Hearing impairment is relatively common among children:
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.
Genetic defects are the most common cause of hearing impairment in newborns. Ear infections, including secretory otitis media, and accumulation of earwax are the most common causes of hearing impairment in infants and older children. In older children, other causes include head injury, loud noise (including loud music), use of aminoglycoside antibiotics (such as gentamicin) or thiazide diuretics, certain viral infections (such as mumps), tumors or injuries that damage the auditory nerve, injury by pencils or other foreign objects that become stuck deep in the ear, and, rarely, autoimmune disorders.
Parents may suspect severe 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:
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
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. This testing is required by law in many states.
Newborns are usually screened in two stages. First, children are tested for echoes produced by healthy ears in response to soft clicks made by a handheld device (evoked otoacoustic emissions testing). If this test raises questions about a child'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 children 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.
In older children, several techniques are used to diagnose hearing impairment:
Treating some causes of hearing loss 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 are available for infants as well as older children. Children with a mild or moderate hearing impairment in one ear usually need an FM radio system that transmits a teacher's voice directly to a set of speakers, hearing aids, or earphones. Cochlear implants (devices placed in the inner ear to stimulate the auditory nerve with an electrical current in response to sounds) are used for most children with severely impaired hearing (see Hearing Loss and Deafness: Treatment in Children).
People in deaf communities are proud of their rich culture and alternative forms of communication. Many people oppose the aggressive treatment of hearing impairment on the grounds that it denies children the opportunities available in those communities. Families who wish to consider this approach should discuss it with their doctor.
Last full review/revision January 2009 by Robert J. Ruben, MD