5 Types Of Tests And Treatment For Hearing Loss In Children

Hearing loss in children can occur for several reasons and be transient or irreversible. Since hearing aids in the development of speech and language abilities in children, it must be diagnosed as early as possible to help children develop and attain their highest potential.

If you believe your child suffers from hearing loss, visit your child’s doctor, who may then refer your child to an ear, nose, and throat (ENT) specialist.

This post discusses the causes, indications, and management choices for hearing loss in children to help you identify and gather some preliminary information on the condition.

How Common Is Hearing Loss In Children?

According to the World Health Organization (WHO), around 5% of the world’s population live with hearing loss, and among them, 34 million are children. WHO also estimates that 60% of childhood hearing loss can be avoided through preventive measures (1).

Hearing loss in children can happen at the time of birth due to maternal and congenital issues and also develop during later stages due to environmental influences.

Types Of Hearing Loss

Hearing loss happens when a part of the auditory system does not work. There are four types of hearing loss in children.

1. Conductive hearing loss: This type of hearing loss occurs when something stops sounds from getting through the outer or middle ear. It can be treated with medication or surgery.

2. Sensorineural hearing loss: It refers to a hearing loss due to a problem in the inner ear or hearing nerves.

3. Mixed hearing loss: It refers to a hearing loss that has elements of both conductive hearing loss and neural hearing loss, meaning there’s a problem in both the inner ear and the outer ear.

4. Auditory neuropathy spectrum disorder: It refers to a hearing loss wherein sound enters the ear normally but isn’t processed well for the brain to understand due to damage of the inner ear or the hearing nerve (2).

Hearing loss is also classified based on the levels of hearing loss.

1. Mild hearing loss: It is when the child has a hearing level of 26–40 decibels (dB). The child would face trouble hearing and understanding soft speech, speech from a distance, and speech against background noise.

2. Moderate hearing loss: It is when the child has a hearing level of 41–60dB. The child would face difficulty hearing regular speech even from a close distance.

3. Severe hearing loss: It is when a child has a hearing level of 61–80dB. Th
   e child may only hear very loud speech or loud sounds in the environment and not hear most conversational speech.

4. Profound hearing loss: It is when the hearing level is over 81dB. The child can only perceive loud sounds as vibrations (1).

Causes Of Hearing Loss In Children

Hearing loss in children can be due to various reasons, ranging from congenital to acquired. It can also be caused by two or more factors combined. Here are a few general causes of hearing loss in children.

Causes of temporary hearing loss in children

• Ear problems: Sometimes, common ear problems such as excessive ear wax (impacted cerumen) and glue ear (non-suppurative otitis media) can also cause loss of hearing. These problems tend to get better with treatment over time.

• Injuries to the ear: Injury to the eardrum or sharp and pointed objects stuck in the ear canal can also cause hearing loss.

• Common ear infections: Ear infections, such as chronic suppurative otitis media that is often characterized by persistent discharge of fluid from a perforation in the middle ear, can also cause hearing loss in children.

Causes of permanent hearing loss in children

• Genetic factors: Around 40% of childhood hearing loss is said to be due to genetic factors. Studies state that hearing loss is frequently found in children born of consanguineous marriages (marriage between two closely related people). Congenital malformation of the ear and the hearing nerve may be due to genetic factors.

• Infections: Certain infections such as rubella and cytomegalovirus during pregnancy may lead to hearing loss in the baby. Also, childhood infections such as meningitis, mumps, and measles can result in hearing loss.

• Conditions during birth: Hearing loss is also associated with premature birth, low birth weight, birth asphyxia (lack of oxygen during birth), and neonatal jaundice.

• Environmental noises: Prolonged exposure to loud noises from smartphones and MP3 players and exposure to short but high-intensity noises, such as from fireworks, might cause permanent hearing loss. In babies, the noisy machinery in a neonatal intensive care unit may also contribute to hearing loss.

• Medicines: The use of ototoxic drugs, such as those for the treatment of malaria and drug-resistant tuberculosis, antibiotics for neonatal infections, and cancer medicines can also lead to permanent hearing loss (1).

Read the next section to understand the signs of hearing loss in children.

