Phonak Pediatric Insights

New Pediatric Research Opens a Doorway for Children With Hearing Loss 

Hearing healthcare is now in a new era. 

According to Dr. Carol Flexer, Ph.D., while it’s important to understand the anatomy and physiology of the ear, it’s more important to understand how the brain interprets linguistic elements.  

“The ear is the structure that captures sound and directs that auditory information to the brain, but it is the brain that processes language,” wrote Dr. Flexer in her Phonak Insight, “The ears are doorways to the brain.”  

“The ears are the doorway to the brain for auditory information, but the knowing of hearing occurs in the brain.” — Dr. Carol Flexer, Ph.D.

In her video, “Auditory brain development for children with hearing loss,” Dr. Flexer elaborated more on pediatric hearing loss being a “doorway problem.” As well, she discussed what audiologists can do to explain this to family members. 

Below is an excerpt from the video. 

What actually is hearing? 

“Hearing is brain access of auditory information,” said Dr. Flexer. “We hear with the brain.” 

Humans are born with amazing sensory structures. The purpose of these sensory receivers are to capture different types of environmental data and change that information into chemo electric and neuroelectric impulses that can be received and read by the brain.  

“The ears are the doorway to the brain for auditory information,” she added, “but the knowing of hearing occurs in the brain.”   

How is meaning associated with auditory information? 

According to Dr. Flexer, knowing the meaning of that auditory information comes from auditory experience, exposure and practice, beginning at 20 weeks before birth.  

“Babies are born with 20 weeks of auditory experience,” she added. “And while it’s not an interactive experience, their brains have been stimulated with auditory information through their mother’s voice.”  

How can we talk about this with parents and family? 

“We can have a narrative with the family that explains that hearing loss is a doorway problem,” said Dr. Flexer.  

This means something in the doorway itself impedes the information from getting to the auditory brain to develop and integrate auditory pathways throughout the brain. 

“Hearing loss is a doorway problem,” she added. 

What is our role as audiologists? 

According to Dr. Flexer, we have to analyze what’s happening in this doorway. That’s what the audiogram does. It measures the quantity and quality of this doorway obstruction. We have to understand this doorway problem in order to know the treatment.  

“Hearing loss is a doorway problem.” 

“If it’s a sensory issue, then the way to get through the doorway is with technology: hearing aids, cochlear implants, bone-anchored devices and of course, remote microphone systems,” she said. “The choice of technology depends on what’s happening in the doorway.”   

How can we talk with families about hearing solutions? 

Dr. Flexer recommended to mention all of our technologies; however, not necessarily the details about each one.  

“I don’t drop different technologies over time,” she said. “Overall, I overview what’s the big picture.” 

“Studies have shown that 40-plus percent of doorways do change over time. Hearing loss may progress, but we’ve got a solution for that progression.”

We have an amazing array of technologies that are designed to breach the doorway and deliver the best auditory information to the brain. And the technology chosen for a baby or child may change over time as the doorway changes.  

“Studies have shown that 40-plus percent of doorways do change over time,” said Dr. Flexer. “Hearing loss may progress. But we’ve got a solution for that progression.” 

We have various technologies that are designed to deal with different types and configurations of doorway problems.  

Is technology enough? 

“As wonderful as our technologies are, they are not the same as the organic doorway,” said Dr. Flexer. “They’re excellent but they’re not perfect.” 

We need to enrich the information we send through the doorway to the brain using hearing devices. As audiologists, link the technology to the use of the technology for the purpose of developing that child’s brain. 

“Link the technology to the use of the technology for the purpose of developing that child’s brain.”

Offer suggestions for the families to enrich and feed their child’s neurodevelopment by conversations that are developmentally appropriate—read aloud, music, working together.  

What is the scientific evidence? 

“We do have studies that show the technology needs to be worn at least 10 hours a day,” said Dr. Flexer. “Human brains are available through an intact doorway for auditory information 24/7.” 

But because none of our pediatric technologies are designed for 24-hour wear, we’re not saying to families to keep this device on for 24 hours.  

What we’re saying is 10 to 12 hours in an enriched, intentional, thoughtful, developmentally appropriate timeframe will develop this child’s brain and set him/her up for listening, talking, reading and learning and making friends. 

For more information, watch the “Auditory brain development for children with hearing loss” video and read the Phonak Insight, “The ears are doorways to the brain.”