16767 Auditory Verbal Therapy

Overview

Auditory Verbal Therapy (AVT) is a family-centred therapy for children with hearing loss. It teaches a child to use hearing technology, such as hearing aids or cochlear implants, to listen to speech and learn to talk. AVT is not a medicine or an operation. It is a coaching approach: a therapist works with the child and the family, and parents or caregivers practise listening and talking games in everyday routines. The goal is to help the child understand spoken language and use speech to communicate, as far as is right for that child.

Hearing loss in children is one of the more common developmental health concerns. AVT is used in many countries, but it is one of several communication approaches. Not every child with hearing loss needs or chooses AVT.

Symptoms

Common symptoms

• Not turning toward sounds or voices
• Speech that is delayed or hard to understand for the child's age
• Often asking people to repeat things
• Difficulty following spoken instructions, especially in a noisy room
• Turning up the TV or phone volume very loud
• Watching faces closely to understand speech
• Seeming tired or frustrated after listening

Symptoms in children

• A baby who does not startle or blink at loud sounds
• A baby who does not babble or make sounds by the expected age
• A toddler who does not respond to their name
• A child who misses sounds or words and relies on looking
• Speech that is unclear or behind other children of the same age
• Difficulty hearing in groups, at school, or in background noise

Symptoms in older adults

• AVT is not usually aimed at older adults, but hearing loss can happen at any age.
• Often asking others to repeat
• Trouble hearing in crowded or noisy places
• TV or radio volume that others find too loud
• Ringing in the ears
• Feeling tired after conversations

Causes

Main causes

• Permanent hearing loss in children can be caused by genetics (traits passed down in families).
• Infections during pregnancy or early childhood, such as meningitis.
• Complications around birth, especially for premature babies or babies who need intensive care.
• Some medicines that can damage hearing, when used during pregnancy or treatment.
• Malformations of the ear or hearing nerve.
• Frequent or long-lasting middle-ear fluid or infections (this is often temporary but needs checking).
• Loud noise, head injury, or age-related changes.

Risk factors

• Family history of hearing loss
• Premature birth, low birth weight, or time in a newborn intensive care unit
• Certain infections during pregnancy
• Frequent ear infections or long-lasting fluid behind the eardrum
• Head injury or exposure to very loud sounds
• Some medical treatments that can affect hearing

When to see a doctor

See a doctor urgently if:

• Sudden hearing loss
• Ear pain with fever, discharge, or swelling
• Hearing loss after a head injury
• A child who stops responding to sound
• Ringing in the ears that starts suddenly after loud noise

Book a routine appointment if:

• You are worried about your child's hearing at any age
• Speech is delayed, unclear, or not progressing
• School reports listening or learning difficulties
• A newborn hearing screening needs a repeat test
• Family history of childhood hearing loss
• You want to discuss communication options, including AVT

Diagnosis

AVT is not diagnosed. The first step is checking the child's hearing and communication. A hearing team, often including an audiologist (a hearing test specialist), ear doctor, speech and language therapist, and teacher for deaf children, will ask about the child's history and watch how the child responds to sound. They may also assess speech, language, and listening skills. If hearing loss is found, the team will discuss whether AVT fits the child's and family's goals.

Tests that may be done

• Newborn hearing screening, if not already done
• Behavioural hearing tests during play, using sounds and toys
• Tympanometry, a quick test of the middle ear
• Otoacoustic emissions, a test of the inner ear's response to sound
• Auditory brainstem response, a test that can be done while the child sleeps
• Speech and language assessment
• Listening and communication assessment by an AVT therapist

What to expect at your appointment

Tests are usually gentle and child-friendly. Some need the child to be quiet or asleep. You will get time to ask questions. An AVT assessment is often play-based: the therapist watches how the child listens and communicates, talks with you about daily life, and agrees goals. You may be asked to try activities at home and return for review.

Treatment

AVT is a teaching therapy, not a cure. It works best when the child has good access to sound through hearing technology and when families practise little and often. Sessions are usually one-to-one and involve play, books, songs, and daily routines. The therapist coaches you so you can use these strategies all day, not just in sessions. The number and length of sessions vary with the child's needs and local services.

Self-care at home

• Use hearing technology as advised by your hearing team, and keep it clean and charged.
• Practise short listening games during everyday routines, such as bath time, meals, or walks.
• Reduce background noise when talking, and face your child when you speak.
• Narrate what you are doing and give your child time to respond.
• Read, sing, and play turn-taking games together.
• Keep appointments and share what is working or not working.
• Ask for help if you feel overwhelmed; you do not have to do this alone.

Medical treatments

There is no medicine that treats AVT itself. Medical care focuses on the child's hearing and ear health. If fluid or infection is part of the hearing problem, your doctor may treat it. If hearing loss is permanent, the specialist hearing team may discuss hearing aids, cochlear implants, or other hearing technology. AVT then helps the child learn to use the sound they can hear. Other professionals, such as speech and language therapists, may also be involved. Always ask your child's healthcare team before changing any treatment.

When is surgery considered?

AVT itself does not involve surgery. Some children may need ear surgery for other reasons, such as grommets for repeated middle-ear fluid or a cochlear implant. These decisions are made with a specialist team and are based on the child's individual needs.

Living with this condition

Day to day, AVT becomes part of family life. You may have regular therapy visits and home practice. Hearing technology needs checking each day. School or nursery staff should know how best to help your child listen, such as sitting near the teacher and reducing noise. Progress can be steady rather than fast, and small gains matter.

Lifestyle tips

• Build quiet talking time into each day.
• Use books, songs, and simple games to make listening fun.
• Tell teachers, childminders, and family members how to support listening.
• Protect ears from very loud noise, for example at concerts or with headphones.
• Keep a simple diary of new sounds or words to share with the therapist.
• Make time for rest; listening can be tiring.

Diet and exercise

There is no special diet for AVT. A healthy, balanced diet and plenty of play and movement support a child's general development and learning. If your child has other health needs, ask your doctor or dietitian for advice.

Mental health and emotional wellbeing

Hearing loss and therapy can be tiring for children and worrying for parents. Children may feel frustrated when they are not understood. Parents may feel guilty, stressed, or isolated. These feelings are common and deserve support. Talk to your hearing team, your doctor, or a counsellor. If you or your child feel unsafe or in crisis, contact your local emergency number or a local crisis support service right away.

Prevention

AVT is a therapy, so it is not prevented. Some causes of hearing loss can be prevented or reduced, but not all. Early identification and support give children the best chance to develop communication skills. If you have concerns, do not wait for a perfect time to ask.

Vaccines

Routine childhood vaccines, and vaccines recommended in pregnancy, can lower the risk of some infections that cause hearing loss. Ask your healthcare provider which vaccines are recommended for you and your child.

Screening programmes

Newborn hearing screening is offered in many countries and helps find hearing loss early. School hearing checks and regular check-ups can also help. If there is a family history of hearing loss or you have concerns, ask for a hearing test even if screening was normal.

Complications

If left untreated

• Delayed speech and language development
• Difficulty understanding speech, especially in groups or noisy places
• Trouble learning at school or joining in conversations
• Social isolation or frustration
• Tiredness from working hard to listen
• Safety risks if the child cannot hear warnings or their name called

Long-term outlook

Many children with hearing loss make good progress with early, consistent support. Outcomes vary, and AVT is not the right fit for every child. Some children use spoken language as their main way to communicate; others use sign language, gestures, or a mix. The best plan is one that fits the child and family. Your hearing team can help you review progress and adjust goals.

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