Signs Of Hearing Loss In Children

Research suggests that children who are born deaf or those who lose their sense of hearing at a very early age can develop language skills on par with their peers with appropriate interventions within six months (1). Therefore, it is necessary to identify the problem early on.

Here are a few common signs of hearing loss in children:

• Slow to learn to talk and may not be able to speak clearly

• Do not respond or look in your direction when you call them

• Tend to talk very loudly

• May often ask you to repeat yourself or may not answer appropriately to your questions

• Tend to turn up the volume of the TV very high (3)

Hearing Tests For Children

Hearing tests conducted in preschools and schools are helpful for identifying the condition early on. Usually, hearing tests for children are conducted within a few weeks of birth, from nine months to 2.5 years, and at around four to five years of age.

Various hearing tests help check hearing problems in children. Here are a few of them.

1. Visual reinforcement audiometry (VRA): This test is done to test hearing loss in children aged six months to 2.5 years. In this test, the child is made to sit on a chair, and sounds are presented. The child is asked to link the sound with a visual reward, such as a toy or a computer screen lighting up.

Once the child associates the sound with the visual reward, the sound’s volume and pitch are varied to determine the child’s reaction to the quietest sound possible.

2. Pure tone audiometry: Also known as the sweep test, it is done for screening a child’s hearing before they start school.

During this test, a machine generates sounds at different volumes and frequencies, which the child should listen to through headphones. The child is asked to press a button when they hear a sound. This way, you can determine the quietest sounds your child can hear.

3. Play audiometry: This test is used to screen children between 1.5 and five years. In this test, sounds are played through earphones, and the child is asked to perform a simple task, such as completing a puzzle. The sounds vary in volume and pitch to determine the quietest sounds your child can hear.

4. Bone conduction test: In this test, a small vibrating device is placed behind the ear, which passes the sounds to the inner ear. This test can help identify the part of your child’s ear that is not working properly.

5. Tympanometry: To hear properly, the eardrum should be flexible; else, the sounds would bounce back. This test is used to find out the flexibility of the eardrum. A soft rubber tube is placed at the ear’s opening, and air is gently blown down the tube while a sound is played through the small speaker inside it. The tube measures the amount of sound that has bounced back (4).

Once the cause of hearing loss is determined, the next step is to manage the hearing loss. Read on to find out ways to treat and manage hearing loss in children.

Treatment And Management Of Hearing Loss In Children

WHO estimates that over 30% of hearing loss in children is caused by measles, mumps, rubella, and ear infections, and it says these can be prevented through vaccinations and good hygiene practices.

Another 17% of the hearing loss is estimated to be caused by birth complications such as premature birth, low birth weight, neonatal jaundice, and lack of oxygen during birth. Improved mother and child care and better delivery conditions can prevent these complications to some extent.

Pregnant women and newborns should not be given medications that contain ototoxic compounds (1).

Treatment for temporary hearing loss

If the hearing loss is temporary, it can be cured with medications and surgery. Your child’s doctor is the best person to prescribe the best medication.

Medications and surgeries are usually recommended to treat conductive hearing loss due to a chronic ear infection. Medications are used as the first line of defense, and if the problem persists, surgery may be recommended. The surgical procedure involves placing a small tube into the eardrum to drain the fluid.

Another type of surgery is corrective surgery; this is recommended for correcting congenital malformations in the middle and outer ear (5).

Management of permanent hearing loss

If your child is diagnosed with a permanent childhood hearing loss, it is best to put them in an early intervention program that focuses on:

• Implementing hearing aids such as a cochlear implant or a bone-anchored device.

• Suitable communication options and therapy.

• Guidance and counseling from parents and experts (1).

With some help, your child can learn sign language. Sign language, along with the hearing aids, can help the child communicate.

Types of Hearing Loss; Centers for Disease Control and Prevention

References

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Reviewer

Dr. Dur Afshar AghaMS

   

Dr. Dur Afshar Agha is a consultant pediatrician with around 26 years of experience in various medical facilities both in Pakistan and Saudi Arabia. She has headed the Department of Preventive Pediatrics at the prestigious, Children’s Hospital and Institute of Child Health in Pakistan and is a life member of the Pakistan Paediatric Association.

Read full bio of Dr. Dur Afshar Agha