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Hearing Impairment in Children

By

Udayan K. Shah

, MD, Sidney Kimmel Medical College at Thomas Jefferson University

Last full review/revision Apr 2022
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Hearing impairment refers to any degree of hearing loss, mild to severe, and can occur when there is a problem with a part of the ear, including the inner, middle, and outer ears, or the nerves needed for hearing.

  • Hearing impairment in newborns most commonly results from cytomegalovirus infection or genetic defects and in older children results from ear infections or earwax.

  • If children do not respond to sounds, have difficulty talking, or are slow starting to talk, the cause may be hearing impairment.

  • A handheld device or a test that measures the brain’s responses to sounds is used to test hearing in newborns, and various other techniques are used for older children.

  • Untreated hearing impairment can impede a child's verbal, social, and emotional development.

  • If possible, the cause is treated, but hearing aids may be needed.

  • If hearing aids are not effective, a cochlear implant can sometimes be helpful.

Hearing impairment is relatively common among children. About 1.9% of children have trouble hearing, and permanent hearing loss is found in more than 1 out of every 1,000 children screened for hearing loss, whether or not they have symptoms.

Hearing impairment is slightly more common among boys. Not recognizing and treating impairment can seriously impair a child’s ability to speak and understand language. The impairment can lead to failure in school, teasing by peers, social isolation, and emotional difficulties.

Causes

The most common causes of hearing impairment in newborns are

When a baby is infected with CMV in the uterus, it is called congenital CMV infection Cytomegalovirus (CMV) Infection in Newborns Cytomegalovirus is a common virus that usually causes few or no problems but can cause serious illness in infants who are infected before birth or around the time of birth. Cytomegalovirus infection... read more . Congenital CMV infection is the most common congenital viral infection in the United States. Infected newborns can be born with hearing loss and many other problems. Hearing loss can also develop later in children who were infected immediately before, during, or shortly after birth.

Genetic defects are also common causes. Some genetic defects cause hearing loss that is evident at birth. Other genetic defects cause hearing loss that develops over time.

The most common causes of hearing impairment in infants and older children are

In older children, other causes include head injury Overview of Head Injuries Head injuries that involve the brain are particularly concerning. Common causes of head injuries include falls, motor vehicle crashes, assaults, and mishaps during sports and recreational activities... read more , loud noise (including loud music), use of certain drugs that can damage the ears Ear Disorders Caused by Drugs Many drugs can damage the ears (ototoxic drugs). Some ototoxic drugs include the antibiotics streptomycin, tobramycin, gentamicin, neomycin, and vancomycin, certain chemotherapy drugs (for example... read more (such as aminoglycoside antibiotics or thiazide diuretics), certain viral infections (such as mumps Mumps Mumps is a contagious viral infection that causes painful enlargement of the salivary glands. The infection may also affect the testes, brain, and pancreas, especially in adults. Mumps is caused... read more Mumps ), tumors Ear Tumors Tumors of the ear may be noncancerous (benign) or cancerous (malignant). Most ear tumors are found when people see them or when a doctor looks in the ear because people notice their hearing... read more or injuries affecting the auditory nerve, injury by pencils or other foreign objects that become stuck deep in the ear Objects in the Ear Objects in the ear can be removed by flushing the ear canal with sterile water or saline or using suction, forceps, or other tools. If the foreign body cannot easily be removed, a referral to... read more , and, rarely, a malfunction of the body's immune system that causes the body to attack its own tissues (autoimmune disorder Autoimmune Disorders An autoimmune disorder is a malfunction of the body's immune system that causes the body to attack its own tissues. What triggers autoimmune disorders is not known. Symptoms vary depending... read more ).

Risk Factors for Hearing Impairment in Children

Did You Know...

  • If children sometimes seem to ignore people who are talking to them, their hearing may be impaired and should be evaluated.

Symptoms

Parents may suspect hearing impairment if the child does not respond to sounds or if the child has difficulty talking or delayed speech.

Less severe hearing impairment can be more subtle and lead to behavior that is misinterpreted by parents and doctors, such as the following:

  • Children sometimes ignore people who are talking to them.

