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You know what hearing is, but what is hearing loss? Hearing loss, or hearing impairment (say: im- pare-ment), happens when there is a problem with one or more parts of the ear or ears, the nerves coming from the ears, or the part of the brain that controls hearing. "Impairment" means something is not working correctly or as well as it should.

Someone who has hearing loss might be able to hear some sounds or nothing at all. People also may use the words deaf, deafness, or hard of hearing when they're talking about hearing loss.

About 3 in 1,000 babies are born with hearing loss, making it the most common birth defect. A hearing problem can also develop later in life.

How Hearing Works

To understand how and why hearing loss happens, it helps to know how the ear works. The ear is made up of three different sections: the outer ear, the middle ear, and the inner ear. These parts work together so you can hear and process sounds. The outer ear, or pinna (the part you can see), picks up sound waves and the waves then travel through the outer ear canal.

When the sound waves hit the eardrum in the middle ear, the eardrum starts to vibrate. When the eardrum vibrates, it moves three tiny bones in your ear. These bones are called the hammer (or malleus), anvil (or incus), and stirrup (or stapes). They help sound move along on its journey into the inner ear.

The vibrations then travel to the cochlea, which is filled with liquid and lined with cells that have thousands of tiny hairs on their surfaces. There are two types of hair cells: the outer and inner cells. The sound vibrations make the tiny hairs move. The outer hair cells take the sound information, amplify it (make it louder), and tune it. The inner hair cells send the sound information to your hearing nerve, which then sends it to your brain, allowing you to hear.

Types of Hearing Loss

There are a few different types of hearing loss: conductive, sensorineural, mixed (conductive and sensory combined), neural, and central.

Conductive (say: kun-duk-tiv) hearing loss. This happens when there is a problem with a part of the outer or middle ear that is blocking sound from going to the inner ear. This type of hearing loss and it is usually mild and temporary because in most cases medical treatment can help.

Sensorineural (say: sen-suh-ree-nur-ul) hearing loss. This happens when there is a problem in the inner ear or with the connection from the inner ear to the brain. This can happen when the tiny hair cells in the cochlea are damaged or destroyed. Depending on the loss, a kid might: hear most sounds (although they would be muffled); hear in quiet but not in noise; hear only some sounds; or hear no sounds at all. Sensorineural hearing impairment is almost always permanent and a kid's ability to talk normally may be affected.

Central hearing loss. This happens when the cochlea is working properly, but parts of the brain are not. This rare type of hearing loss is difficult to treat.

What Causes Hearing Loss?

Hearing loss can happen because a person was born with parts of the ear that didn't form correctly and don't work well. Other problems can happen later because of an injury or illness, including:

middle ear fluid

serious infections, such as meningitis

head injury

listening to very loud music, especially through headphones or ear buds

repeated exposure to loud sounds, such as machinery

Lots of kids have had ear infections, which also can cause hearing loss. Permanent hearing loss from an ear infection is rare, though.

How Does a Doctor Test for Hearing Loss?

If a doctor thinks that a baby or child may have hearing loss, the doctor will recommend that the parents take the kid to an audiologist. An audiologist (say: awd-ee- ah-luh-jist) is someone who is specially trained to test and help with the problems related to hearing loss.

A pediatric audiologist tests a child's hearing by doing different types of tests. They even have hearing tests for babies! Maybe you've had a hearing test, when you wore headphones and had to raise your left or right hand to show that you could hear in each ear.

If an audiologist finds that a child has hearing loss, he or she will recommend treatment and suggest the family work with a special team. This team can help figure out the best way for the kid to learn and communicate.

How Is Hearing Loss Treated?

The kind of treatment depends on the type of hearing loss, how severe it is, and the child's other needs. Common treatments include medicine, operations, hearing aids, or other assistive listening devices, which emphasize voices and help kids hear better in noisy settings. With early treatment, most kids will be able to hear normally again, and most importantly, will be able to develop speech and language.

Hearing aids are kind of like tiny amplifiers. They help make sounds louder and can even pick up the sounds so that what kids hear is clearer. Hearing aids deliver amplified sounds (via sound vibrations) from the eardrum and middle ear to the inner ear or cochlea. Hearing aid technology is available that can adjust the volume of sounds automatically.

For some kids who can't hear or understand words even with the help of hearing aids, there is a device called a cochlear implant (say: ko-klee-ur im-plant). This is a very tiny piece of electronic equipment that is put into the cochlea during an operation. It takes over the job of the damaged or destroyed hair cells in the cochlea by turning sounds into electrical signals that stimulate the hearing nerve directly.

