Patient education: Hearing loss in children (The Basics)

Written by the doctors and editors at UpToDate

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What is hearing loss? —

This is when a child cannot hear as well as usual in 1 or both ears. Some children with hearing loss can hear some but not all sounds. Others cannot hear at all.

Some children are born with hearing loss. Others get hearing loss as they get older.

What are the symptoms of hearing loss? —

It depends on what is causing the hearing loss.

Symptoms can include:

●Hearing less sound than usual

●Hearing no sound at all

●Hearing ringing, buzzing, or roaring

●Feeling like the ear is plugged

Your child might not be able to tell you about these symptoms. If so, you might notice:

●Your child does not react to loud noises.

●Your child does not turn to the sound of your voice.

●Most children who are your child's age can talk, but your child has not learned yet.

●Your child does not speak clearly.

●Your child ignores you or does not follow instructions.

●Your child sets the volume on the TV or other devices very loud.

●Your child has trouble in school.

What causes hearing loss? —

It depends on the type of hearing loss. Types include:

●Sensorineural hearing loss ("SNHL") – This can happen if there is a problem in the inner ear or if nerves in the ear are damaged (figure 1). Causes include:

•Genetic hearing loss – This is something a person can be born with, related to a problem with their DNA. It is the most common cause of SNHL in children. Often, hearing loss starts when the person is a baby. But in some cases, hearing loss starts later in life. There are many types of genetic hearing loss. In most types, hearing loss is the only problem caused by the disorder. But some can also cause other health problems.

•Infections during pregnancy – Certain infections can be passed from a pregnant person to their baby during pregnancy. These can infect the cochlea and cause hearing loss. A virus called cytomegalovirus ("CMV") is the most common cause of this type of hearing loss.

•Infections later in childhood – Serious infections can also affect the cochlea as a child gets older. For example, a serious infection in the brain called "bacterial meningitis" can cause hearing loss.

•Being born premature – Babies born before 37 weeks of pregnancy (3 or more weeks before the due date) are called "premature." They are more likely to have SNHL, especially if their birth weight was very low (less than 3.5 pounds, or 1.5 kg).

•Loud noises – Being around loud noises without ear protection can lead to hearing loss over time. This type of hearing loss can happen from listening to music or other sounds too loudly through headphones.

●Conductive hearing loss – This happens when sounds can't get to the inner ear because of problems in the middle or outer ear (figure 1). Examples include:

•Ear infections – These are the most common cause of conductive hearing loss in children. It can harder for a child to hear when they have an ear infection. But in most cases, the hearing loss gets better as the ear infection goes away. Children who get a lot of ear infections can have permanent hearing loss.

•Ear wax impaction – This is when ear wax builds up enough to affect hearing.

•Problems with the shape of the ear – This is when parts of a baby's outer or middle ear did not develop normally during pregnancy.

●Mixed hearing loss – This is when both SNHL and conductive hearing loss happen at the same time.

Certain injuries and tumors can also cause hearing loss of any type.

Will my child need tests? —

Yes. Your child's doctor or nurse will ask about your child's symptoms and do an exam. They will look inside your child's ear using a special tool called an "otoscope." They might need to remove ear wax from the first. Then, they will decide which tests your child should have.

Tests can include:

●Office hearing tests – The doctor can check your child's hearing using special tools, which might include "tympanometry." This is a test that uses air pressure to show doctors how well the eardrum works.

●Audiometry – These are tests to check for hearing loss. They are done by a hearing specialist, called an "audiologist." The tests can show:

•What type of hearing loss your child has

•How severe it is

•If both ears are affected the same way

Audiometry usually involves several tests. The audiologist will decide which tests are right for your child based on their age:

•Tests often used for babies:

-Auditory brainstem response – The audiologist puts 3 small devices called "electrodes" on your baby. They go on the forehead, the back of the neck, and behind the ear. They connect to a machine that measures how your child's brain responds to a clicking sound.

