear hearing protectors when carrying out noisy tasks at home and help to develop good habits in your children from a young age.
• Turn down the volume when listening to music in a confined space.
• Turn down the volume on personal stereo headsets. Smartphones let you set a safe listening limit in settings. The volume of a personal headsets should be at a level where you can still hear someone speaking to you an arm’s length away. 
• Using noise-cancelling headphones can help eliminate external background noise and allow the MP3 player to be played at lower volume.

Children with UHL often develop and use various adaptive strategies to enhance their hearing and communication abilities. These strategies help them cope with the challenges of having reduced hearing in one ear and make the most of their available hearing. You can support your child with UHL to develop these adaptive strategies from the outset through modelling the behaviours when interacting with your child.

Optimal seating and positioning

• Car trips: Placing your child’s car seat so their affected ear is alongside the window will help them hear the other people in the car with their good ear.
• Social interactions: When interacting with peers or in group settings, children can place themselves so their good ear is closest to the person speaking.
• Dinner time: Sitting with their good ear towards the other people at the dinner table can help your child enjoy family conversations during meals.
• Classroom seating: Sitting in the front of the classroom and positioning their good ear towards the teacher can help your child with UHL hear instructions more clearly.

Visual cues and lip reading

• Face the speaker: Encouraging others to face your child while speaking to them allows them to use visual cues and lip-reading for better understanding of speech.
• Clear line of sight: Being able to clearly see the speaker helps your child pick up other visual information that adds to what they hear and improves understanding.

Environmental modifications

• Reduce background noise: Minimising background noise at home and in school settings, such as turning off unnecessary electronic devices, can improve their ability to focus on important sounds.
• Acoustic treatments: Using carpets, curtains, and soft furnishings can reduce echo and reverberation, making speech easier to hear and understand.

Communication Strategies

• Clarification Requests: Teaching your child to ask for repetition or clarification if they miss something can help ensure they understand the conversation.

By employing these adaptive strategies, you can assist your child with UHL and their ability to hear and understand spoken language. These strategies not only enhance their communication skills but also support their academic and social development.

Children learn best through everyday activities and interactions within their natural environments. By weaving language into daily routines like playtime, mealtime, and family outings, families can support their child’s speech and language development. In a language-rich environment, children are surrounded by words and conversations, giving them numerous opportunities to hear and use language.

Families play a crucial role in creating a home environment that is rich in language experiences. By engaging in meaningful conversations with your child, reading to them daily, singing songs, and playing language-based games, you are providing a rich language environment. By describing daily activities, asking open-ended questions, and encouraging your child to express their thoughts and feelings, you can create a home environment that nurtures your child’s vocabulary growth, comprehension skills, and overall communication abilities.

In today’s digital age, it is important to limit children’s screen time. The World Health Organization (WHO) recommends that children under age 5 spend one hour or less on digital devices each day, and that those under age 1 should have no screen time at all. While certain digital tools can help the process of introducing children to new vocabulary, concepts, and stories, they shouldn’t take the place of direct human interaction, which is the most effective way for children to learn language.

You already know how important it is to fill your child’s life with language. You want your child with UHL to hear all the songs you sing, the stories you share and the snippets of conversations that make up your family life. There are a few steps you can take to create an environment at home that will make it easier for your child to hear and listen.

The three main barriers to understanding speech for anyone with a hearing loss are:

1. Distance from the sound
2. Background noise
3. Reverberation

Distance from the sound

Loudness, pitch, and distance from sound are all important in our ability to hear. Children with hearing loss have a reduced hearing range. Your child may have difficulty understanding what you are saying when you are talking from a distance.

Fortunately, we communicate with young babies at close range – they are usually only an arm’s length away as we cuddle, play and attend to their needs.

You do need to be aware of the impact of distance on your growing child’s listening ability. When you call from the next room for your child to put away the toys and they do not do it, they may not have heard your request. This is one of the dilemmas of being the parent of a child with hearing loss – have they not done it because they couldn’t hear you properly, or are they being disobedient?

Background noise

We all know the experience of trying to make out what someone is saying to us in a bar or a rock concert. We know the person is talking to us, and we can probably catch a few words and get the gist of the conversation. We probably know something about the topic and can use our knowledge and experience to understand what they are saying. And we are hearing with two ears.

