In this episode of the Where Parents Talk podcast, host Lianne Castelino explores the alarming statistics surrounding hearing impairment in Canada, particularly among children, with Peter Stelmacovich, an audiologist and hearing loss patient.

Stelmacovich, who is part of HearCanada's Mississauga clinic, shares his lived experience with the profound implications hearing loss can have including: language acquisition and academic success.

He emphasizes the importance of early detection and intervention.

The conversation explores the role of technology, including hearing aids and cochlear implants, in enhancing communication and independence for children facing these challenges.

Additionally, the stigma associated with hearing loss and the impact of device usage on emotional and mental health, are examined, while emphasizing open communication between parents and educators to foster a supportive environment.

Takeaways:

• Hearing loss in children is more common than many realize, with two out of every 1,000 births leading to permanent hearing loss at birth.
• The infant hearing program in Canada is crucial for early detection, allowing intervention much sooner than before, reducing developmental lags.
• Parents should actively monitor for subtle signs of hearing loss in their children, such as issues with language development or academic performance.
• Effective communication strategies, such as using wireless remote microphones, can significantly enhance a child's ability to hear in noisy environments.
• It is essential to maintain a proactive approach to hearing health, including regular check-ups and addressing any concerns promptly to prevent long-term impacts.
• Understanding the stigma around hearing loss, especially in teenagers, can help foster a supportive environment that encourages seeking necessary treatment.

Links referenced in this episode:

• whereparents talk.com
• HearCanada.com

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Welcome to the Where Parents Talk podcast. We help grow better parents through science, evidence and the lived experience of other parents.

Learn how to better navigate the mental and physical health of your tween teen or young adult through proven expert advice. Here's your host, Lianne Castelino.

It has recently been described as one of the fastest growing health crises in Canada. What do parents need to know about hearing loss in kids? Welcome to Where Parents Talk. My name is Leanne Castellino.

Our guest today is an audiologist who lives with hearing loss himself. Peter Stelmakovich is also a hearing health advocate and founder of Hear Canada's clinic in Mississauga, Ontario.

Peter is also a father and he joins us today from from Mississauga. Thank you so much for taking the time.

Oh, my pleasure, Leanne. Pleasure to be here, Peter.

I wonder if we could start by setting the table for our conversation as it relates to the current state of hearing loss in this country, how would you go about characterizing that specifically as it relates to children and young people in general?

About 10% of the Canadian population has a hearing loss, and that includes adults in pediatrics. The data I can tell you about is, for example, two out of every 1,000 births, this child has a permanent hearing loss right at birth.

And then another two out of thousand will develop a hearing loss by age 5. And these are permanent hearing losses.

And then, of course, we have a hearing loss in children that occurs from otitis media or middle ear infections. And there about 75% of all children will experience at least one episode of ear infection before their fifth birthday.

So there is a lot of hearing loss due to otitis media, middle ear infections, which can also have quite significant impacts on your child's language development and academic performance.

So understanding those stats as you've laid them out, what do you believe parents in particular should be aware of when it comes to hearing health of their children?

Well, first of all, I just want to start saying we are very fortunate in Canada and in Ontario, where I am, to have the infant hearing program. There is some form of this in all the provinces in Canada. They do vary a little bit in terms of how comprehensive the programs are.

It's not enough just to identify the hearing loss. You have to do something about it as well. And so some of the programs in Canada kind of stop short.

They identify, but they don't always have the same degree of follow up. So that is something that other provinces are working on to improve.

But the infant hearing program is great because prior to the infant hearing program, parents Might have to wait. Hearing loss was detected often around three or three and a half years of age.

And that's because the child is supposed to be talking now and they're not talking. And then you go, gee, you know, I wonder why. Oh, maybe I'll grow it. And then. But they actually had quite a significant hearing loss.

And then we start using hearing aids or a cochlear implant at that stage in life. But now we're three or three and a half years behind and so the child has to do catch up.

So that's, so that's great that we have that to prevent, you know, this lag time and this delay. So that's really good. So that's one thing that I think parents need to know about is the infant hearing programs.

And, and also too parents need to know that because the child is learning to speak still the impact of a hearing loss on a child is far greater than the impact of a hearing loss on an adult who has a fully intact language and linguistic system in place. And so, but if you're learning to speak English or French or any language with a hearing loss, it's, it's very difficult.

And so that's why we need to get on top of it with children very, very quickly.

When you say get on top of it, what does the ideal state look like in terms of when a child should be tested for their hearing and how often that should occur?

Again, fortunate, all babies are tested before they leave the hospital. And that's important. The second thing is that watch for sign signs of hearing loss in your child.

