HEARING PROBLEMS IN CHILDREN
Hearing loss may be defined as difficulty perceiving sounds to a certain degree. The issue usually arises due to problems with the ears’ structures. While hearing loss is more commonly associated with older adults and the elderly, it can also affect infants and children.
Hearing is important for a child to learn properly. Because children are still undergoing various stages of development, hearing loss during any of these crucial stages can lead to gaps in their growth and learning. This includes how they process or receive information and how they respond to people and their environment.
Parts of the Ear
The ear has many anatomic structures that contribute to our sense of hearing. It is divided into three main areas: the outer ear, middle ear, and inner ear. The latter is connected to the auditory nerve, which sends information on what we hear to the brain for processing. The brain also relies on structures in the inner ear to help maintain the body’s balance.
The outer ear comprises the ear cartilage and the ear canal bordered by the eardrum. The ear cartilage receives sound waves from the environment. These sound waves pass through the ear canal and reach the eardrum as vibrations.
The middle ear starts with the eardrum and includes three tiny bones: the malleus, incus, and stapes. The malleus is attached to the eardrum. The incus is attached between the other side of the malleus and the stapes. The sound waves from the eardrum converted to vibrations are passed on to the malleus, incus, and stapes, and on to the inner ear.
The inner ear is comprised of specialized organs that detect and transmit information on sound and balance. The cochlea is a snail-shaped, fluid-filled organ where vibrations from the eardrum are passed on. The counterpart organs for balance are the semi-circular canals, which contain some crystals and fluid. Changes in the body’s position and balance correspond to the shifting of fluids in these canals.
Receptors in the cochlea and the semi-circular canals that detect the vibrations and fluid shifts are connected to the auditory nerve, which sends this information to the brain.
What is hearing loss?
Hearing loss is the inability to recognize or perceive sounds to a certain degree, usually resulting from issues with the structures of the ear.
Most people can hear sounds at a range of 0-20 decibels (dB). The lower the decibels, the quieter the sound is. The following table shows different levels of hearing loss based on the lowest audible decibels:
Mild hearing loss
Moderate hearing loss
Severe hearing loss
Profound hearing loss
Hearing loss is not simply being unable to hear anything. Symptoms may vary by person, such as
- Cannot hear below a certain volume
- Cannot hear sounds of a higher or lower frequency
- Cannot hear sounds from a certain direction
Causes of hearing loss
About half of babies have hearing loss because of a genetic condition, most often as part of a genetic syndrome. On the other hand, one-fourth of babies develop hearing loss because of birth-related events or complications, such as head trauma during a difficult delivery. Beyond infancy, most cases of hearing loss are acquired.
Congenital hearing loss
Maternal infections during pregnancy, especially TORCH infections, can lead to hearing loss. Among these perinatal infections, cytomegalovirus (CMV) and herpes are two of the most prevalent infections associated with congenital hearing loss.
TORCH stands for the perinatal infections: toxoplasmosis, rubella, cytomegalovirus, and herpes. This group of infections also includes syphil is, varicella-zoster (chickenpox), and parvovirus B19.
Other than maternal infections, causes of congenital hearing loss include genetic syndromes. Some examples are Down syndrome, Alport syndrome, Usher syndrome, Treacher Collins syndrome, and Crouzon syndrome.
Acquired hearing loss
Acquired hearing loss can occur at any period after birth. There are various possible causes of acquired hearing loss, the most common of which is an acute middle ear infection (otitis media with effusion). Other reasons that could lead to this condition are:
- Some infections affecting the brain (meningitis, encephalitis)
- Viral infections (measles, chickenpox, mumps, influenza)
- Drugs that can damage the ear (ototoxic drugs)
- Physical injuries affecting the ears
- Constant exposure to loud sounds
Types of hearing loss
There are three categories of hearing loss: conductive, sensorineural, or a combination of the two.
Conductive hearing loss
In conductive hearing loss, there are problems within either the outer or middle ear, making it difficult for sound waves to reach the inner ear properly. Kids often describe their hearing loss as though speech is muffled or jumbled up.
The most common cause of conductive hearing loss is also otitis media with effusion. Fortunately, most cases of conductive hearing loss are temporary. However, repeated or chronic ear infections may damage ear structures and lead to sensorineural hearing loss, which may become permanent.
Sensorineural hearing loss
In sensorineural hearing loss, there are problems in the transmission of information from the inner ear to the auditory nerves and up to the brain's processing centers.
While conductive hearing loss is more common in children than sensorineural hearing loss, the latter is the most frequent cause of permanent hearing loss in kids.
Mixed hearing loss
Mixed hearing loss, also known as single-sided deafness, is a combination of conductive and sensorineural hearing loss. One ear may have normal hearing, with hearing loss in the other.
Different causes include head trauma, infections, drugs harmful to the ears, and other genetic conditions.
Signs of hearing loss in infants and children
In newborns and infants, hearing loss is usually elicited from newborn hearing screening, which is done within the first few days of life. Hearing loss is suspected in older infants and school-aged children when they notice delays in attaining developmental milestones. This includes skills in understanding and expressing language. Behavioral issues may also arise from hearing loss.