Learning and Communicating

A kid with hearing loss may attend a special school, special classes within a regular school, or be part of a regular classroom. Depending on how severe their hearing loss is, some kids may work with audiologists or speech-language pathologists to help them develop their hearing and speaking skills.

Some people with hearing loss may need to use special techniques like these to communicate:

speechreading (also called lip-reading), which involves looking closely at a person's lips, facial expressions, and gestures to help figure out spoken words

Sign Language, which is a language of hand movements that allows deaf people to communicate without speaking. Remember: American Sign Language (ASL) is different from sign language used in other countries, even different from British Sign Language!

Cued Speech and Signed Exact English, which use handshapes to translate what's being said. They're meant to be used with spoken language to help people understand anything they can't comprehend through lip reading.

What about talking on the phone? Thanks to a telecommunication device (also called a TDD), a conversation can be typed out instead of spoken. The messages appear on a special screen or on a printout.

You might wonder how a hearing-impaired person could see a movie or watch TV. Closed-captioned TV shows and movies provide text at the bottom of the screen, so people with hearing loss can read along to follow the action. Technology is changing all the time, and you will probably see newer and better tools to help hearing-impaired kids and their families and friends.

So hearing-impaired kids can go to school, talk on the phone, and watch a movie. If that sounds a lot like a typical kid's life, you're right!

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Hearing loss happens when there is a problem with the ear, nerves connected to the ear, or the part of the brain that controls hearing. Someone who has hearing loss may be able to hear some sounds or nothing at all. To learn more, read this article for kids.

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Deaf Child Worldwide - Causes of deafness

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There are many reasons why a child can be born deaf or become deaf early in life. It is not always possible to identify the reason.

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Determining hearing loss in children facts

Children can be tested for hearing loss at any age.

There are several risk factors associated with hearing loss, including ear infections, prematurity, diseases, and syndromes.

Early identification of hearing loss will permit effective intervention, allowing for speech, language and cognitive development that are on target with a child's peers.

The ABR and the OAE evaluations are effective tests for infants and children who cannot cooperate for a traditional hearing evaluation.

Visual reinforcement audiometry and play audiometry are two behavioral methods used for testing cooperative children, which can obtain results similar to an adult evaluation.

A test of the middle-ear system should be included in a diagnostic hearing evaluation for all children.

When a hearing loss is detected, the child should be referred to an otolaryngologist or ENT to identify the cause of the loss. Further recommendations can be made by the ENT.

Myth

Accurate hearing testing cannot be done until a child reaches the age of 5 or 6.

Fact

Current technology now permits the accurate assessments of hearing in children starting within a few hours of birth. In fact, all states have mandates that testing of hearing be done in the newborn prior to discharge from the hospital.

Why test a child's hearing?

A child with undetected hearing loss may not be able to develop normal speech and language or acquire the cognitive abilities (knowing, thinking, and judging) needed for learning. Children whose hearing loss is not identified until, for example, 2 or 3 years of age may suffer from permanent impairment of speech, language, and learning.

The early identification of hearing loss permits the initiation of treatment and rehabilitation of the hearing-impaired child at a very young age. The child can then learn more normal speech skills when hearing loss is identified early and intervention begins.

Hearing loss can range from a mild impairment to profound loss. Many people think that hearing is only graded as normal or deaf. They may also think that the child is hearing normally if he or she is responding to sounds and voices. However, there are many subtle gradations between normal hearing and deafness and a child's hearing loss may not be apparent.

For example, it is common for a child with moderate hearing loss to develop speech and language and yet miss over half of what is being said. A child in this situation will have a distinct disadvantage in development and learning and will often reach a point where advancement stops unless the hearing loss is detected and treatment begins.

The stress on a child with hearing loss (and their family) can be enormous because the child does not understand why it is constant struggle to learn seemingly simple material (and the family is baffled as to why their bright child is not doing well).

The degree of hearing loss often determines the impact it will have on the child throughout life. However, with early identification and treatment, the impact can be lessened.

What are the causes, risk factors, and signs of hearing loss in children?

There are a number of risk factors for hearing loss in children, so there are a number of special reasons why a child's hearing may need to be screened or tested. Common indications for a hearing evaluation include

speech delay,

frequent or recurrent ear infections,

a family history of hearing loss (hearing loss can be inherited),

syndromes known to be associated with hearing loss (for example, Down syndrome, the Alport syndrome, and Crouzon syndrome),

infectious diseases that cause hearing loss (for example, meningitis, measles, and cytomegalovirus [CMV] infection),

medical treatments that may have hearing loss as a side effect, including some antibiotics and some chemotherapy agents,

poor school performance, and

diagnosis of a learning disability or other disorder, such as autism or pervasive developmental disorder (PDD).

