Written by the Inclusive Developmental and Therapy Center therapy team · medically reviewed by Dr Muhammad Suffyan, MB BS (GMC 8023727) · Last reviewed July 2026
Children learn to talk by listening, so a hearing problem shows up first as a speech problem. If your child is late to talk, speaks unclearly, or does not always answer to their name, a hearing test is the very first thing to rule out — before you wait another six months to see whether it settles.
At our centre in Model Town, Multan we provide speech and language therapy for children with hearing impairment: children still waiting for a hearing test, children whose hearing has been muffled by repeated ear infections, and children who already wear hearing aids or a cochlear implant.
A device delivers sound. On its own it does not teach a child what that sound means. Learning to listen — noticing a voice, telling one word from another, following a whole sentence in a noisy room — is a skill that has to be taught, practised and built up. That teaching is what speech and language therapy adds on top of the hearing aid or implant.
Hearing loss is also not all-or-nothing. Many of the children we meet hear well on some days and poorly on others, or hear low sounds clearly while missing the quiet high ones — s, sh, f, t, k. Those are exactly the sounds that carry meaning and word endings in both Urdu and English. A child like that is often called inattentive or naughty long before anybody thinks to check their ears.
Which signs suggest hearing is affecting my child’s speech?
- Under 12 months: does not startle at loud sounds, does not turn towards your voice, or babbling that started and then faded away
- By 18 months: no clear words, and no reaction when you call from another room
- 2–3 years: family struggle to understand them, or word endings drop off — “ca” for cat, “bu” for bus
- School age: mishears instructions, answers a different question, or copies what other children are doing to keep up
- Answers to their name when they can see your face, but not when you call from behind
- Watches mouths closely, says “haan?” or “what?” a lot, or needs things repeated
- Turns the TV up loud, or sits right in front of it
- Speech that became less clear during or after a run of colds and ear infections
- Ear pain, discharge (kaan behna) or a smell from the ear — this needs an ENT doctor now, not a wait-and-see
- Tires quickly at school, or is described by teachers as dreamy, slow or not paying attention
How does speech therapy help a child with hearing loss?
- We start with what your child can actually detect. The Ling six sounds — ah, ee, oo, m, sh, s — take a minute and tell us whether quiet, high and low speech sounds are getting through with the hearing aids (آلہ سماعت) or implant switched on
- Listening before speaking: noticing that a sound happened, telling two sounds apart, and picking a voice out of background noise
- Understanding and vocabulary — naming, then following instructions that grow longer, then the small unstressed words (is, on, the, -ing) that are the first things lost when hearing is patchy
- Speech clarity work on the sounds your child cannot hear well, taught through touch, sight and mouth position rather than by asking them to copy a sound they never heard
- Parent coaching, because almost all of your child’s listening hours happen at home, not in a therapy room
- Device habits that matter in Multan: a listening check every morning, keeping aids dry in the heat and dust, spare batteries for load-shedding days, and knowing that a whistling ear mould usually means it no longer fits
- Working alongside your audiologist and ENT doctor — we tell them what we hear in the room, and adjust our targets when they change the settings
- Guidance for your child’s teacher: seat them away from the fan and the corridor, get their attention before speaking, and check what they understood instead of asking “did you hear me?”
If you suspect a hearing problem, get the hearing tested — that step does not need to wait for anything else, and an ENT doctor should see any child with ear pain, ear discharge or a sudden drop in hearing quickly. Everything else — listening, understanding, talking — we can start building alongside, from the day you first notice something, with no diagnosis in hand.
Picture a two-year-old whose hearing loss is picked up early, fitted with the right device, and started on therapy within a few months. The first thing that changes is usually not words — it is attention to sound: turning when someone speaks, going still at a new noise. Understanding comes next, then single words, then word endings and the small joining words. Progress tends to follow that order, and it moves faster in a home where people talk to the child all day and slower in a house full of background noise. Started early, spoken language can end up far closer to that of hearing children than if the loss had been missed.
An illustrative, general example — not a real child. Every child is unique; the only way to know what yours needs is a proper assessment.What the research tells us
Everything we do is grounded in published research, not just opinion. Here are a few findings from trusted, independent sources:
A large study found that children with hearing loss who met all three early benchmarks — screened by one month, identified by three months, and in early intervention by six months — had significantly better vocabulary than those who did not.