So one of the things is obvious if they have ear infections, and so we're going to have to manage that. The other thing that can occur is something called silent otitis media or silent middle ear infection.

And what that is is that the child has fluid behind the eardrum and it's affecting their hearing, but they have no pain or any other symptoms associated with it.

So in order to understand what the child is experiencing, imagine taking foam noise hearing protection, rolling them up, putting them in your ears and try to communicate that way. That is what the child with otitis media is experiencing.

So it's really important to watch for some of the signs and some of them can be quite subtle.

For instance, if you have a mild or loss of hearing in a one on one situation with the parent at home, they might be fine, but then when they go to the classroom, that's when they might start showing signs that they're not hearing well. So in my case, for example, it was my grade one teacher that expressed concern because it wasn't really showing up at home in a one to one situation.

And then it was Mrs. Peters, my wonderful grade one teacher, was the one that identified it.

So if your teacher is expressing concern, believe them because they probably are correct.

Now the other things to watch for too is if the child is showing any speech and language difficulties or any academic performance issues or perhaps even what looks like behavioral issues that may be related to hearing. So if any of these things are of concern, make sure that your child gets a hearing test. So can rule that out.

Let's dive into your lived experience. Peter, you talk about your grade one teacher having been the first to sort of flag it for you roughly around the age of 5 years old.

How did childhood hearing loss affect your day to day life and your interactions with others at that young age and what was done about it?

Well, the, it was quite a significant impact. You have to kind of remember too, it's a combination of the condition you have plus society equals the amount of disability you have.

So take for example when I went to school, elementary school, unfortunately we had the open concept education system and for those of your viewers are familiar with that, basically the school I went to was built without walls. So there was 12 classrooms in the upper level, 12 classrooms in the lower level with no walls. The noise levels were terrible.

And so I had a lot of difficulty hearing in that environment. And then that happened again later when I was in university and went back to massive class sizes. So it definitely affected me quite significantly.

I think what really helped me is again my grade one teacher, who is wonderful and also my mother just had a strong love of reading.

And I believe the fact that she read to us every night before we went to bed for at least 30 minutes was a factor in helping me because she was right beside me, I was hearing her, I was seeing the words. And I think that that was a big part of what made me got me through it. So then I did start to wear hearing aids around that time.

And then later in life my hearing loss kept progressing over time. So about around the age of 40 I did lose the rest of my hearing and that's when I got a cochlear implant which has been of enormous benefit.

So I feel that I'm quite a lucky survivor because in the end I managed to get my master's in audiology, also a master's in health administration. So I did get a lot of good degrees. And it was the combination of the hearing aids and also something we Call remote microphone.

Wireless remote microphones are also really important for hearing in the classroom or hearing in noisy situations. So those are the things that really helped me a lot.

So then, in what specific ways would you say that your lived experience then inspired you to become an audiologist?

Yeah, I would have to say that it would be nice if putting on a pair of hearing aids would solve your hearing problems perfectly like a pair of glasses would, but they don't. So the issue still is, is that it's difficulty hearing with a lot of background noise or speech over a distance.

So there is wireless remote microphones that can be used in conjunction with the hearing aids and cochlear implant, which are extremely important in classroom situations. Later in high school and in university and as an adult in noisy situations such as a restaurant or if I'm going to a conference.

These wireless remote microphones are also a critical part.

And just, you know, living with the hearing loss and coming up with strategies in order to help myself hear better, I think that's something that I really want to share with people when they come see me at Hear Canada.

And when they come to see you, what can they expect from an audiologist examination?

We will do what's called pure tone audiometry. So that basically tests the softest levels in which you can hear. But we also want to assess your ability to understand speech.

So we test your ability to repeat back words. We'll also do another test, and this may be useful for teenagers and certainly adults is looking at the ability to hear in background noise.

So we have a test for that as well to see what additional technologies after we do that assessment.

And then we have to then determine what would be the best hearing aid and the best wireless microphone system that would work for that particular hearing loss.

And then finally, of course is counseling how to use it properly and how to maintain it, because there is work involved with that that sounds very comprehensive.

And certainly looks at the issue or potential issue, you know, in a 360 holistic way. Stigma, Peter, is central when we talk about hearing loss that's either diagnosed or undiagnosed. What typically does that stigma look like?

With an undiagnosed hearing loss, what happens is people misinterpret your behavior.

They may think that you're unintelligent, you're dumb, or I've been called perhaps, you know, when I didn't respond right, you know, to somebody aloof or something like that. And so people don't always realize that that's hearing loss related. But you can't hide the hearing loss, it will show through.