In addition, the circumstances surrounding the pregnancy and birth may be associated with subsequent hearing loss. If there is a history that includes any of the following, a child should have a hearing assessment.

low birth weight (less than 2 pounds) and/or prematurity

assisted ventilation (to help with breathing for more than 10 days after birth)

low Apgar scores (numbers assigned at birth that reflect the newborn's health status)

severe jaundice after birth

maternal illness during pregnancy (for example, German measles [rubella])

hydrocephalus

Some parents start to suspect that their child cannot hear normally because the child does not respond to his or her name consistently or asks for words, phrases, or sentences to be repeated. Another sign can be that the child does not seem to be paying attention to sounds or to what is being said.

On the average, only half of all children diagnosed with a hearing loss actually have a known risk factor for hearing loss. This means that the cause is never known in about half of children with hearing loss. For this reason, all states in the U.S. have instituted a universal hearing screen so that all babies have their hearing screened before they go home from the newborn nursery.

Who tests hearing in children?

A specialist who tests a person's hearing is called an audiologist. An audiologist has an advanced degree (minimum of master's degree) in diagnostic hearing testing techniques and auditory rehabilitation for children and adults. However, because testing hearing in children requires specific equipment, setup, and training, not all audiologists test children. When a child is referred for a hearing evaluation, it should be confirmed at the time of scheduling that the testing audiologist has a pediatric specialty and the appropriate setup to test hearing in children.

Can very young children have their hearing tested?

A child of any age can be tested with the appropriate hearing test. The type of test utilized depends on the child's age in years or developmental level. Some hearing tests require no behavioral response from the child, while other tests utilize games that entice a child's interest. The key is to find the right test method for each child.

How is hearing tested in an older infant or young child who cannot follow specific instructions?

Cooperative and alert infants or young children (ages 5 months to 2 and a half years) are frequently tested using a method called visual reinforcement audiometry (VRA). For this test, the child sits on a caregiver's lap in the center of a room.

Play Audiometry Photo - Hearing Loss in Children

Speakers are situated to the child's right and left side. The speakers have toys (usually mounted inside boxes) hung below, which can be animated by the tester. The child is then "conditioned" to turn his or her head toward the side from which the sound is presented. When the child turns to the correct side, the toy is lit up, providing positive reinforcement that encourages the child to continue participating in the task. Children (and adults) will instinctively turn toward a novel sound without having to think about the response, which is why this test is effective for children as young as 5 months of age. This method can also be used with small insert earphones, which allow the hearing of each ear to be tested individually. Below is a diagram of the setup for the VRA test.

VRA Setup Illustration - Hearing Loss in Children

There are, however, some limitations to the VRA test. For an accurate test, the child must participate and needs to be cooperative and alert. Additionally, if only speakers are used for testing, the results can only be used to predict hearing for the "better" ear. There is no way to tell if both ears are hearing the test sounds, or if only one ear is hearing all of the sounds, unless a device is utilized to isolate the ears (for example, earphones). It is not unusual, however, to achieve test results for individual ear information by having the child wear earphones during portions of the VRA test. The ability to localize sound even with one impaired ear can be quite good. Often, otoacoustic emission (OAE) tests are completed in conjunction with VRA testing to obtain some ear-specific results (OAE tests will be discussed later in this article).

Children 3-5 years of age who are capable of more complicated tasks are often tested using a technique called play audiometry, in which sounds are paired with a specific response or task. For example, a child is taught to hold a peg next to his or her cheek. When the child hears the sound, the child places the peg on a Peg-Board.

Play Audiometry Photo - Hearing Loss in Children

Speech testing can be completed using pictures, for example, the child points to the correct picture as the tester's voice is presented at softer and softer levels. Once again, the child needs to be a willing participant. The advantage of this format is that results obtained are often as detailed as an adult test session.

How can hearing be assessed in a child who is unable to cooperate?

Some children are unable to cooperate for hearing evaluations, either due to their age or to a developmental delay (for example, a child with severe mental retardation). Currently, there are two different types of tests that are utilized for children who are unable to cooperate. The first is the frequency-specific auditory brainstem response (ABR) evaluation. An ABR is a physiological measure of the brainstem's response to sound. It tests the integrity of the hearing system from the ear to the brainstem. The test is performed by placing four to five electrodes on the child's head, after which a variety of sounds are presented to the child through small earphones. As the hearing nerve fires, the sound stimulus travels up to the brain. The electrical activity generated by the nerve can be recorded by the electrodes and presented as waveforms on a computer screen. The audiologist can then present different loudness levels of each sound and determine the softest levels at which the child can hear. The child can be tested using all the sounds of a conventional hearing evaluation (adult hearing evaluation).

