- Hearing loss or hearing impairment in newborn children is usually the result of cytomegalovirus infection or genetic defects; in older children, it is a consequence of ear infections or the presence of earwax.
- If children do not respond to sounds, have difficulty speaking, or are delayed in saying the first words, their hearing may be impaired.
- A handheld device or test that measures the brain’s responses to sounds is used to assess hearing in newborns; for older children, there are several techniques available.
- Untreated hearing impairment can prevent a child’s social, verbal, and emotional improvement.
- If possible, the cause is treated, but the use of a hearing aid may be necessary.
- If hearing aids are not effective, a cochlear implant can sometimes help.
Hearing impairment is relatively common in children. About 1.9% of children are hearing impaired, and permanent hearing loss is found in more than 1 in 1,000 children screened for hearing loss, whether or not they have symptoms.
Hearing impairment is slightly more common in males. Failure to recognize or treat a hearing impairment seriously affects a child’s ability to speak and understand language. The deficiency causes poor school performance, marginalization from peers, social isolation, and emotional problems.
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Causes of hearing impairment in children
The most common causes of hearing impairment in newborns are:
- Congenital cytomegalovirus (CMV) infection
- Genetic defects
When a baby is infected with cytomegalovirus (CMV) in the womb, it is called congenital cytomegalovirus (CMV) infection. Congenital cytomegalovirus (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 appear later in children who were infected immediately before, during, or shortly after birth.
Genetic defects are also common causes. Some genetic defects create a hearing loss that is obvious at birth. Other genetic defects cause hearing loss that evolves.
The most frequent causes of hearing impairment in newborns and older children are
- Ear infections (otitis) and secretory otitis media in children
- Earwax build-up
In older children, other causes are considered such as head trauma, loud noises (including loud music), use of certain drugs (such as aminoglycoside antibiotics or gentamicin) or thiazide diuretics, certain viral infections (such as mumps ), tumors, trauma from pencils or other foreign objects inserted deep into the ear and, in very rare cases, an autoimmune disease.
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Risk factors for hearing impairment in children
- Low birth weight (especially when it is less than 1.5 kg)
- Low Apgar score (less than 5 in the first minute or less than 7 at 5 minutes after birth)
- Infection before birth with rubella, syphilis, herpes, cytomegalovirus, or toxoplasmosis
- Low blood oxygen levels or seizures caused by difficult labor
- Abnormalities of the skull or face, especially those affecting the outer ear and external auditory canal (see Developmental Abnormalities of the External Ear )
- The high concentration of bilirubin (a waste product) in the blood (see Jaundice of the Newborn )
- Bacterial meningitis (see Meningitis in Children )
- Blood infections ( septicemia )
- Using an artificial respirator (a machine that helps draw air into and out of the lungs) for a long period of time
- Use of certain drugs, such as aminoglycoside antibiotics and some diuretics
- Archives of early hearing loss in a close relative or parent
All of the above, plus the following:
- A head injury with a loss of consciousness or skull fracture
- The chronic infections of the middle ear or a cholesteatoma
- Some neurological disorders, such as neurofibromatosis and neurodegenerative disorders (such as Hunter syndrome )
- Exposure to high-intensity noise or for long periods
- Perforation of the eardrum due to infection or trauma
Symptoms of hearing impairment in children
Parents suspect a severe hearing impairment if the child does not respond to sounds or has difficulty or slow speech.
Minor hearing impairment is less obvious and causes behaviors that are often misinterpreted by parents and the doctor:
- Affected children ignore the person speaking to them, but only occasionally.
- Children can speak and hear well at home, but not at school because mild or moderate hearing impairment only causes problems in the background noise of a classroom setting.
In general, if children are developing well in one setting but have noticeable social, behavioral, language, and learning difficulties in a different setting, they should be screened for hearing impairment.
