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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| Content last modified Sep 2022
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Topic Resources

Common causes of hearing loss are genetic defects in neonates and ear infections and cerumen in children. Many cases are detected by screening, but hearing loss should be suspected if children do not respond to sounds or have delayed speech development. Diagnosis is usually by electrodiagnostic testing (evoked otoacoustic emissions testing and auditory brain stem response) in neonates and by clinical examination and tympanometry in children. Treatment for irreversible hearing loss may include a hearing aid or cochlear implant.

In the US, permanent childhood hearing loss is detected in 1.1/1000 infants screened. On average, 1.9% of children reported “hearing trouble.” Hearing impairment is slightly more common among boys than girls; the average male:female ratio is 1.24:1.

Etiology of Hearing Impairment in Children

Neonates

The most common causes of hearing loss in neonates are

Congenital CMV infection is the most common intrauterine infection in the US. CMV infection may account for as much as 21% of all sensorineural hearing loss at birth. In addition, because CMV infection also may cause late-onset hearing loss, CMV may account for as much as 25% of sensorineural hearing loss present at 4 years of age (2 Etiology references Common causes of hearing loss are genetic defects in neonates and ear infections and cerumen in children. Many cases are detected by screening, but hearing loss should be suspected if children... read more Etiology references ).

Table

Risk factors for hearing loss in neonates include the following:

Infants and children

The most common causes of hearing loss in infants and children are

Risk factors for hearing loss in children include those for neonates plus the following:

Etiology references

  • 1. Goderis J, De Leenheer E, Smets K, et al: Hearing loss and congenital CMV infection: A systematic review. Pediatrics 134(5):972–982, 2014. doi: 10.1542/peds.2014-1173

  • 2. Kimani JW, Buchman CA, Booker JK, et al: Sensorineural hearing loss in a pediatric population: Association of congenital cytomegalovirus infection with intracranial abnormalities. Arch Otolaryngol Head Neck Surg 136(10):999–1004, 2010. doi: 10.1001/archoto.2010.156

Symptoms and Signs of Hearing Impairment in Children

If hearing loss is severe, the infant or child may not respond to sounds or may have delayed speech or language comprehension. If hearing loss is less severe, children may intermittently ignore people talking to them. Children may appear to be developing well in certain settings but have problems in others. For example, because the background noise of a classroom can make speech discrimination difficult, the child may have problems hearing only at school.

Not recognizing and treating impairment can seriously impair language comprehension and speech. The impairment can lead to failure in school, teasing by peers, social isolation, and emotional difficulties.

Diagnosis of Hearing Impairment in Children

  • Electrodiagnostic testing (neonates)

  • Clinical examination and tympanometry (children)

Screening Hearing tests Screening (along with physical examination) is an important part of preventive health care in infants, children, and adolescents. To detect iron deficiency, clinicians should determine hematocrit... read more all infants before age 3 months is often recommended and is legally mandated in most US states (1 Diagnosis reference Common causes of hearing loss are genetic defects in neonates and ear infections and cerumen in children. Many cases are detected by screening, but hearing loss should be suspected if children... read more Diagnosis reference ). The initial screening test is evoked otoacoustic emissions testing Testing Testing , using soft clicks made by a handheld device. If results are abnormal or equivocal, auditory brain stem evoked responses Testing Testing are tested, which can be done during sleep; abnormal results should be confirmed with repeat testing after 1 month. If a genetic cause is suspected, genetic testing can be done.

In children, other methods can be used. Speech and overall development are assessed clinically. The ears are examined, and tympanic membrane movement is tested in response to various frequencies to screen for middle ear effusions. In children age 6 months to 2 years, response to sounds is tested. At age > 2 years, ability to follow simple auditory commands can be assessed, as can responses to sounds using earphones. Central auditory processing evaluation Testing Testing can be used for children > 7 years without neurocognitive deficits who seem to hear but not to comprehend.

Imaging is often indicated to identify the etiology and guide prognosis. For most cases, including when neurologic examination is abnormal, word recognition is poor, and/or hearing loss is asymmetric, gadolinium-enhanced MRI is done. If bone abnormalities are suspected, CT is done.

Diagnosis reference

  • 1. US Preventive Services Task Force: Universal screening for hearing loss in newborns: US Preventive Services Task Force recommendation statement. Pediatrics 122(1):143–148, 2008. doi: 10.1542/peds.2007-2210

Treatment of Hearing Impairment in Children

  • Hearing aids or cochlear implants for irreversible hearing loss

  • Sometimes teaching a nonauditory language

Reversible causes and abnormalities are treated.

If hearing loss is irreversible, a hearing aid Hearing aids Worldwide, about half a billion people (almost 8% of the world's population) have hearing loss ( 1). More than 10% of people in the US have some degree of hearing loss that compromises their... read more Hearing aids can usually be used. They are available for infants as well as children. If hearing loss is mild or moderate or affects only one ear, a hearing aid or earphones can be used. In the classroom, an FM auditory trainer can be used. With an FM auditory trainer, the teacher speaks into a microphone that send signals to a hearing aid in the nonaffected ear.

The COVID-19 pandemic required hearing specialists to develop ways of remotely monitoring and interacting with children with hearing loss. Some of these methods, eg, remote monitoring and programming of devices and online or in-app speech therapy techniques, may remain useful to patients even after pandemic restrictions are lifted.

Treatment references

  • 1. Brotto D, Sorrentino F, Favaretto N, et al: Pediatric hearing loss management in the COVID-19 era: Possible consequences and resources for the next future. Otolaryngol Head Neck Surg 166(2):217–218, 2021. doi: 10.1177/01945998211012677

  • 2. Marom T, Pitaro J, Shah UK, et al: Otitis media practice during the COVID-19 pandemic. Front Cell Infect Microbiol 11:749911, 2022. doi: 10.3389/fcimb.2021.749911

Key Points

  • Common causes of hearing loss in neonates are cytomegalovirus infection or genetic defects and in infants and older children are cerumen accumulation and middle ear infusions.

  • Suspect hearing loss if a child's response to sounds or development of speech and language is abnormal.

  • Screen infants for hearing loss, beginning with evoked otoacoustic emissions testing.

  • Diagnose children based on results of clinical examination and tympanometry.

  • Treat irreversible hearing loss with a hearing aid or cochlear implant and language support (eg, teaching sign language) as needed.

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