Hearing Loss in Children

What is hearing loss?

Hearing and speech are essential tools for learning in children. While most babies are born with normal hearing, one to three out of every 1,000 are born with some degree of hearing loss.

Hearing loss can affect how your child’s brain develops — specifically the hearing and listening portions of the brain — and lead to a delay in your child’s speech and language development. Your child’s social-emotional development and academic performance may also be affected by hearing loss.

Fortunately, many of the complications of hearing loss can be prevented if your child is diagnosed early and appropriate treatment begins before your child is 6 months old.

Types of pediatric hearing loss

Hearing loss in children can be present at birth (congenital) or acquired after birth. The two primary types of hearing loss are:

  • Sensorineural hearing loss – This type of hearing loss is related to damage or a defect in the inner ear or in the neural connection to the brain. Sensorineural hearing loss can be caused by congenital factors or can occur after birth.
  • Conductive hearing loss – A reduction of sound being sent to the inner ear caused by a problem in the outer or middle ear. Conductive hearing loss is the most common type of hearing loss in children and is usually acquired. In a minority of cases, this type of hearing loss is congenital.

Hearing loss can also be a mix of both of these types, affecting both the inner ear and outer/middle ear. In rare cases, hearing loss can be a result of a nerve dysfunction known as auditory neuropathy or auditory dyssynchrony, in which sounds enter the inner ear normally, but the signals between the ear and brain are impaired.

Causes

Both sensorineural and conductive hearing loss can be caused by a variety of congenital and acquired factors. The following are the most common factors related to each type of hearing loss.

Sensorineural hearing loss

Congenital factors:

  • Genetic factors and syndromes
  • Low birth weight or prematurity
  • Infection present at birth (i.e. toxoplasmosis, rubella, cytomegalovirus, herpes, syphilis)
  • Maternal diabetes
  • Complications associated with Rhesus (Rh) factor in the blood

Acquired factors:

  • Loud noise exposure
  • Infections
  • Head trauma
  • Damage from certain medications that can be harmful to the ears

Conductive hearing loss

Congenital factors:

  • Abnormalities of the pinna (the outside of the ear)
  • Abnormalities of the external ear canal
  • Abnormalities of the tympanic membrane (eardrum)
  • Abnormalities of the ossicles (three tiny bones in the middle ear)

Acquired factors:

Signs and symptoms

Symptoms of hearing loss in children can vary and depend on your child’s age, as well as whether the condition was present at birth or developed later. If your child is born with hearing loss, it’s likely the condition will be noticed and diagnosed at the hospital. If your child develops hearing loss later, you may be one of the first people to recognize your child is having an issue with hearing or understanding speech.

You may suspect your child has a hearing loss if:

  • Your infant is not startled at loud noises or fails to respond to the sound of a familiar voice
  • Your baby doesn’t turn toward an object that’s making noise, such as a rattle or other noisy toy, and doesn’t turn toward you when hearing you speak
  • Your baby doesn’t make babbling sounds
  • Your toddler doesn’t point to familiar objects when named, follow simple commands, use several different words or listen to stories and songs

Testing and diagnosis

Early intervention and detection of hearing loss is important to maximize a child’s spoken speech and language development. Every baby born in a hospital in the United States is screened for hearing loss before leaving the hospital. All 50 states and the District of Columbia have Early Hearing Detection and Intervention (EHDI) laws or voluntary programs that test hearing in newborns.

Infants who do not pass newborn screening will require further diagnostic hearing testing before they are 3 months old. When necessary, infants should be enrolled in early intervention programs by 6 months of age.

At The Children’s Hospital of Philadelphia, a multidisciplinary team provides comprehensive hearing evaluations for infants, children and teens. A wide range of hearing tests can be used to determine how your child hears at any age. Depending on the age of your child, different behavioral tests can be used to match your child’s level of participation and his understanding of the tasks involved.

Tests may include:

  • Otoacoustic emissions
  • Auditory brainstem response
  • Tympanometry
  • Visual reinforcement audiometry
  • Conditioned play audiometry
  • Conventional audiometry

Learn more about each of the hearing tests your child may receive.

Treatments

Treatment of your child’s hearing loss depends on a variety of factors including the:

  • Cause of your child’s hearing loss
  • Severity of hearing loss
  • Age/development of your child
  • Recommendation of the multidisciplinary team
  • Your family’s input

Treatment may include:

  • Use of hearing aids. These devices can amplify and change sound to maximize audibility of speech signals. Talk to your child’s doctor to learn if a hearing aid could help your child.
  • Cochlear implants. A surgically implanted device that transmits electrical stimulation to the inner ear to give the perception of sound. Only certain children are candidates for this type of device. Consult your child's doctor or audiologist to learn if a cochlear implant could help your child.
  • Intervention services. There are a variety of communication options or philosophies that were developed to promote communication in children with hearing loss. Consult your child’s audiologist or speech pathologist for more information.

At CHOP, we take a multidisciplinary approach to treating children with hearing loss. Your child’s healthcare team may include:

  • Audiologists: Doctors of audiology are professionals who specialize in the evaluation and management of hearing and balance problems in people of all ages. Audiologists are also involved with the fitting and management of hearing aids and other assistive devices.
  • Otolaryngologists: Physicians with special training in medical and surgical treatment for children who have disorders of the ears, nose and throat.
  • Speech-language pathologists: Master’s prepared clinical professionals who help evaluate and treat children with difficulties with speech, language and swallowing.


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