‘A whole world opened up to him’: Celebrating a new life of sounds this Autism Awareness Month

Parents of children with autism can have unique challenges in diagnosing and treating their children’s hearing loss. For Autism Awareness Month, blogger Jen B. from Oregon, U.S. has written about her 3-year-old son Xander’s hearing journey, from difficult diagnoses to helping him learn to wear his new sound processor.

You can follow Jen’s blog here on WordPress or here on Facebook.


“Xander!” “Xander!” “Xander!?”

But no response did I ever get from my son.

Xander, now 3, plays at school.

Xander, now 3, plays at school.

He will turn on a dime if he hears his favourite theme song start up. He’ll sing along in perfect pitch. And yet, dogs barking right next to him never make him flinch.

My son was born three weeks early with a collapsed lung and rapidly dropping sugars. Very soon he was transferred to a hospital with a Neonatal Intensive Care Unit (NICU). When I first saw him it was obvious that there was a slight deformity of his right ear. I assumed he had lain on it wrong in utero, and that it would work itself out.

The hospital gave Xander a hearing screening, as was standard procedure for all NICU babies. The nurse came in while he was asleep on me and checked his left ear first, because that’s always, even now, the ear he has to have facing out while snuggling.

Everything was fine.

The nurse tried twice to check his right ear and still seemed perplexed, because she couldn’t get the readings she was used to. Ultimately, she marked it as a pass.

It was only later we learned Xander’s hearing wasn’t normal.

My son has Autism Spectrum Disorder. He was diagnosed at only 18 months old. He is now 3 years old and considered non-verbal. He speaks, but not necessarily with what professionals would call, “purpose.”

Autism affects all forms of communication. Where a neurotypical child with a hearing loss might pull at their ear, say they can’t hear, or make some sort of gesture – something — we got nothing. It gradually became clear he needed to have his hearing assessed.

At about 2 years old Xander finally saw an audiologist. Autism can make a child both seek out stimulations (sensory seeking) and feel overwhelmed by them (sensory overload), so diagnosing hearing loss can be a challenge. In a room with all sorts of things making noise and lighting up, Xander wasn’t very cooperative. His tubes were clear, but the audiologist scheduled him for a sedated Auditory Brainstem Response (ABR) hearing screening. All the worst-case scenarios came into my mind during the scan, which felt agonisingly long.

Jen poses with 3-year-old Xander, wearing his Baha 5 Sound Processor on a Softband.

Jen poses with 3-year-old Xander, wearing his Baha 5 Sound Processor on a Softband.

The doctors learned Xander had conductive hearing loss in his right ear, and to learn more he would need a CT scan of his temporal bone. The doctors decided further diagnosis was not urgent and told me things like, “just speak to him on the left side” and, “in cars he probably won’t be able to hear you.”

About six months later Xander need an MRI for another issue, so we decided to have the CT scan done at the same time while he was sedated. We learned he is missing the third stapes, or stirrup – one of the bones of the ear – on his right side, a rare condition.

There is a surgery to implant a prosthetic stapes, but Xander’s major facial nerve runs where the bone should be, making the operation too risky. We decided instead to treat Xander’s hearing loss through bone conduction.

The sensory sensitivity caused by Xander’s autism made it hard for him to wear his first sound processor. The constant vibration against his head, the increase in noise and the strap around his head were difficult for him to tolerate. I would try bribing him, like I do with his glasses. “If you put it on, you can have a candy.” It didn’t help much.

When Xander’s trial was over, he received his Cochlear Baha 5 Sound Processor, and we both loved the way it looked. When I pointed out how cool he looked wearing it on his Softband, he beamed with pride and wore it for several days, for long stretches at a time – even to school!

Believe me when I tell you that I cried when I said, “Xander!” and he looked up at me.

He was able to hear the start of his favourite show in the whole world. He was mesmerized. He had never noticed all the nuances of it before he got his Baha processor. He could understand enunciations. He could hear his electronic toys, the ones that had never interested him before. A whole world opened up to him.

But for a child with autism, that can be really intimidating.

After an accident left him injured, Xander has become even more sensitive to stimulation, and sometimes getting him to wear his sound processor is nearly impossible.

Well, every day is a different day in the world of autism. While trying to take a photo of him wearing his sound processor, I was able to capture a whole video. He let it stay on while cruising around a department store today. I was so excited, and I hope tomorrow he’ll leave it on even longer.

