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Denise is dressed like a little fairy in a beautiful pink dress. She is all smiles and she charms everyone in the room with her attentive big brown eyes. It is almost as if she knows what important role she is playing, and she is playing it beautifully!

She sits perfectly quiet like a miniature model while we fiddle with her ears and insert the custom-made, silicone earmoulds to check the physical fit. We check the length of the tubing that runs from the earmould, which will connect onto the hearing aid.

Denise has, in the meantime, found a stress ball on the desk. She decided to check out if it had better purposes than reducing stress for overworked adults. By the looks of it, her experiment turns out favourably as it works wonders for her teething gums!

Ready to start
My fellow audiologist connects the hearing aids to the computer and we are ready to start. By this time we had already explained to the family what to expect. Denise would probably not react much when we finished the programming of the hearing aids and switch them on. The main reason for this would be that, even though she would be able to hear sound, it would still not have any meaning to her.

It is exactly the same way in which a newborn baby would react to sound. It doesn’t really look like they can hear, as they are not able to follow the direction of a sound. The only initial visible reaction would be to very loud sounds. As weeks go by, they would slowly start to respond more to sounds. These reactions are very small and initially more likely to happen in response to louder sounds. A startled reaction would be the best example of that, a sudden movement of the baby’s arms or blinking in response to a sudden loud sound.

Another response to look out for would be any change in the current activity of the child that coincides with the sound. For example, if she is busy sucking her dummy, a sudden stop in the sucking activity would indicate that she has heard the particular sound.

However, even though Denise is almost six months old, her hearing age would be much less, which might mean that we might have to wait for a few weeks before we get any reaction from Denise, indicating that she is hearing.

Feedback test
Thus, we were cautiously excited, not expecting too much in this session. After programming the hearing aids, the next step was to perform a feedback test. During this test, the hearing aid makes a series of different sounds – this is to determine whether there is a risk of the hearing aid making a whistling sound due to the earmould not sealing the ear canal off properly.

The test takes into account the type and severity of the hearing loss, the programming done to fit this hearing loss, the size and shape of the ear and ear canal as well as the physical fit of the earmould in the ear. The results of the test will tell us if the fitting is good and it will minimise the risk of the hearing aids making whistling noises while in Denise’s ears.

This is where the story gets really interesting. Right in the middle of the feedback test, Denise stopped chewing on the stress ball, frowned, and started to cry. I couldn’t help it, I laughed out loud! It was the best reaction we could have hoped for! Denise was hearing something, and since it was a new (and loud) sound, she wasn’t sure how to handle it!

We redid the feedback test two more times, and every time we had the exact same reaction. Denise was definitively hearing the sounds made by the feedback test and responding to it!

Once we were done with the programming and the tests, we reduced the volume of both hearing aids slightly. Usually, when someone is fitted with hearing aids for the first time, hearing all the sounds you have missed out on, all at once, can be overwhelming. The brain needs time to adapt to the new sound environment. In subsequent visits, the volume of the hearing aids will be gradually adjusted to normal.

Good signs
We switched the hearing aids on and continued to talk normally. Our eyes were fixed on Denise to see how she would react to hearing sound so clearly, probably for the first time in her life. I kept talking to Liezl and her parents, pointing out a couple of good signs so far.

First of all, she didn’t cry when we switched the hearing aids on. This means that the volume and sound quality is comfortable, and not as loud as during the feedback test. Secondly, the hearing aids didn’t whistle, which meant the physical fit of the hearing aids in the ears was good.

And then it happened. Denise turned her attention to one of her favourite toys, a little doggy-cloth. She was chewing on it when I snapped my fingers. Perfectly on cue, she stopped chewing – a textbook reaction!

Halfway through the process of explaining how the hearing aids worked and how to operate them, we noticed that Denise was actually looking at the person speaking. If someone else started talking, it took her a couple of seconds, but after a while she would be looking into the direction of the speaker. She was doing so well!

Soon after this, Denise decided she had enough excitement for one day and took a nap. Liezl put her in her carry chair and we wrapped the session up. It was time to take Denise home. Liezl, thinking about the light drizzling of rain outside, snapped the canopy on the chair forward to shelter her from the rain. Almost immediately Denise’s eyes flung wide open. She heard the snapping sound. Another perfect reaction!

A number of reactions
We were confident that Denise was hearing, since she showed a number of reactions during the session which she didn't show before:

• She had a consistent response to the (loud) feedback test, indicating that she was hearing the sound.
• The hearing aids were not too loud, since she didn’t start crying when they were switched on.
• The hearing aids were not too soft either, since she responded well to our voices, my finger clapping and the snapping sound of her carry chair.
• The physical fit of the earmoulds were good, as she didn't tug at them and there was no whistling sound indicating a bad fit.

After the trauma of accepting that Denise has a hearing loss, we couldn’t be blessed with better reactions. Liezl and her parents now felt confident enough to introduce Denise into the wonderful world of sound. We scheduled a follow-up appointment, but assured them that they could phone if they needed assistance or guidance in the meantime.

It is a privilege to be part of such a wonderful journey. Denise has got a lot going for her. Not only does she have parents that love her to bits and grandparents to take her hands along the road, but now she also has a brand new set of ears and a whole new world to explore.
 

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