And that stigma is greater. Now, is there a stigma associated with wearing hearing aids itself?

Studies have shown that's true, but I feel that often it just happens with teenagers too. They're often their own worst. En me, teenagers want to be cool and they think that their hearing aids will be uncool.

So one of the things I've tried to do as well with teenagers is try and increase the cool factor of what hearing aids can do. So I'll show teenagers how they can wirelessly connect their hearing aids to like their gaming system.

Or when I practice my electric guitar, for instance, I have a way of connecting my wireless mics to the system so it just transmits to me alone and doesn't disturb everybody else. So I try to do what I can to make hearing aids seem cooler.

They connect to your phone, you can stream music with them, you can connect to all sorts of things through Bluetooth technology. So those are some of the things I try to do, increase the cool factor of hearing aids. And I think it seems to help with the teenagers, you know.

Well, and when we talk about tweens and adolescents, I mean, you'd be hard pressed these days in many places to find somebody in that age group that doesn't have, you know, hearing headphones in their ears. Either they're really small or they're really large. Often noise canceling, you know, it's hard enough to sort of manage an adolescent's behavior.

But what should parents be mindful of that they may want to share with that young person about potential damage that they could be doing to their hearing. What do they need to know about that?

Well, they need to, you can set some safety limits in certain smartphones to make sure it doesn't exceed a certain loudness. The other thing to do is because these earphones aren't always fully occluding, they don't totally plug the ear.

So the noise of say, the bus or the subway or public transportation or traffic can still come through. And so what this the teenager does is turn the volume up even higher.

It doesn't seem that loud, but it's because they were trying to raise that over the background noise. So try not to use or listening to music in loud environments because you're going to make your own AirPods or smartphone too loud.

So we want to make sure that we don't damage the hearing from that.

And so that would be things for hearing health care prevention, but for the younger children, I think the things to watch for mainly there Are again, any academic performance issues, any behavioral issues, any speech and language delays, all of these things could be hearing loss related. And we should make sure that there's no hearing loss in your child that possibly could explain that behavior.

To give you another example, my own son, when he was in grade grade one, I didn't realize that he had, was walking around with silent otitis media. Here I am an audiologist, have a hearing loss myself and I missed it too.

But we got a call from the teacher about behavioral issues and I realized that actually was hearing related.

Had his hearing tested, turns out he had middle ear fluid, had him scheduled for surgery for tubes in order to drain the middle ear, and then his academic performance just took off after that. So these are the things that parents need to be cognizant of.

Well, and in your own lived experience, as I understand it, Peter, you know, communication for you was challenging. It became exhausting. You relied on lip reading as your hearing deteriorated.

You talked about from grade one essentially to the age of 40, you know, you were relying on, on different aids to help you through that time.

Were there any early signs that perhaps you know, your parents or those around you may have missed that could have helped address an earlier diagnosis for you?

Again, listen to the daycare worker or the classroom teacher if they express any concerns because it may only show up, say in the classroom, particularly with the mild or losses of hearing. And so watch for that.

Look for inconsistencies in responding because on one, on one, the milder losses of hearing may, you'll be fine, but then speech at a distance is an issue. And I should also clarify too, the names we use for degrees of hearing loss. These are based on adults.

The classifications are slight, mild, moderate, moderate, severe, severe and profound. But there's nothing slight or mild about any hearing loss in a child.

In fact, we use a stricter criteria for what's considered normal hearing in a child compared to an adult. Children we use a 15 decibel criteria and adults we use 25.

If a child has a 25dB loss, which is a hearing level which is considered normal in an adult, it will affect their language development in a child. So that's why we use a stricter criteria. But the terminology can be confusing to parents.

So if you see an audiologist and they say, well, well, your child has a mild loss. But we need to do all these things. There's nothing mild about a mild hearing loss in a child. Every hearing loss needs to be addressed in a child.

Certainly a very important message for parents. What Peter Are some of the short term and long term impacts of undetected hearing loss?

Yeah, definitely. You will see challenges in language development and academic performance.

Back in the day when children were held back for a year or failed and had to repeat a grade, we don't do that anymore.

But back in the day when we did do that, children with these very mild or slight hearing losses were twice as likely to fail a grade than they were the normal hearing counterparts. And that's with a very, very mild loss, but it's not mild in terms of how it affects the child.

So yes, every hearing loss needs to be addressed in a child. It's extremely important when you're talking about children.

Of course, many parents may have to grapple with trying to differentiate whether their child is ignoring them. That is to say, whether the hearing response is a behavioral related issue or something that may require attention.