Background noise is a problem for all children and anyone with hearing loss. Young children are unable to ‘predict from context.’ They have limited vocabulary and experience and can’t fill in the missing pieces of conversation as adults can. For children with typical hearing, their ability to understand sentences in noisy environments does improve through the early childhood years. They reach adult levels of speech understanding in noise in their teens. Children and adults with hearing loss will always find background noise challenging.

What can you do?

Homes with young children are noisy places. It is part of the fun of having children! But limiting background noise can make it much easier for your child with UHL to learn and understand what others are saying.

• Read to your child in a quiet environment and make sure their hearing ear is closest to you.
• Turn off the TV/radio/music at mealtimes. Sit at the table together and chat. Mealtimes provide excellent opportunities for language development.
• Vacuum cleaners, washing machines and lawnmowers all make it very difficult for your child to understand what you are saying to them. Be aware of this if you give them instructions or warn them about something.

Families spend a lot of time in the car, and this can also be a difficult listening environment for children with UHL.

• Turn off the radio and wind up the windows if you are talking in the car, or listening to music or a book.
• Your child with UHL should be sitting with their affected ear alongside the window for easier listening.

Reverberation

Reverberation is the persistence of sound in a room after the original sound has stopped—like an echo. A room with ‘good acoustics’ is designed to reduce reverberation and make it easier to understand speech. Reverberation time depends mainly on the size of a room or space and the surface materials used. An empty bedroom with wooden floors has a longer reverberation time than a room with carpet, furniture and curtains.

What can you do at home?

Reverberation is usually more of a problem for children in the classroom than at home.

However, contemporary homes with open-plan living, timber floors and blinds on the windows are not easy listening environments for anyone with hearing loss. Soft furnishings that absorb sound reduce reverberation and make listening and understanding easier at home.

Carpets are better than hard floors, and curtains are better than bare windows or blinds.

Small things can make a difference in improving the listening environment for your child at home.
Reducing noise and reverberation will help your child to listen and understand
speech and participate fully in your family’s life.

Children with hearing loss exert more listening effort than their hearing peers when processing speech. Lip reading, interpreting expressions and filling in the gaps in conversations involve active concentration, often for extended periods, and this can cause significant fatigue. Children with UHL become more fatigued than normal hearing children, even when the affected ear is aided². Fatigue can affect your child’s classroom performance, capacity to learn effectively, social relationships and their quality of life.

Children with hearing loss have described feeling tired, drained, or exhausted after periods of concentrated listening. Increased listening effort can lead to cognitive fatigue, where the child is likely to have difficulty concentrating, become distractible and be less attentive. Cognitive fatigue, in turn, can lead to feelings of stress, tension and emotional difficulties.

The experience of listening-related fatigue in children with hearing loss varies widely. The amount of fatigue doesn’t directly correlate with the degree or type of hearing loss. There are currently no specific tests for measuring listening fatigue in children with hearing loss. Nevertheless, it’s important to recognise that children with hearing loss have an increased risk of fatigue at school.

There are strategies for managing listening-related fatigue that can be implemented in the school setting.

More information: Listening fatigue at school

Parents naturally want the best for their children and are uniquely positioned to understand their needs and speak up on their behalf. As parents of a child with UHL, you may need to become advocates—speaking up for your child to negotiate for services and support. Many parents find themselves becoming advocates when their child starts school, but there are numerous situations before school where advocacy skills can be beneficial, such as finding an early intervention service and starting child care or preschool.

Being an advocate for your child requires preparation and a well-informed approach. Here are some steps you can take to become an effective advocate:

• Build relationships with professionals: Maintain a good working relationship with the professionals involved in your child’s care. Ask questions, ensure you understand their responses, and don’t hesitate to reach out to them.
• Educate yourself: Become informed about UHL, its potential effects, and outcomes for children with UHL. Know your child’s rights regarding services and support, and stay updated on research and any new or discontinued services for children with UHL.
• Understand the system: Learn the rules, terminology, and jargon related to education and support services. This is particularly helpful when developing plans for the NDIS or advocating for support at school.
• Keep records: Maintain thorough records, including reports from professionals and notes from phone calls or meetings. You can send follow-up letters or emails to clarify what was said and agreed upon.
• State your case: Practice stating your case clearly, calmly, and confidently. Rehearse what you want to say beforehand to ensure you communicate effectively.