  • Children are able to talk and hear well at home but not in school because mild or moderate hearing impairment may cause problems only in the midst of the background noise of a classroom.

In general, if children are developing well in one setting but have noticeable social, behavioral, language, or learning difficulties in a different setting, they should be screened for hearing impairment.

Screening and Diagnosis

  • For newborns, routine hearing screening tests

  • For older children, a doctor's evaluation and tympanometry

  • Imaging tests

Because hearing plays such an important role in a child’s development, many doctors recommend that all newborns be tested for hearing impairment by the age of 3 months.

Most states require that newborns undergo routine screening tests Newborn Screening Tests Many serious disorders that are not apparent at birth can nonetheless be detected by various screening tests. Early diagnosis and prompt treatment can reduce or prevent many disorders that may... read more to detect hearing impairment. Newborns are usually screened in two stages. First, newborns are tested for echoes produced by healthy ears in response to soft clicks made by a handheld device (evoked otoacoustic emissions testing Testing Testing ). If this test raises questions about a newborn’s hearing, a second test is done to measure electrical signals from the brain in response to sounds (the auditory brain stem response test, or ABR). The ABR is painless and usually done while newborns are sleeping. It can be used in children of any age.

If results of the ABR are abnormal, the test is repeated in 1 month. If hearing loss is still detected, children may be fitted with hearing aids and may benefit from placement in an educational setting responsive to children with impaired hearing.

If doctors suspect the child has a genetic defect, genetic testing can be done.

In older children, several techniques are used to diagnose hearing impairment:

  • Asking a series of questions to detect delays in a child’s normal development or to assess a parent’s concern about language and speech development

  • Examining the ears for abnormalities

  • For children aged 6 months to 2 years, testing their response to various sounds

  • Testing the response of the eardrum to a range of sound frequencies (tympanometry Testing Testing ), which may indicate whether there is fluid in the middle ear

  • After age 2 years, asking children to follow simple commands, which usually indicates whether they hear and understand speech, or testing their responses to sounds using earphones

Prognosis

Not recognizing and treating hearing impairment can seriously impair speech and understanding of language. The impairment can lead to failure in school, teasing by peers, and social and emotional problems.

Treatment

  • Treating the cause when possible

  • Hearing aids or cochlear implants

  • Sign language

Treating reversible causes of hearing loss and ear defects can restore hearing. For example, ear infections can be treated with antibiotics or surgery, earwax can be manually removed or dissolved with ear drops, and cholesteatomas can be surgically removed.

Most often the cause of a child’s hearing loss cannot be reversed, and treatment involves use of a hearing aid to compensate for the impairment as much as possible.

Hearing Aids: Amplifying the Sound

The behind-the-ear hearing aid is the most powerful but least attractive hearing aid. The in-the-ear hearing aid is the best choice for severe hearing loss. It is easy to adjust but is difficult to use with telephones. The in-the-canal hearing aid is used for mild to moderate hearing loss. This aid is relatively inconspicuous. The completely-in-the-canal hearing aid is used for mild to moderate hearing loss. This aid has good sound, is nearly invisible, and can be easily used with telephones. It is removed by pulling on a small string. However, it is the most expensive and hard to adjust.

Hearing Aids: Amplifying the Sound

Cochlear implants Cochlear Implants Many causes of hearing loss have no cure. In these cases, treatment involves compensating for the hearing loss as much as possible. Most people with moderate to severe loss use hearing aids... read more Cochlear Implants (a surgically implanted system that sends electrical signals directly into the auditory nerve in response to sounds) may be used for children whose hearing loss is severe enough that it cannot be managed with hearing aids.

People in deaf communities are proud of their rich culture and alternative forms of communication. Many deaf people oppose surgery for the treatment of severe hearing impairment on the grounds that it may deny children membership in the deaf community. Families who wish to consider this approach should discuss it with their doctor.

More Information

The following are some English-language resources that may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

See the following sites for comprehensive information about updates on research and funding initiatives, educational materials, support services, and quick links to related topics:

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