Hearing loss 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, their hearing may be impaired.
A handheld device or a test that measures the brain’s responses to sounds is used to test hearing in newborns, and various 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 1000 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.
(See also Hearing Loss Hearing Loss Worldwide, about half a billion people (almost 8% of the world's population) have hearing loss. More than 10% of people in the United States have some degree of hearing loss that affects their... read more in adults.)
Causes of Hearing Impairment
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
Ear infections Overview of Middle Ear Infections in Young Children Middle ear infection is infection of the space immediately behind the eardrum. Middle ear infections (otitis media) may occur in older children and adults (Home.Page Otitis Media (Acute)) but... read more and secretory otitis media Secretory Otitis Media in Children Secretory otitis media is fluid that accumulates behind the eardrum and remains there after an acute middle ear infection or blockage of the eustachian tube. A previous ear infection is the... read more
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 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 ), 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 , 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, autoimmune disorders.
Did You Know...
Symptoms of Hearing Impairment
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:
Children ignore people who are talking to them some but not all of the time.
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 of Hearing Impairment
For newborns, routine screening tests
For older children, a doctor's evaluation and tympanometry
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). 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 Worldwide, about half a billion people (almost 8% of the world's population) have hearing loss. More than 10% of people in the United States have some degree of hearing loss that affects their... read more ), 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
Imaging tests are often done to identify the cause of hearing loss and guide prognosis. Magnetic resonance imaging Magnetic Resonance Imaging (MRI) In magnetic resonance imaging (MRI), a strong magnetic field and very high frequency radio waves are used to produce highly detailed images. MRI does not use x-rays and is usually very safe... read more (MRI) is done for most children. If doctors suspect bone abnormalities, computed tomography Computed Tomography (CT) In computed tomography (CT), which used to be called computed axial tomography (CAT), an x-ray source and x-ray detector rotate around a person. In modern scanners, the x-ray detector usually... read more (CT) is done.
Prognosis of Hearing Impairment
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 of Hearing Impairment
Treating the cause when possible
Hearing aids or cochlear implants
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 Hearing Aids 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 are available for infants as well as older children. If hearing loss is mild or moderate or affects only one ear, a hearing aid or earphones can be used. Children who have hearing impairment in only one ear can be helped by using an FM auditory trainer Treatment in children Worldwide, about half a billion people (almost 8% of the world's population) have hearing loss. More than 10% of people in the United States have some degree of hearing loss that affects their... read more that transmits a teacher’s voice to a hearing aid in the normal ear.
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 but is difficult to use with telephones. 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.
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 (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.
Children may also require therapy to support their language development, such as being taught a visually based sign language Treatment in children Worldwide, about half a billion people (almost 8% of the world's population) have hearing loss. More than 10% of people in the United States have some degree of hearing loss that affects their... read more .
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 about Hearing Impairment
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:
A.G. Bell Association for the Deaf and Hard of Hearing: Support, information, resources, and more to ensure people who are deaf and hard of hearing can hear and speak
American Society for Deaf Children: Information for children and youth of all hearing levels regarding access to communication support, language and learning opportunities, mentoring, and advocacy
Hearing Health Foundation: Information about preventing and curing hearing loss and other hearing disorders
Helen Keller National Center for Deaf-Blind Youths & Adults (HKNC): Information for how people who are blind, visually impaired, deaf-blind or have combined hearing and vision loss can live and work independently through training and other resources
National Association of the Deaf: A civil rights organization for deaf and hard-of-hearing people in the United States