Teaching  your child self-advocacy skills

Your child can benefit from learning self-advocacy skills from an early age, as you won’t always be there to speak up for them. There are a few things you can implement to help your child become an effective self-advocate:

• Encourage independence: Create opportunities for your child to be independent and advocate for themselves. Let them order for themselves in a café, ask a sales assistant for help, or share a concern with their teacher.
• Provide the right vocabulary: Give your child the vocabulary and understanding of their hearing loss to explain their needs to others.
• Promote problem-solving: Resist the urge to always jump in and solve problems for them. Allow your child to take the lead and lean on you only when necessary.
• Practice communication: Help your child practice ways of communicating their needs in an open and respectful manner.
• The power of humour: Your child will likely face some awkward or challenging moments, and finding the funny side of some situations can help ease any tension and often earn the respect of those involved.
• Mentorship: Introduce your child to someone older with UHL. Sharing experiences with a mentor can provide confidence and guidance for young people learning to negotiate their needs at school and in the wider world.

By advocating for your child and teaching them self-advocacy skills, you equip them with the confidence and tools to navigate challenges and express their needs effectively. These skills foster independence and resilience that will serve your child well throughout their life.

One of the difficulties people with unilateral hearing loss have is recognising where a sound is coming from. We need sound to reach both our ears to localise the sound. Our brain receives the sound signal from both ears and can accurately interpret where a sound is coming from.

With unilateral hearing loss, your child’s brain may only receive the signal from the better ear, and while your child will hear the sound, they won’t be able to tell where it is coming from. The greater the degree of hearing loss, the more difficult localising sound will become.

The most noticeable difficulty for families is when calling their children. Tell them exactly where you are, or they will struggle to find you.

Road safety

An inability to localise sound has a more critical impact – safety, particularly on the road. Your child may hear a car but not know its direction. Good road safety behaviour starts early. Children learn from watching their parents, and they copy their behaviour. Set a good example from the start:

• Cross the road at traffic lights or pedestrian crossings.
• Don’t cross the road between parked cars. Children cannot see an approaching vehicle, and the child with unilateral hearing loss may not hear the car or know which side the car is coming from.
• Car parks can also be hazardous for the same reason.

Generally, children under 10 need active adult supervision when crossing the road. They have difficulty judging how far away a car is and how fast it is going. Children also find it hard to identify if a place is safe to cross the road. Learning to cross the road safely takes time and practice. Walking with your child to the shops or school is an ideal time to teach road safety behaviour.

Stop – Look – Listen – Think

Teach you child to STOP – LOOK – LISTEN – THINK  when crossing the road. Model the process when you are crossing the road with your child.

STOP: ‘Is this a good/safe place to cross?’

LOOK: ‘Is the car coming towards you or driving away? ‘Is the car going fast or slow? Can the driver see you?’

LISTEN: ‘Can you hear any traffic? Remember you need to look and see where it is coming from!’

THINK: ‘ Is the road safe in both directions?’ ‘Do you think it’s safe to cross now?’

Bicycle safety

All children need to be taught cycling safety. Start teaching them good riding habits when they get their first bike. Children with UHL may experience two additional challenges when riding their bike:

• When riding on the pavement, children may not hear when a car is pulling out of a driveway, and the driver may not be able to see them. They need to learn to be cautious at each driveway.
• When riding on a bike track, they may not hear another bike coming from behind or be able to decide which side to move when the rider rings their bell. Rear vision mirrors or learning to ride on the left side of the path so that other bikes can overtake may avoid a few unnecessary mishaps.

Talking to your child about their hearing loss and the extra precautions they must take
will help them understand their responsibilities and keep them safe.

Starting daycare or preschool for a child can feel like a big step, but with the right approach, you can find a service that suits your child and your family.

 Choosing the right service

Children with disabilities can enrol in any early childhood education or childcare service in Australia. When choosing a service, it’s important to communicate your child’s needs and abilities early on to find the best match.

Key points to consider include your child’s needs and interests, the staff’s confidence and comfort in caring for your child, and whether there are other children with additional needs at the service. Talking to other parents, especially those with children with hearing loss, can provide valuable insights into the services you are exploring.