The limitation of the ABR is the need for the child to be quiet and still. The electrical potential the computer is recording from the auditory nerve is very small. Any muscle movement, including something as small as an eye blink, can obliterate the hearing response; therefore, the infant or child must be sleeping during the test. Infants less than 3 months old can be tested during natural sleep. Children older than 3 months are typically sedated for about one hour (under the supervision of a physician) during the test. The most common oral sedative used is chloral hydrate.

The second type of test to objectively evaluate children is the otoacoustic emission (OAE) test. This test can be done as a supplement to the ABR or as an initial screen of hearing. An otoacoustic emission test measures an acoustic response produced by the inner ear (cochlea). The acoustic response measured is in essence the response produced by the inner ear as it bounces back out of the ear in response to a sound stimulus. The test is performed by placing a small probe that contains a microphone and speaker into the child's ear.

Otoacoustic Emissions (OAE) Photo - Hearing Loss in Children

As the child sits or rests quietly, sounds are generated in the probe and responses that come back from the cochlea are recorded. Once the cochlea processes the sound, an electrical stimulus is sent to the brainstem. In addition, there is a second and separate sound that does not travel up the nerve but comes back out into the child's ear canal. This "byproduct" is the otoacoustic emission. The emission is then recorded with the microphone probe and represented pictorially on a computer screen. The audiologist can tell which sounds yielded a response/emission and the strength of those responses. If there is an emission present for those sounds critical to speech comprehension, then the child has "passed" the hearing screen. As a supplement to the ABR, the OAE serves as a crosscheck to either confirm normal hearing or verify the site-of-lesion for the hearing loss as the inner ear. OAE tests the integrity of the hearing organ for sound (the cochlea), but it does not evaluate the hearing beyond the cochlea. That is why the OAE is often paired with the ABR or with a behavioral test that can evaluate a child's responsiveness to sound.

The results from an ABR and an OAE evaluation can predict the child's hearing, determine if there is a loss, determine the type of hearing loss, and help with decisions regarding intervention. Intervention can include medical treatment, surgery, or hearing aids and therapy.

Are any additional tests done during a pediatric hearing evaluation?

A thorough diagnostic test also includes an evaluation of the middle-ear system. The middle ear is the space behind the eardrum and is a common site for ear infections in children.

A tympanogram is a measure of the compliance of the middle-ear system mobility (including the eardrum) and is an objective method for confirming abnormalities of the eardrum or middle ear space, such as

fluid behind the eardrum,

a hole or perforation of the eardrum, or

stiffness of eardrum or middle-ear bones (for example, otosclerosis).

The tympanogram is completed by inserting a probe in the ear and creating a vacuum-tight seal. The air pressure is changed in the ear canal from positive to negative, and the movement of the eardrum is recorded. The amount and shape of the movement can either exclude or signify different problems, as previously listed. The test is fast, objective, and is not painful (although sometimes the insertion of the probe may upset children).

When a loud sound is presented to a healthy ear, the eardrum will contract, a sort of built-in hearing protection mechanism (although it's not very effective). This contraction of the eardrum is called the acoustic reflex. The absence of this reflex can further confirm problems of the middle ear or may help to identify or confirm a hearing loss. Acoustic reflexes are typically evaluated concurrent with the tympanogram.

Many general pediatricians perform this test in their offices as a screening test and to aid in the diagnosis of ear infections or effusions (fluid in the middle ear space).

What happens when hearing loss is detected? What is the treatment for hearing loss in children?

When hearing loss is identified, a thorough search for its cause must be undertaken. In many situations, the hearing loss can be attributed to an ear infection or to fluid trapped in the middle-ear space. In this situation, the pediatrician can often prescribe antibiotics to treat the infection. If the infection is persistent, or the hearing loss is still present after treatment of the infection, then the child should be referred to a medical doctor who specializes in diseases of the ear and auditory system (an otolaryngologist or ENT). The otolaryngologist will often administer further testing, and in some situations, he or she may recommend additional therapy such as surgery ( ear tubes). If the hearing loss is persistent or is related to a nerve or inner-ear problem, the otolaryngologist will often recommend an evaluation by an audiologist for hearing aids and rehabilitative therapy (which includes speech therapy and social integration of the hearing-impaired child).

What is the latest hearing test being used in children?