-Otoacoustic emissions – The audiologist puts a small microphone into your baby's ear. The microphone makes sounds (clicks or a tone) and measures sound waves from the cochlea.

-Behavioral audiometry – This involves playing sounds to see how your baby responds.

•Tests often used for toddlers:

-Play audiometry – The child wears headphones. The audiologist plays sounds at different volumes (loud and quiet) and tones (high and low) and asks the child to touch or move a toy every time they hear a sound.

-Visual reinforcement audiometry – The audiologist plays sounds and asks the child to look toward where they think the sound is coming from. When the child turns their head in the right direction, the audiologist rewards them by showing a toy that moves or has a flashing light.

•A test often used for older children, called an audiogram – This is also called "pure tone testing." It involves sitting in a soundproof room with a headset. The audiologist plays sounds at different volumes and tones and asks your child to raise their hand or press buttons in response to the sounds.

●Imaging tests, such as a CT scan – These create pictures of the parts inside and around the ear. They help doctors check how certain parts inside the ear are shaped. If the parts did not form correctly, or if they are damaged, it can cause hearing loss.

●Genetic testing – The doctor might do genetic testing or send your child to a genetic specialist, called a "geneticist." This can help them figure out what is causing your child's hearing loss and how to treat it.

Depending on your child's situation, the doctor might order other tests. For example, in babies with SNHL, doctors often test for infections that are likely to cause it.

How is hearing loss treated? —

It depends on how severe the hearing loss is and what is causing it.

If the hearing loss is temporary, your child might need:

●Antibiotics to treat an ear infection

●Decongestant medicines, if your child has a cold or viral infection

●Medicines to reduce swelling in the ear

●To have ear wax removed

●To have tiny tubes put in their eardrum, if they have fluid in the ear (figure 2)

If the hearing loss is permanent, your child might need:

●Hearing assistive technology – These are devices and software to help children with permanent hearing loss. They can help your child communicate and understand certain sounds, such as speech, music, and fire alarms. Examples include hearing aids, cochlear implants, and alerting devices.

●Sign language – This is a way of communicating using gestures and signs. Some people learn sign language and use it along with devices that help them hear. Others might only use sign language.

●Extra support for school – Children with hearing loss are at risk for having problems with communication, speech, and learning. But if your child gets support soon after hearing loss starts, they are less likely to have these problems. For example, they might get speech therapy. If your child has permanent hearing loss, talk to their school about getting your child the help they need.

Can hearing loss be prevented? —

Sometimes. Some types of hearing loss can be prevented.

To protect your child's hearing:

●Avoid loud noises:

•When using headphones or earbuds, make sure the sound is not too loud. Your child should be able to hear you when you speak to them. If they can't, turn down the volume. They should also take regular breaks from the device.

•Protect your child's ears if they are in noisy places, such as at a concert. If it is so noisy that you need to shout to be heard, then the noise is loud enough to harm your child's hearing. In these situations, you can have your child wear earplugs or ear protectors.

●Avoid ear injuries – It is important not to clean your child's ears using cotton swabs (Q-Tips) or other tools. This can damage the inside of the ear.

●Get your child all the vaccines their doctor recommends – Some causes of hearing loss, such as meningitis, can be prevented with vaccines.

Should my child be screened for hearing loss? —

Yes. All children should get tests to check, or "screen," for hearing loss.

All babies should be screened before going home from the hospital. After that, most children should continue to have regular screening beginning at 4 years old. Your child's doctor will tell you when your child should be screened.

Children who are more likely to have hearing loss should be screened more often. Your child might be more likely to have hearing loss if:

●They stayed in the "neonatal intensive care unit" ("NICU") after being born.

●They have family members with hearing loss.

●They had certain infections.

When should I call the doctor? —

Call your child's doctor or nurse if:

●Your child's hearing loss gets worse.

●You child hears new ringing in their ears, or any other changes in their hearing.

●Your child stops reacting to loud noises.

●Your child has problems with balance.

●Your child is having a hard time at school.

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Patient education: Hearing loss in children (The Basics)

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