The following are important developmental milestones in hearing loss:
- By 1 month old - does not get startled by loud noises
- By 4-6 months old - does not turn to the source of sound
- By 12-15 months old - does not say “dada”, “mama”, or other single words
- By 18 months old - unable to say 5-10 different words
- By 2 years old - unable to speak in two- or three-word phrases
- By 2 1/2 years old - speech is still mostly mumbled or unclear
The following behavioral patterns might also be signs of hearing loss in children:
- They do not respond when their name is called.
- They only realize you are in the same room as them when you are in their line of sight.
- They have difficulty expanding their speech to include other vowels and consonants.
- They only respond to low-pitched sounds.
- They also have problems maintaining their balance, such as keeping their head steady, standing or walking alone, etc.
Diagnosing hearing loss
All babies born in a healthcare facility usually undergo hearing screening before they go home. This is also known as an otoacoustic emissions test. Other tests that confirm hearing loss include the auditory brainstem response and behavioral audiometry tests. These may also be utilized for older children suspected of having hearing loss.
Treatment for hearing loss
Treatment will depend on the cause and type of hearing loss. For cases of conductive hearing loss, therapy may include antibiotics or myringotomy tube insertion. In sensorineural hearing loss, amplification aids and speech therapy are advised. Other assistive listening devices are bone conduction implants, cochlear implants, and personal frequency modulation (FM) systems.
Additional modifications from the child’s community or support group may help in the overall management of hearing loss. This includes speaking in front of the child where they can see mouth movements, speaking with good verbal intonation, as well as decreasing background noise and noise pollution.
An earlier diagnosis also enables early initiation of treatment. This minimizes the potential delay and damage to a child’s learning progress and overall development.
Screening for hearing loss
Newborns are typically screened for hearing loss before they are discharged from the hospital with their moms. If a baby was born outside the hospital or was unable to receive newborn care from a healthcare professional, hearing screening can still be done within the first month of birth.
Babies who receive positive results in a hearing screening should undergo a full hearing test to confirm hearing loss. This should be done within three months.
Periodic hearing screening may also be done for kids between 4 to 18 years old during health maintenance visits. The American Academy of Pediatrics advises screening at the following ages:
A. Audiology screening
- 4 years old
- 5 years old
- 6 years old
- 8 years old
- 10 years old
B. Audiometry screening (once for each age group)
- 11-14 years old
- 15-17 years old
- 18-21 years old
The frequency of these tests will depend on your healthcare provider’s assessment. Children with risk factors may be screened more frequently.
Hearing is an important tool for a child’s development. Therefore, all children should undergo screening for hearing loss for early intervention. Most babies with hearing loss have a genetic condition, while other causes in infants and older children include infections, drugs with adverse effects, and a history of physical trauma. Some screening tests for hearing loss include otoacoustic emissions test, auditory brainstem response, and the behavioral audiometry test.
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- Smith, R., & Gooi, A. (2022). Hearing loss in children: Screening and evaluation. UpToDate. Wolters Kluwer Health. Taken from: https://www.uptodate.com/contents/hearing-loss-in-children-screening-and-evaluation
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilties (2022). Parts of the Ear. US Department of Health & Human Services. Taken from: https://www.cdc.gov/ncbddd/hearingloss/parentsguide/understanding/partsoftheear.html
- The University of Texas Health Science Center at Houston (n.d.). Ear Anatomy – Inner Ear. Taken from: https://med.uth.edu/orl/online-ear-disease-photo-book/chapter-3-ear-anatomy/ear-anatomy-inner-ear/
- Dimitrov L, Gossman W. Pediatric Hearing Loss. [Updated 2022 Jul 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538285/
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (2022). What is Hearing Loss in Children?. US Department of Health & Human Services. Taken from: https://www.cdc.gov/ncbddd/hearingloss/facts.html
- Stegmann, B. J., & Carey, J. C. (2002). TORCH Infections. Toxoplasmosis, Other (syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus (CMV), and Herpes infections. Current women's health reports, 2(4), 253–258.
- American Academy of Pediatrics (2019). Hearing Loss in Children. Caring for Your Baby and Young Child: Birth to Age 5 7th Edition. Taken from: https://www.healthychildren.org/English/health-issues/conditions/ear-nose-throat/Pages/Hearing-Loss.aspx
- Raising Children Network (Australia) Limited (2021). Deafness and hearing loss. Taken from: https://raisingchildren.net.au/disability/guide-to-disabilities/assessment-diagnosis/hearing-impairment
- Johns Hopkins All Children’s Hospital (n.d.) Types of Hearing Disorders. Taken from: https://www.hopkinsallchildrens.org/Services/Rehabilitation/Audiology/Types-of-Hearing-Disorders
- Texas Children's Hospital (n.d.) Mixed hearing loss. Taken from: https://www.texaschildrens.org/departments/audiology/types-hearing-loss/mixed-hearing-loss
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