Setting your expectations

Before visiting any childcare centres, it’s a good idea to consider what you’re looking for. Are you wanting a place where your child can socialise and receive supervision, or do you prefer a more specialised educational environment? Do you want the staff to have training in special needs, or are you comfortable providing guidance about your child’s needs? Will a general childcare program suffice, or do you want something more specialised? Having clear expectations will make it easier to communicate your needs and narrow down your options.

When communicating with childcare providers, it’s important to share information about your child’s needs. Start by providing general information about your child’s abilities and see how the provider responds. Don’t hold back important details, as this could impact the level of care your child receives. Once you have narrowed down your choices, share more specific details about your child, such as their medical and physical needs, behavioural challenges, ways to comfort or calm them, and activities they enjoy or find challenging. Providing these details will help create a supportive environment for your child.

Settling in

Selecting a childcare provider is the first step in establishing a long and positive relationship. Expect a period of adjustment as you and your child get used to the new routine. It’s normal to encounter some challenges along the way, but stay positive and work through them. Observe how your child is adapting, and communicate any concerns with the childcare worker or supervisor. If you feel that the provider is not meeting your child’s needs, address the issue early or consider other options. 

Every child adjusts differently, so give your child the time and space they need to settle in. Maintain open communication between you and the provider to maintain a nurturing environment where your child can thrive.

Starting school is an exciting time in any child’s life, but it can also be a source of stress for families with a child who has unilateral hearing loss. Questions run through your head, such as:

• ‘Is my child ready to start school?’
• ‘Which school will best suit my child’s needs?’ and
• ‘Will the school provide the right listening environment for my child?’

A school will appreciate knowing well in advance (at least six or nine months before school starts) that your child will be attending their school. Early communication with the school allows them ample time to prepare for your child’s arrival.

Is my child ready to start school?

School readiness depends on several factors, including your child’s age and maturity level. Listen to the advice of preschool teachers and health professionals while also considering what you know about your child.

Providing a stimulating learning environment at home will set the foundations for a successful transition to school. Here are some ways to do this:

• Read a range of books with your child, including fiction, non-fiction, nursery rhymes, and poetry.
• Visit interesting places and expose your child to a broad range of experiences. Discuss what they saw and learnt with them afterwards.
• Encourage social interactions with family and friends and nurture early friendships.
• Give your child the vocabulary and understanding of their hearing loss to explain their needs to others.
• Empower your child to advocate for themselves; they must do this independently at school.
• Build their self-advocacy confidence in small, supportive settings so they feel comfortable addressing their listening needs in the school environment.

 
Which school will best suit my child’s needs?

Start your research and preparation early. Most children with UHL will attend mainstream schools and may receive few considerations. Therefore, ensuring the school understands your child’s needs and can provide the necessary support for full access to the curriculum is crucial.

Visiting schools in your area is a good idea. Attend open days with your child to gauge their feelings about each school. Talking to other parents and students can provide valuable insights into the school community. Finally, arrange a meeting with the principal to discuss your child’s needs and ask any questions.

Will the school provide the right listening environment for my child?

Children with UHL need to concentrate harder to understand what is said in noisy environments. This can make them tired, which makes learning more difficult. A good listening environment at school makes a significant difference to children with UHL.

Consider these questions when selecting a school:

• Are there other children with hearing loss at the school? If so, the staff may have a better understanding of your child’s needs, and a visiting teacher of the deaf might be available to offer advice.
• How large are the classes? Larger classes are noisier, making it harder for your child to hear.
• Where is the school located? Schools on main roads may be noisier, making listening more challenging.
• Is the classroom design suitable? Avoid demountable and open-plan classrooms, as these often have higher noise levels, making it harder to understand what is being said in the classroom.
• Have the classrooms been acoustically treated? Look for classrooms with carpeted floors, curtains, and acoustic tiles on the ceiling, as these features improve the listening environment.
• What opportunities exist for parent involvement? As a parent of a child with UHL, you should build solid relationships with the school staff. Good communication and a willingness to be involved will foster a successful partnership with the school.

Have I made the right decision?