Any tips on how parents can make that differentiation?

They can't. The only way to rule that out is to do a hearing test. And I see children hearing here Canada.

Unfortunately, OHIP does not cover the cost of hearing testing. And so that's the Ontario program and basically pretty much across Canada, the hearing testing is typically not covered, but it's.

But we can certainly test the child here and make sure that they don't have a hearing loss. It's the only way you, you can't really tease out from watching the child what is behavior and what is hearing.

And it's the inconsistency too, which is, which is normal for a child. Childhood hearing loss is that sometimes, sometimes they seem to hear you, sometimes they don't.

That is still hearing because it could be speech at a distance, there could be background noise present. You might not be facing the child. So these are the things that can lead to inconsistent hearing.

But that is the nature of what a hearing loss in a child can look like. And so have the child seen by an audiologist like myself, I hear Canada and have them just rule out the hearing loss.

That's really the best way to do that. There's nothing we can really do at home to tease out which is which.

You talked about newborn screening for hearing, but I'm interested to know what kind of cadence would be optimal in terms of having a child examined for their hearing. How often should that happen? In an ideal state.

It would be good. The infant hearing program is crucial and it's had a massive effect on how the children are functioning.

But later in life, you know, to have your child's hearing tested like every year, that's not necessarily what is done because you will have a out of pocket expense with that.

But again, if your child has a history of ear infections or any of those other things I talked about, language delays, academic performance, behavioral concerns, then I would definitely have your child's hearing check to rule that out.

Along those lines, Peter, what would you say a proactive approach to hearing health in a family should ideally include?

Again, watch for those signs. Test the hearing. Don't hesitate to get your child's hearing tested just to make sure that's ruled out.

Once you've ruled that out, I just want to make a plug for another thing that's important for developing the auditory system system and that is, believe it or not, music lessons. Formal music lessons. There was a wonderful research done by Dr. Nina Kraus at Northwestern University.

She has a website called Brain Volts and she has got a lot of information on the value of formal music lessons in terms of a child's cognitive development. Studies have shown that children that take music lessons actually increases their IQ as well.

And it just has a huge effect on improving and developing the auditory system. Another example is adults who have had formal music training as a child.

Later in life, they have a better ability to hear in background noise than adults who did not have formal music lessons. So watch out for ear infections. Test hearing if you see any of those issues.

Take music lessons, formal music lessons, because that's important for your child's auditory development. Protect your ears from the noise. Those are some of the things that I think are really important for parents to know about now.

Peter, you talked about the cochlear implant that you had during your 40s and how that was game changing for you.

Can you explain maybe some of the latest advancements that, you know, the average person may not be aware of as it relates to hearing loss and what parents really should know about some of these options if they don't.

Yeah, hearing aids are they. They've progressed so much. The, the technology that's in there is incredible.

And, and the addition that plus again, some of these remote microphones that you can use in conjunction with the hearing aid and cochlear implant have progressed so much that there's very few situations that I think I can't help. I help almost every situation. There are so many solutions out there. Hearing aids don't whistle as much as they used to in the past.

We can be more precise in how we fit it. The noise reduction microphones that are in the hearing aid itself have improved.

We even have things in hearing aids that actually can lower the frequency of certain speech sounds from an area where the child can't hear to the area where the child can hear to make certain speech sounds such as f s voiceless th. These are very high frequency speech sounds. And we can actually lower the pitch on some of those sounds in today's hearing aids.

It's incredible what they can do today. And we have solutions. You, you name the situation. I can find a solution for you.

You know, it's there's then, then once we exhaust those OPP opportunities, we have cochlear implants for if hearing aids don't help you anymore. It's there really is nothing we can't really help.

And that's what I enjoy most about, you know, working with clients here at Hear Canada is I can really help almost any situation.

Speaking of Hear Canada, how would you describe just in general, what Hear Canada offers for those listeners and viewers who may be unfamiliar with your organization?

So we have offices across Canada and we have audiologists and hearing instrument specialists in various locations.

And Hear Canada provides full hearing testing, throughman management, which is earwax removal for adults, and of course the prescription and provision of hearing aids and other assistive listening devices for children and adults with hearing loss. So we provide a very full, comprehensive service.

And really the goal is not necessarily the sale of the device, but the goal is improved performance and function. We ask patients what their goals are, where they would like to hear better, and we use that their own goals as the measure of our success.

And so we really try to really look at how the person is living with hearing loss and how can we improve their quality of life.

Lots of terrific information. Peter Stovich, audiologist with Hear Canada. Really appreciated your time and insight today. Thank you so much.

Pleasure being here.

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