For children with autism like Xander, treating hearing loss might not be a linear journey, but each day brings new opportunities for him to listen to his teacher at school, his toys, and even respond when I call him, “Xander.”

The opinions expressed in this blog are my own views and not those of Cochlear.

If your child is showing signs of hearing loss, use this tool to find a clinic near you.

Want to share your story, hearing tips or Baha advice with The Baha Blog? Let us know! Find us on Twitter at @TheBahaBlog, on Facebook at our page The Baha Blog or via email at bahablog@cochlear.com.

What is MPO? A simple analogy for a complicated audiological term

Learning about the science behind treating hearing loss can be daunting. There are so many terms, concepts and measurements – it’s often hard to understand what each of them really means for your hearing, and how these concepts influence the way you treat your hearing loss.

Here we will try to explain one of those concepts, a sound processor’s maximum power output (MPO),  or maximum output force level (the technical term for bone conduction devices), with a simple analogy: the ceiling of a house. Understanding MPO can give you insight on why your audiologist chooses or recommends a certain sound processor for your individual hearing needs, and this knowledge can empower you to ultimately make a choice that best suits you.

Different people have different levels of hearing loss, measured in an audiogram. Your level of hearing loss will determine your need for amplification. The fitting range is the most common measurement for any given sound processor. Fitting range is a guide to understand the level of hearing loss a device can address. When audiologists determine which sound processor would provide the most benefit to you, they compare your hearing loss to the sound processor’s fitting range. For example, the Cochlear Baha 5 Sound Processor has a fitting range that covers hearing loss to 45 decibels (dB) SNHL.1

All sound processors have limits on how much power they can provide, and this limit is the most important contributor to a device’s fitting range. A device’s power limit is known as the maximum power output, or MPO. In a chart measuring a device’s output (see illustration below), the MPO appears as a line graph showing the maximum power (in dB) it can provide across the hearing (frequency) range – from deeper sounds like the hum of traffic to higher-pitched sounds like a bird’s song. Now imagine the MPO line takes the shape of a house’s ceiling.

MPO-07The height of the ceiling is important: Just as a taller person needs a high ceiling to be comfortable, a person with a high level of hearing loss needs a high MPO level to hear sounds comfortably.

Cochlear and other manufacturers make sound processors with different levels of amplification to “fit” your individual hearing loss, as the person in this illustration “fits” into their house.

However, just as its peak height (the highest level of power provided) is important, the shape of the MPO line – the way it slopes or curves across the chart – is also important. This shows how the sound processor delivers power across a range of the most important lower to higher frequencies. The average MPO is calculated across a number of frequencies, which illustrates the shape of this line.

MPO-03The MPO on some devices delivers significantly more power to middle-range frequencies than the lower or higher frequencies important for speech. For these devices, the MPO chart looks more like a house with a very pointed ceiling and short walls. A tall person may stand comfortably in the centre, but they can’t walk over to the window without bumping their head on the ceiling. In these sound processors, at the lower and higher frequencies important for speech, sounds hit the “ceiling” of the sound processor’s power limits, distorting them.

MPO-01Ideally, a device with a high average MPO allows you to clearly hear sounds across the frequency range – in the same way that a house with a gently sloped ceiling allows you to move around freely inside, all the way to peer out each window without bumping your head.

As most people have hearing loss across a wide range of frequencies, a peaked MPO means the sound processor may not amplify sound along the whole frequency range where they need it. The person wearing this sound processor actually hears sounds less clearly across these important frequencies.

A chart shows the shape of the MPO of Cochlear sound processors (yellow) vs. competitor (orange). Circles on the chart show what sounds are represented at certain frequencies.

A chart compares the power in a device with a high average MPO (yellow) with a device with a peaked MPO (orange). Circles on the chart show what sounds are represented at certain frequencies.

Two devices may have a similar fitting range but can differ widely in average MPO. Ideally you should experience clear sounds, even moving across lower and higher frequencies, without hitting the “ceiling” distorting the sounds you hear. This is what a high average MPO delivers.

To find out whether you could benefit from a more powerful device, or to learn more about your treatment options, use this tool to find a clinic near you.

MPO is compared between Cochlear sound processors (yellow) and a competitor's (orange). The graph shows what sounds are represented at different frequencies.

The power is compared between  a device with a high average MPO (yellow) and a device with a peaked MPO (orange).

1 Flynn M. (2015) Smart and Small – innovative technologies behind the Cochlear Baha 5 Sound Processor. Cochlear Bone Anchored Solutions AB, 629761.