Families choose schools for many reasons, such as religious affiliations, family traditions, or the desire to send all their children to the same school. It may take some time to determine if you’ve made the right choice for your child with UHL. Flexibility is helpful, as what works for one child may not work for another. If you feel a different school environment might be better for your child’s learning needs, exploring other options is worth considering.

As children mature, it’s crucial to include them in any decision-making process about their schooling. Their input can provide valuable insights into their comfort levels, preferences, and any specific challenges they may face. By involving them, you empower your child, helping them feel more in control and confident about their school years.

1. Zhang, V. W., et al. (2023). Audiological characteristics of children with congenital unilateral hearing loss: insights into Age of reliable behavioural audiogram acquisition and change of hearing loss. Frontiers in Pediatrics, 11. https://doi.org/10.3389/fped.2023.1279673
2. Bakkum, K. H. E., et al. (2023). Subjective Fatigue in Children With Unaided and Aided Unilateral Hearing Loss. Laryngoscope, 133(1), 189-198. https://doi.org/10.1002/lary.30104
3. Cupples, L., Ching, T. Y. C., & Hou, S. (2024). Speech, language, functional communication, psychosocial outcomes and QOL in school-age children with congenital unilateral hearing. Frontiers in Pediatrics, 12. https://doi.org/10.3389/fped.2024.1282952
4. van Beeck Calkoen, E. A., et al. (2019). The etiological evaluation of sensorineural hearing loss in children. European Journal of Pediatrics, 178(8), 1195-1205. https://doi.org/10.1007/s00431-019-03379-8
5. Boothroyd, A. (2008). The acoustic speech signal. In J.R. Madell and C. Flexor (Eds.), Pediatric Audiology : Diagnosis, Technology, and Management (pp.159-167). New York: Thieme.
6. Sung, V., Downie, L., Paxton, G. A., Liddle, K., Birman, C. S., Chan, W. W., Cottier, C., Harris, A., Hunter, M., Peadon, E., Peacock, K., Roddick, L., Rose, E., Saunders, K., & Amor, D. J. (2019). Childhood Hearing Australasian Medical Professionals network: Consensus guidelines on investigation and clinical management of childhood hearing loss. Journal of Paediatrics and Child Health, 55(9), 1013-1022. https://doi.org/10.1111/jpc.14508
7. Medical assessments for children with a permanent hearing loss. (2024). Retrieved from https://www.aussiedeafkids.org.au/resources/your-childs-hearing/causes-of-hearing-loss/medical-assessments/
8. Hawley, T., & Gunner, M. (2000). Starting Smart: How Early Experiences Influence Brain Development. Zero to Three.
9. Lerner, C., Dombro, A., & Levine, K. (2000). Magic of everyday moments booklets: How the brain, body and mind grow from birth to 3. Retrieved from https://www.zerotothree.org/resource/magic-of-everyday-moments-booklets-how-the-brain-body-and-mind-grow-from-birth-to-3/.
10. Endevelt-Shapira, Y., Bosseler, A. N., Mizrahi, J. C., Meltzoff, A. N., & Kuhl, P. K. (2024). Mother–infant social and language interactions at 3 months are associated with infants’ productive language development in the third year of life. Infant Behavior and Development, 75, 101929. https://doi.org/https://doi.org/10.1016/j.infbeh.2024.101929
11. 5 Steps for Brain-Building Serve and Return. Retrieved from https://developingchild.harvard.edu/resources/5-steps-for-brain-building-serve-and-return/
12. Mullen, G. (2017, 09/27). More Than Words: Using Nursery Rhymes and Songs to Support Domains of Child Development. Journal of Childhood Studies, 42, 42. https://doi.org/10.18357/jcs.v42i2.17841
13. Fox, M. (2001). Reading magic: How your child can learn to read before school—and other read-aloud miracles. Sydney: Pan Macmillan Australia Pty Ltd.
14. Bagatto, M., et al. (2019). Consensus practice parameter: Audiological assessment and management of unilateral hearing loss in children. International Journal of Audiology, 58, 1–11.
15. National Institute on Deafness and Other Communication Disorders. (2015). Ear infections in children. Retrieved from https://www.nidcd.nih.gov/sites/default/files/Documents/health/hearing/EarInfectionsInChildren.pdf.