Hearing Impairment in Children

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

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 that can damage the ears Ear Disorders Caused by Drugs Many drugs, including medications, can damage the ears. These drugs are called ototoxic drugs. They include the antibiotics streptomycin, tobramycin, gentamicin, neomycin, and vancomycin, as... 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 or injuries affecting the auditory nerve, 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, a malfunction of the body's immune system that causes the body to attack its own tissues (autoimmune disorder Autoimmune Disorders An autoimmune disorder is a malfunction of the body's immune system that causes the body to attack its own tissues. What triggers an autoimmune disorder is not known. Symptoms vary depending... read more ).

Parents may suspect 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.

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 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:

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.

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.

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 15% 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.

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 15% 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.

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