One of the newest tests being utilized is the auditory steady state response (ASSR) evaluation. This is a test that is used in conjunction with the ABR. It is completed while the child is sleeping, or sedated, and it makes recordings from the auditory nerve as the response travels up to the brainstem. The generators for this test are commonly accepted to be similar to those of the ABR. One advantage of ASSR is that the stimuli used to test the child's hearing are more frequency-specific, which allows the audiologist to predict hearing levels for a wide range of sounds with increased accuracy. In addition, the ASSR is faster and has the ability to test at levels somewhat louder than the ABR (due to equipment limitations of the ABR), making the distinction between severe and profound losses more clear. It should be noted, however, that results for a mild hearing loss and normal hearing are indistinguishable from each other, so there is potential for a misdiagnosis for children with mild hearing loss.

From

Health Solutions From Our Sponsors

Medically reviewed by Margaret Walsh, MD; American Board of Pediatrics

REFERENCE:

Adcock, Lisa M., MD, et al. "Screening the newborn for hearing loss." UptoDate. Updated Jul 21, 2016.

Complete List

Top Detecting Hearing Loss in Children Related Articles

Apgar Score

The Apgar score is a method for assessing a neonate's heart rate, respiratory effort, muscle tone, skin color, and reflex irritability. Each of these signs is give a point value from 0-2. A perfect score of 10 means the infant is in excellent condition, while a score of 0-3 means the infant needs immediate resuscitation.

Autism Screening and Diagnosis

Autism spectrum disorder (ASD) diagnosis requires two steps -- developmental screening and comprehensive diagnostic evaluation. Develpmental screening helps tell if children have delays. Comprehensive diagnostic evaulation may include looking at the child's behavior and development and interviewing the parents. It may also include hearing and vision screening, genetic testing, neurological testing, and other medical testing.

Down Syndrome Overview

Get the facts on Down syndrome, a genetic disorder caused by an additional set of chromosomes in a developing fetus. Down syndrome signs and symptoms include:

distinctive facial features,

growth retardation, and

decreased mental function and IQ.

Blood tests and ultrasound may be used to screen for Down syndrome but chromosome analysis of the fetus is needed to diagnose the condition. People with Down syndrome age more quickly and may develop Alzheimer's disease as young as age 40. Sometimes people are diagnosed with mosaic Down syndrome, in which case they have more than one type of chromosomal makeup.

Ear Infection

Middle ear infection or inflammation (otitis media) is inflammation of the middle ear. There are two forms of this type of ear infection, acute and chronic. Acute otitis media is generally short in duration, and chronic otitis media generally lasts several weeks. Seventy-five percent of children in the U.S. suffer from otitis media at some point.

Signs and symptoms in babies, toddlers, and children may:

Be irritable and pull and tug at their ears

Be fussy

Have problems feeding or sleeping

Complain about pain and fullness in the ear

Have a fever

A buildup of pus in the ear

Have signs and symptoms of an upper respiratory infection

Treatment depends upon the type (chronic or acute).

Ear Tubes

When a child has repeated middle ear infections or fluid build-up in the ears, which causes problems with speech or hearing, surgery to place tubes inside the ear is often recommended. The surgery is called myringotomy. Preparing your child for this procedure will help comfort them, and knowing what to expect before, during, and after surgery is important as well.

Ear Wax

Earwax (ear wax) is a natural substance secreted by special glands in the skin on the outer part of the ear canal. It repels water, and traps dust and sand particles. Usually a small amount of wax accumulates, dries up, and then falls out of the ear canal carrying with it unwanted particles. Under ideal circumstances, you should never have to clean your ear canals. The absence of ear wax may result in dry, itchy ears, and even infection. Ear wax may accumulate in the ear for a variety of reasons including; narrowing of the ear canal, production of less ear wax due to aging, or an overproduction of ear wax in response to trauma or blockage within the ear canal.

Hydrocephalus

Hydrocephalus is an abnormal buildup of cerebrospinal fluid (CSF) in the ventricles of the brain. The fluid is often under increased pressure and can compress and damage the brain. Symptoms of hydrocephalus vary with age, progression of the disease, and individual tolerance to the condition. Hydrocephalus is most often treated by surgery in which a shunt system is inserted.

Newborn Infant Hearing Screening

A newborn infant hearing screening is performed before a child is discharged from the hospital. If an infant doesn't pass the test, a rescreen is performed. Detecting hearing loss at an early age increases a child's chance of having a healthy and more productive life. There are two methods of testing hearing in infants: auditory brainstem response (ABR) and otoacoustic emission (OAE). Both tests are accurate, automated, and don't require a visible response from the infant.