— Yoshinaga-Itano, Sedey, Wiggin & Chung, Pediatrics (2017). View sourceGlue ear — fluid trapped behind the eardrum after colds and ear infections — is common in young children and usually clears on its own within about three months. There is no effective medicine for it, so doctors normally watch and re-test rather than treat straight away, and re-check hearing if it persists.
— UK National Health Service — Glue ear. View sourceA Cochrane review of grommets (ventilation tubes) for glue ear found the hearing benefit was concentrated in the first six months, by which time children who had no surgery had usually improved on their own, and found no measurable effect on speech and language development. The reviewers noted that no trial has been carried out in children who already have speech, language or developmental difficulties — so a child who is already behind is a decision for your own ENT doctor, not a statistic.
— Cochrane Database of Systematic Reviews — Browning et al., grommets for otitis media with effusion in children (2022). View source
Other areas we help with
Hearing & Speech: questions parents ask
Should my child have a hearing test before starting speech therapy?
Yes. A hearing test is the first thing to rule out for any child who is late to talk. Ask an audiologist for an OAE screen, tympanometry (which checks for fluid behind the eardrum) and, for babies or children who cannot cooperate, a BERA/ABR test done while they sleep. Therapy does not have to wait for the appointment — the two run alongside each other. See how our speech and language therapy in Multan works.
My child had lots of ear infections and now speaks unclearly. Is that linked?
It often is. Repeated ear infections leave fluid behind the eardrum — glue ear — and speech then sounds the way voices sound underwater. Children miss the quiet endings of words, so their own speech comes out unclear. Glue ear usually clears within about three months, but if hearing was patchy through the months your child was learning to talk, those speech sounds still have to be taught. Read about unclear speech and articulation.
Can speech therapy help after a cochlear implant or hearing aids?
Yes, and it is usually essential. The device delivers sound; it does not teach a child what the sound means. After fitting, a child learns in order: to notice sound, to tell sounds apart, to understand words, and only then to say them. Listening-focused therapy, steady practice at home in your own language, and regular tuning appointments with your audiologist are what turn a working device into real conversation.
My child does not answer to his name. Is it hearing or autism?
Hearing is checked first, because it is the simplest thing to rule out and the easiest to miss — parents often describe it as bacha awaaz par nahi mudta, the child does not turn towards sound. A useful pointer: a child missing their name because of hearing usually responds well when they can see your face, and still points, shows and shares. Less pointing, little eye contact and playing alone with normal hearing is worth assessing further. Both can exist together.
My child passed the hearing test but still cannot follow what I say. What now?
A normal hearing test means the ears are picking sound up. It does not mean the brain is making sense of it, or that language has developed. Two common explanations are auditory processing difficulty — hearing fine one-to-one but lost in noise or in long instructions — and a language disorder, where understanding and sentence-building lag behind. Read about auditory processing difficulties and developmental language disorder.
Will my child manage both Urdu and English with hearing loss?
Many children do, and hearing loss is not a reason to drop a language. Mixing Urdu, Saraiki, Punjabi and English at home does not cause delay, and you should count the words your child has across all their languages together rather than in one. What matters far more is the amount of close, face-to-face, unhurried talk your child gets each day, in whichever language your family speaks most warmly.
Is it too late? My child is six and barely talks.
It is not too late. Earlier is easier — that is the honest answer — but children keep learning language well past the toddler years, and an older child brings memory, reading and motivation that a two-year-old does not have. The goals simply shift: understanding classroom language, vocabulary for lessons, clearer speech, and being able to say when they have not heard something.
What can I do at home while we wait for an appointment?
Get down to your child’s eye level and face them before you speak, rather than calling from another room. Turn the TV off while you talk — background noise is the single biggest obstacle. Say the word, then wait a few silent seconds for a reply. Check hearing aids every morning. Try the ah, ee, oo, m, sh, s sounds quietly, out of sight, and see which ones your child notices. Take the free 2-minute check, or tell us what you have noticed and we will guide you.
Worried about your child? Let’s talk.
A short, friendly conversation is the best first step. Call, text or WhatsApp us — we’ll listen and guide you, with no pressure.
MPS Road, Block A Model Town, Multan (near Bloomfield Hall School, Street No. 2) · Mon–Sat, 10 AM – 7 PM