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Screening and diagnosis
- For newborns, routine screening tests
- For older children, clinical evaluation and tympanometry
- Imaging tests
Since hearing plays an important role in a child’s development, many doctors recommend that all newborns be screened at around 3 months of age to identify hearing impairment early.
Newborns are required to undergo routine screening tests in most states to rule out hearing impairment. Neonates are routinely evaluated in two phases. The newborn’s ears are first tested for echoes in response to soft clicks generated by a handheld device, as in healthy ears (evoked otoacoustic emissions test). If this test raises questions about the newborn’s hearing, a second test is done to measure electrical signals from the brain in response to sounds (auditory brainstem response test or auditory evoked potentials). The auditory evoked potentials test is painless and is usually performed while newborns sleep. It can be done in children of any age. If the results are abnormal, the test is repeated after one month.
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If doctors suspect that the child has a genetic defect, they can order genetic testing.
In older children, several tools are used to diagnose hearing impairment:
- Ask parents if they detect a delay in the normal development of the child or assess the parents’ concern about language and speech development.
- Check the ears for possible abnormalities.
- Examine the response to various sounds in children between the ages of 6 months and 2 years
- Examine the response of the eardrum to a range of sound frequencies ( tympanometry ) that can detect if there is fluid in the middle ear.
- After 2 years of age, ask children to perform simple commands, which usually indicate how well they hear and understand speech. Your responses to sounds can also be assessed using headphones.
Imaging tests are often done to identify the cause of hearing loss and establish the prognosis. One is performed nuclear magnetic resonance (NMR) in most children. If bone abnormalities are suspected, a computed tomography (CT) scan is done.
Failure to recognize or treat a hearing impairment seriously affects speech and language understanding in children. Impairment causes poor school performance, marginalization from peers, and social and emotional problems.
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Treatment for hearing impairment in children
- Treat the cause whenever possible
- Hearing aids or cochlear implants
- Sign language
Treatment of reversible causes of hearing loss and hearing defects restores hearing. For example, ear infections can be treated with antibiotics or by surgery, earwax can be removed manually or by dissolving it with ear drops (ear drops), and cholesteatomas can be removed surgically.
Most often, the cause of the child’s hearing loss is irreversible, and treatment includes the use of hearing aid to compensate for the impairment as best as possible.
There are hearing aids for both infants and older children. If the hearing loss is mild or moderate or affects only one ear, hearing aids or headphones can be used. Children with hearing impairment in only one ear can benefit from a frequency modulated hearing training system that transmits the teacher’s voice directly to a hearing aid in the healthy ear.
Cochlear implant in a child
The implant consists of a sound processor placed behind the ear and that transmits the sound signals to the transmitter (circular) connected to the scalp. The transmitter transmits the message to electrodes embedded in the cochlea of the inner ear. Electrical impulses from the cochlea pass to the brain, allowing the person to hear.
Therapy to support language development, such as teaching sign language, may also be needed.
People in deaf communities feel satisfied with the richness of their culture and their alternative forms of communication. Many deaf people oppose surgical treatment for hearing impairment because it may prevent children from belonging to the deaf community. Families who wish to consider this approach should discuss it with their physician.
The following are some resources that may be helpful. Note that Kidsrush.com is not responsible for the content of these resources.
Visit the following websites for comprehensive information on the latest news on research and funding initiatives, educational materials, support services, and quick links to related topics:
AG Bell Association for the Deaf and Hard of Hearing: Support, information, resources, and more to ensure deaf and hard of hearing people can hear and speak.
American Society for Deaf Children: Information for children and youth of all hearing levels about access to communication support, language and learning opportunities, mentoring, and legal advocacy.
Hearing Health Foundation: Information on how to prevent and cure hearing loss and other hearing disorders.
Helen Keller National Center for Deaf-Blind Youths & Adults (HKNC ): Information on how blind, visually impaired, deaf-blind people o with combined hearing and vision loss can live and work independently through training and other resources.