Otitis Externa

Swimmer's ear (external otitis) is an infection of the skin that covers the outer ear canal.

Causes of swimmer's ear include excessive water exposure that leads to trapped bacteria in the ear canal. Symptoms of simmer's include a feeling of fullness in the ear, itching, and ear pain. Chronic swimmer's ear may be caused by eczema, seborrhea, fungus, chronic irritation, and other conditions.

Common treatment includes antibiotic ear drops.

Pregnancy

Signs and symptoms of pregnancy vary by stage (trimester). The earliest pregnancy symptom is typically a missed period, but others include

breast swelling and tenderness,

nausea and sometimes vomiting,

fatigue, and

bloating.

Second trimester symptoms include

backache,

weight gain,

itching, and

possible stretch marks.

Third trimester symptoms are

additional weight gain,

heartburn,

hemorrhoids,

swelling of the ankles,

fingers, and face,

breast tenderness, and

trouble sleeping.

Eating a healthy diet, getting a moderate amount of exercise, also are recommended for a healthy pregnancy. Information about the week by week growth of your baby in the womb are provided.

CONTINUE SCROLLING FOR RELATED SLIDESHOW

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What Causes Hearing Loss in Children? Signs, Types, Symptoms

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Do you know what causes hearing loss in children? Learn the most common causes of hearing loss in children, and learn the various signs, symptoms, and types of hearing loss, including mild hearing loss, high frequency hearing loss, unilateral hearing loss, and sensorineural hearing loss.

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Otitis Media

What is otitis media?

Otitis media is an inflammation in the middle ear (the area behind the eardrum) that is usually associated with the buildup of fluid. The fluid may or may not be infected.

Symptoms, severity, frequency, and length of the condition vary. At one extreme is a single short period of thin, clear, noninfected fluid without any pain or fever but with a slight decrease in hearing ability. At the other extreme are repeated bouts with infection, thick "glue-like" fluid and possible complications such as permanent hearing loss.

Fluctuating conductive hearing loss nearly always occurs with all types of otitis media. In fact it is the most common cause of hearing loss in young children.

How common is otitis media?

Otitis media is the most frequently diagnosed disease in infants and young children (1). Seventy-five percent of children experience at least one episode of otitis media by their third birthday. Almost one-half of these children will have three or more ear infections during their first 3 years of life (2). Health costs for otitis media in the United States have been reported to be $3 billion to $5 billion per year (3).

Why is otitis media so common in children?

The eustachian tube, a passage between the middle ear and the back of the throat, is smaller and more nearly horizontal in children than in adults. Therefore, it can be more easily blocked by conditions such as large adenoids and infections. Until the eustachian tube changes in size and angle as the child grows, children are more susceptible to otitis media.

How can otitis media cause a hearing loss?

Three tiny bones in the middle ear carry sound vibrations from the eardrum to the inner ear. When fluid is present, the vibrations are not transmitted efficiently and sound energy is lost. The result may be mild or even moderate hearing loss. Therefore, speech sounds are muffled or inaudible.

Generally, this type of hearing loss is conductive and is temporary. However when otitis media occurs over and over again, damage to the eardrum, the bones of the ear, or even the hearing nerve can occur and cause a permanent, sensorineural hearing loss.

Can hearing loss due to otitis media cause speech and language problems?

Children learn speech and language from listening to other people talk. The first few years of life are especially critical for this development.

If a hearing loss exists, a child does not get the full benefit of language learning experiences.

Otitis media without infection presents a special problem because symptoms of pain and fever are usually not present. Therefore, weeks and even months can go by before parents suspect a problem. During this time, the child may miss out on some of the information that can influence speech and language development.

How can I tell if my child might have otitis media?

Even if there is no pain or fever, there are other signs you can look for that may indicate chronic or recurring fluid in the ear:

Inattentiveness

Wanting the television or radio louder than usual

Misunderstanding directions

Listlessness

Unexplained irritability

Pulling or scratching at the ears

What should I do if I think that otitis media is causing a hearing, speech, or language problem?

A physician should handle the medical treatment. Ear infections require immediate attention, most likely from a pediatrician or otolaryngologist (ear doctor). If your child has frequently recurring infections and/or chronic fluid in the middle ear, two additional specialists should be consulted: an audiologist and a speech-language pathologist.

An audiologist's evaluation will assess the severity of any hearing impairment, even in a very young or uncooperative child, and will indicate if a middle ear disorder is present.

