Pediatric Hearing Loss

While most babies are born with normal hearing, some (3/1000) children will show signs of hearing loss shortly after birth or develop problems later during their developing years. Regardless of when hearing loss is first detected in children, it’s important to seek treatment as soon as a possible problem is spotted. Developing a better understanding of possible reasons for pediatric hearing loss can help parents take necessary steps to ensure that their children can do the following heading to adulthood:

• Develop
• Learn
• Socialize

Some children are born with some degree of hearing loss. Hearing problems present at birth are often genetic, although some issues develop as a result of conditions such as pregnancy-related infections or prematurity. Premature babies also have a higher risk of developing hearing loss, especially those with very high bilirubin (>20).

A middle ear infection known as otitis media sometimes leads to pediatric hearing loss. It sometimes occurs in children without small Eustachian tubes (small passageways connecting the middle ear to the nose). The hearing loss experienced is due to fluid buildup because of the infection. It’s often temporary, but it sometimes leads to long-term hearing loss. Pediatric hearing impairment may also be caused by:

• Childhood illnesses (e.g., ear infections)
• Serious cases of influenza
• Meningitis
• Head injuries
• Exposure to loud noises/sounds

If hearing loss isn’t detected at birth, the first people to notice a problem are either parents or teacher, depending on when symptoms first appear. The most obvious sign of a hearing problem in children is a lack of response when given verbal commands or a lack of comprehension when being spoken to. Additional signs of impairment may include no reaction to loud noises, failing to look in the direction of sounds or voices, a lack of attention, crankiness, or irritability for no apparent reason, a noticeable reduction in energy levels, or ear pain.

Testing is typically done on newborns at the hospital shortly after birth before they are released to go home. If a hearing problem is suspected in children at a later point, they will likely be referred to an ear, nose, and throat specialist for a series of pediatric hearing tests. Such testing usually involves:

• Auditory brainstem testing: automatic testing of hearing which does not require cooperation from the child, though the child has to be sleeping.
• Visual Reinforcement Audiometry (VRA): A test performed in a soundproof room on children from seven months in age to 2 1/2 years of age. Eye shifts towards sound will determine the extent of hearing loss.
• Conditioned play audiometry: Performed on children from 2 1/2 years to five years of age, this hearing test involves a “game” where children must place objects in certain spots when prompted to do so by various sounds.
• Otoacoustic Emissions (OAEs): Involving the insertion of probe into the ear canal, this type of hearing test is recommended for children who are difficult to test with other methods.
• Audiometer tests: Older children may be tested with standard audiometer testing that requires the patient to respond to various sounds produced while wearing earphones.

Some children with hearing loss are treated with what’s termed “watchful waiting,” meaning that parents are told to simply look for signs of changes in hearing. In some situations, childhood hearing problems go away with little or no intervention. If an infection is the source of the problem, medications such as antibiotics are typically recommended. Ear tubes are sometimes inserted to help with drainage problems and hearing loss related to fluid accumulation that last chronically. Treatment may also include:

• Hearing aids (for children one month of age and older)
• Cochlear implant to help with inner ear problems
• Therapy to help with learning and comprehension issues

Pediatric ear surgery may become an option if childhood hearing impairment is due to deformities affecting external parts of the ear or middle ear structures such as the ear canal (microtia and atresia). Some children will have both middle ear and external ear differences that will need to be corrected with surgery to improve hearing. A tympanoplasty may be performed on children with hearing loss linked to issues with an eardrum (tympanic membrane). Stapedectomy may be performed in cases of congenital stapes fixation.

Some signs of pediatric hearing loss are subtle, so much so that affected children may not even be aware that they’re experiencing a problem. Other times, hearing loss may become progressively worse or come on suddenly as the result of a sports-related injury or a hard impact.

Fortunately, there are many treatment options available today to help children with varying degrees of hearing loss enjoy normal, productive lives with minimal disruptions and inconveniences.