HEARING LOSS IN CHILDREN: RISKS, PREVENTION AND TREATMENT
Hearing loss can impact speech and language development
Tamara felt stressed. She had observed that Toby, her 10-yearold son, did not respond when she called his name. He had failed his hearing screen in school twice, and his grades were dropping. Today she had brought Toby to meet with Toby’s ENT doctor, Dr. Leslie Smith. After examining Toby’s ears, nose and throat, Dr. Smith explained that Toby would need a hearing test to check his hearing and introduced them to the audiologist (hearing specialist). The audiologist had Toby wear headsets and then tested his hearing with different frequencies of sound and at various loudness levels in a sound-treated booth. The test lasted about 20 minutes and showed hearing loss in both his ears.
Hearing loss is when a person cannot hear as well as they previously could or should from birth. Children can either be born with hearing loss or develop hearing loss later due to infections, injury or loud noise exposure. Hearing loss affects two out of 1,000 newborn babies. Children can be born with hearing loss because of infections, toxic drugs to the inner ear, noise exposure or genetic diseases.
A pediatric otolaryngologist, commonly known as a children’s ear, nose and throat (ENT) physician, should be consulted if a child shows signs of hearing impairment or has frequent ear infections. An ENT has specialized training in caring for children with medical and surgical conditions of the ear, nose and throat, and in the case of children with hearing loss, ENT physicians can help determine a treatment plan and next steps.
Children’s hearing is especially important as it is how most children learn language and communicate with others. Hearing loss can negatively impact children’s speech and language development, school performance and social skills. As in the scenario above, Tamara noticed that Toby’s grades in school were lower because he could not hear his teachers.
One of the main reasons for hearing loss in children is ear infections, which are more frequent in the colder months. These infections typically occur in children between 3 months and 3 years old but are common until age 8. Twenty-five percent of all children will have repeated ear infections. Children who attend daycare, are exposed to cigarette smoke in the household, have asthma or allergies, are teething and/ or have pacifier use are at higher risk of ear infections.
To prevent ear infections, parents can do things such as make sure their children wash their hands often to help prevent germs from spreading, avoid contact with people who are sick, and stay up to date on all their recommended vaccinations.
Another cause of hearing loss in children is loud noise exposure. Approximately 10- 15% of school-aged children in the USA have some degree of hearing loss due to loud noise exposure. Loud noises can damage the tiny cells in the ear, called hair cells, that help us hear. These hair cells can’t grow back, so a person’s hearing cannot be fixed once they are gone. It is important to protect children’s ears from loud noise exposure by limiting the amount of time spent around loud noises, keeping a lower volume on the TV or radio, and wearing earplugs or noise-canceling headphones when around loud noises, like at a concert or sporting event, and moving away from noisy environments.
Although hearing cannot be recovered after loss, treatments and tools are available for children who have experienced hearing loss. For example, hearing loss caused by chronic ear infections, a build-up of fluid behind the eardrum and common in children, may be treated with surgery that involves implanting a tube into the eardrum to help drain this fluid. Other treatment options may include hearing aids, cochlear implants or other assistive devices that manage life with hearing loss rather than increase hearing, such as television and video captioning, telephone amplifiers, audio loop systems, and flashing and vibrating alarms.
For newborns, hearing screens are routine and help detect disabling hearing loss at birth. If a child passes their newborn hearing screen but starts to show symptoms of hearing loss later, or if parents suspect their child has difficulty hearing, it is best to seek medical attention as soon as possible.
The first step in diagnosing hearing loss is a hearing test or audiogram. During an audiogram, a child will listen to different sounds in a sound booth and tell the doctor or audiologist when they hear them. If a child does have hearing loss, the test will show the extent of the loss and where it is in the ear. Once hearing loss is diagnosed, the treatment options may include hearing aids, sign language or other communication methods, speech therapy or surgically implanted devices like cochlear implants.
Hearing aids are small devices worn in the ear that can make sounds louder and help sounds be picked up by hair cells that then send the signal to the auditory nerve to finally send the sound signal to the brain. Depending on how severe the hearing loss is, and if hearing aids do not help, children may need a cochlear implant.
Cochlear implants can help a child hear sounds when there is profound hearing loss in both ears or profound hearing loss in one ear and hair cells are not working. The implant can avoid the damaged hair cells and directly send the sound to the auditory nerve to carry the sound signal to the brain.
Remember, prioritizing a child’s ENT health and hearing is vital for children to learn and communicate with others. Parents can help prevent hearing loss in kids by protecting their ears from loud noises and preventing ear infections. If parents suspect their child has difficulty hearing, it is best to seek medical attention as soon as possible. Once hearing loss is diagnosed, the doctor will work with the child and their family to develop a plan that includes multiple options to help the child hear better.
Lindsay Boven, MD, otolaryngology - head and neck surgery fifthyear resident at LSU Health Shreveport. Payam Entezami, MD otolaryngology - head and neck surgery, fifth-year resident at LSU Health Shreveport. Gauri Mankekar, MD, Ph.D., assistant professor of otolaryngology – head and neck surgery, fifth-year resident at LSU Health Shreveport.