A speech-language pathologist measures your child's specific speech and language skills and can recommend and/or provide remedial programs when they are needed.

Will my physician refer my child for these special evaluations?

As a parent, you are the best person to look for signs that suggest poor hearing. The American Academy of Pediatrics recognizes this when it states, "Any child whose parent expresses concern about whether the child hears should be considered for referral for behavioral audiometry without delay".

Parents should not be afraid to let their instincts guide them in requesting or independently arranging for further evaluation whenever they are concerned about their children' s health or development.

Congenital Causes

The term congenital hearing loss implies that the hearing loss is present at birth. It can include hereditary hearing loss or hearing loss due to other factors present either in utero (prenatal) or at the time of birth.

Genetic factors are thought to cause more than 50% of all incidents of congenital hearing loss in children (4). Genetic hearing loss may be autosomal dominant, autosomal recessive, or X-linked (related to the sex chromosome).

In autosomal dominant hearing loss , one parent who carries the dominant gene for hearing loss and typically has a hearing loss passes it on to the child. In this case there is at least a 50% probability that the child will also have a hearing loss. The probability is higher if both parents have the dominant gene (and typically both have a hearing loss) or if both grandparents on one side of the family have hearing loss due to genetic causes. Because at least one parent usually has a hearing loss, there is prior expectation that the child may have a hearing loss.

In autosomal recessive hearing loss , both parents who typically have normal hearing, carry a recessive gene. In this case the probability of the child having a hearing loss is 25%. Because both parents usually have normal hearing, and because no other family members have hearing loss, there is no prior expectation that the child may have a hearing loss.

In X-linked hearing loss, the mother carries the recessive trait for hearing loss on the sex chromosome and passes it on to males, but not to females.

There are some genetic syndromes,in which, hearing loss is one of the known characteristics. Some examples are Down syndrome (abnormality on a gene), Usher syndrome (autosomal recessive), Treacher Collins syndrome (autosomal dominant), Crouzon syndrome (autosomal dominant), and Alport syndrome (X-linked).

Other causes of congenital hearing loss that are not hereditary in nature include prenatal infections, illnesses, toxins consumed by the mother during pregnancy or other conditions occurring at the time of birth or shortly thereafter. These conditions typically cause sensorineural hearing loss ranging from mild to profound in degree. Examples include:

Intrauterine infections including rubella (German measles), cytomegalovirus, and herpes simplex virus

Complications associated with the Rh factor in the blood

Prematurity

Maternal diabetes

Toxemia during pregnancy

Lack of oxygen (anoxia)

Acquired Causes

Acquired hearing loss is a hearing loss which appears after birth, at any time in one's life, perhaps as a result of a disease, a condition, or an injury. The following are examples of conditions that can cause acquired hearing loss in children are:

Ear infections (otitis media) (link to specific section above)

Ototoxic (damaging to the auditory system) drugs

Meningitis

Measles

Encephalitis

Chicken pox

Influenza

Mumps

Head injury

Noise exposure

Finding Help

How can I find an audiologist or speech-language pathologist?

Search ASHA ProFind or contact the American Speech-Language-Hearing Association's Action Center, 2200 Research Boulevard #425, Rockville, Maryland 20850. Phone: 800-638-8255 or 301-296-5700.
Where can I find a pediatric audiology facility?
Search EHDI-PALS, a website with a national pediatric audiology facilities directory and great educational resources for families.

References

1. Dhooge, I.J. (2003). Risk factors for the development of otitis media. Current Allergy and Asthma Reports, 3: 321-325.

2. National Institute on Deafness and Other Communication Disorders. (2002). Otitis media (ear infection) (NIH Publication No. 974216). Bethesda, MD: Author.

3. Alsarraf, R., Jung, C.J., Perkins, J., Crowley, C. & Gates, G.A. (1998). Otitis media health status evaluation: A pilot study for the investigation of cost-effective outcomes of recurrent acute otitis media treatment. Annals of Otology, Rhinology and Laryngology, 107: 120-128.

4. Canalis, R.F., & Lambert, P.R. (2000). The ear: Comprehensive otology. Philadelphia: Lippincott Williams & Wilkins.

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What is otitis media? Otitis media is an inflammation in the middle ear (the area behind the eardrum) that is usually associated with the buildup of fluid. The fluid may or may not be infected. Symptoms, severity, frequency, and length of the condition vary.

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Disease Areas & Medicines | Scripps Research

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Scripps Research scientists decipher the underlying biological causes of disease and use this hard-won knowledge to advance medicine and healthcare. We develop preventative and therapeutic drugs, lead the way to the clinical implementation of wireless technologies in medicine, and use advances in genomic sequencing, mobile technologies and increasingly sophisticated bioinformatics to help usher in a new era of precision medicine.

