Hearing Loss in Children

Hearing loss in children may be present at birth (congenital) or acquired later in childhood. It can affect one (unilateral) or both (bilateral) ears, and can range from mild to severe (deafness). There are many different potential causes to hearing loss, and it can be an isolated condition or a symptom of another disease or condition.

There are three main types of hearing loss:

Sensorineural hearing loss: Sensorineural hearing loss, often known as “nerve deafness,” is a permanent type of hearing loss is caused by damage or loss of function in the inner ear. Sensorineural hearing loss can be congenital or acquired. Causes of congenital sensorineural hearing loss include:

• Genetic factors or conditions present at birth
• Inherited conditions
• Infections in the birth parent during pregnancy, such as toxoplasmosis, rubella, herpes or syphilis
• Birth parent with diabetes
• Complications from Rh factor in blood
• Structural abnormalities of the ear, such as enlarged vestibular aqueduct syndrome (EVA)

Acquired sensorineural hearing loss causes may include:

• Loud noise exposure
• Injury
• Infections
• Damage from certain medicines that can be harmful to the ears
• Premature birth or low birth weight

Conductive hearing loss: This is the most common cause of hearing loss in children. It occurs when something is blocking the outer or middle ear and prevents sound waves from reaching the inner ear. Conductive hearing loss can be present at birth, however it usually develops later. The most common cause is an ear infection, but other causes include excessive wax, an object getting stuck in the ear canal, middle ear tumors or ruptured eardrum.

Mixed hearing loss is a combination of sensorineural and conductive hearing loss.

Signs of Hearing Loss in Children

Signs and symptoms of hearing loss in children will vary depending on age and their ability to communicate with you. Signs in babies and toddlers include:

• Not startling to loud noises.
• Lack of reaction to voices.
• Not attempting to locate a sound’s source.
• Reacting to some sounds but not others.
• Delay in reaching developmental milestones.
• Has frequent middle ear infections or fluid in the ear.

For older children, signs may include:

• Delayed speech and language development.
• Frequently says, “What?” or asks for things to be repeated.
• Frequently turns up the volume of TV or audio devices.
• Difficulty understanding or following instructions.
• Difficulties with oral and written communication.
• Academic, behavioral or social difficulties at school or home, especially those surrounding language, literacy and communication.

Diagnosing Hearing Loss

When hearing loss is suspected in a child, they will likely be referred to a pediatric audiologist for a comprehensive assessment. This exam will include an array of tests designed to determine the presence and/or extent of hearing loss. The assessment may include:

• Taking a medical history and discussing the child’s signs and symptoms of hearing loss and speech and language development (if applicable for child’s age).
• An otoscopy exam, which uses a small device with a light (otoscope) to examine the ear canal, eardrum and middle ear.
• Age-appropriate hearing test (audiometry test).
• Auditory brainstem response testing (ABR), which uses electrodes attached to the skin to record brainwave activity in response to sound.
• A tympanometry test, which is used to assess middle ear function and help determine the type of hearing loss.
• Otoacoustic emission (OAE) test, which uses small earphones to play sounds in the child’s ear to elicit and record the response from the inner ear (optoacoustic emissions).

Your child’s care team may also order imaging tests such as computed tomography (CT) or magnetic resonance imaging (MRI) to look at the anatomy of the middle and inner ear and observe any potential abnormalities that may be affecting their hearing.

Hearing Loss Treatment

Treatment of hearing loss in children depends on the type and severity of the hearing loss. Your family may work with a team of pediatric experts to address hearing loss management, including audiologists, otolaryngologists (ear, nose and throat physicians), speech-language pathologists and others. These specialists will develop a treatment plan based on each child’s individual needs and provide families with the tools and resources to help children with hearing loss develop effective communication. Treatment options may include:

• Hearing aids: Hearing aids can be effective for children as young as 2–3 months. Children born with hearing loss who receive early intervention can improve their language development and have a better chance of meeting important developmental milestones.
• Cochlear implants: When hearing aids are not effective, these surgically implanted devices stimulate the hearing nerve directly to allow children to hear and develop language skills.
• Hearing habilitation/rehabilitation: This type of therapy teaches children with hearing loss skills to help them listen and communicate effectively. Hearing habilitation may include speech therapy and teaching skills such as American Sign Language (ASL) and lip reading.