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Over 5% of the world's population - or 466 million people - has disabling hearing loss (432 million adults and 34 million children). It is estimated that by 2050 over 900 million people - or one in every ten people - will have disabling hearing loss.

Disabling hearing loss refers to hearing loss greater than 40 decibels (dB) in the better hearing ear in adults and a hearing loss greater than 30 dB in the better hearing ear in children. The majority of people with disabling hearing loss live in low- and middle-income countries.

Approximately one third of people over 65 years of age are affected by disabling hearing loss. The prevalence in this age group is greatest in South Asia, Asia Pacific and sub-Saharan Africa.

Hearing loss and deafness

A person who is not able to hear as well as someone with normal hearing - hearing thresholds of 25 dB or better in both ears - is said to have hearing loss. Hearing loss may be mild, moderate, severe, or profound. It can affect one ear or both ears, and leads to difficulty in hearing conversational speech or loud sounds.

'Hard of hearing' refers to people with hearing loss ranging from mild to severe. People who are hard of hearing usually communicate through spoken language and can benefit from hearing aids, cochlear implants, and other assistive devices as well as captioning. People with more significant hearing losses may benefit from cochlear implants.

'Deaf' people mostly have profound hearing loss, which implies very little or no hearing. They often use sign language for communication.

Causes of hearing loss and deafness

The causes of hearing loss and deafness can be congenital or acquired.

Congenital causes

Congenital causes may lead to hearing loss being present at or acquired soon after birth. Hearing loss can be caused by hereditary and non-hereditary genetic factors or by certain complications during pregnancy and childbirth, including:

maternal rubella, syphilis or certain other infections during pregnancy;

low birth weight;

birth asphyxia (a lack of oxygen at the time of birth);

inappropriate use of particular drugs during pregnancy, such as aminoglycosides, cytotoxic drugs, antimalarial drugs, and diuretics;

severe jaundice in the neonatal period, which can damage the hearing nerve in a newborn infant.

Acquired causes

Acquired causes may lead to hearing loss at any age, such as:

infectious diseases including meningitis, measles and mumps;

chronic ear infections;

collection of fluid in the ear (otitis media);

use of certain medicines, such as those used in the treatment of neonatal infections, malaria, drug-resistant tuberculosis, and cancers;

injury to the head or ear;

excessive noise, including occupational noise such as that from machinery and explosions;

recreational exposure to loud sounds such as that from use of personal audio devices at high volumes and for prolonged periods of time and regular attendance at concerts, nightclubs, bars and sporting events;

ageing, in particular due to degeneration of sensory cells; and

wax or foreign bodies blocking the ear canal.

Among children, chronic otitis media is a common cause of hearing loss.

Impact of hearing loss

Functional impact

One of the main impacts of hearing loss is on the individual's ability to communicate with others. Spoken language development is often delayed in children with unaddressed hearing loss.

Unaddressed hearing loss and ear diseases such as otitis media can have a significantly adverse effect on the academic performance of children. They often have increased rates of grade failure and greater need for education assistance. Access to suitable accommodations is important for optimal learning experiences but are not always available.

Social and emotional impact

Exclusion from communication can have a significant impact on everyday life, causing feelings of loneliness, isolation, and frustration, particularly among older people with hearing loss.

Economic impact

WHO estimates that unaddressed hearing loss poses an annual global cost of US$ 750 billion. This includes health sector costs (excluding the cost of hearing devices), costs of educational support, loss of productivity, and societal costs.

In developing countries, children with hearing loss and deafness rarely receive any schooling. Adults with hearing loss also have a much higher unemployment rate. Among those who are employed, a higher percentage of people with hearing loss are in the lower grades of employment compared with the general workforce.

Improving access to education and vocational rehabilitation services, and raising awareness especially among employers about the needs of people with hearing loss, will decrease unemployment rates for people with hearing loss.

Prevention

Overall, it is suggested that half of all cases of hearing loss can be prevented through public health measures.

In children under 15 years of age, 60% of hearing loss is attributable to preventable causes. This figure is higher in low- and middle-income countries (75%) as compared to high-income countries (49%). Overall, preventable causes of childhood hearing loss include:

Infections such as mumps, measles, rubella, meningitis, cytomegalovirus infections, and chronic otitis media (31%).

Complications at the time of birth, such as birth asphyxia, low birth weight, prematurity, and jaundice (17%).

Use of ototoxic medicines in expecting mothers and babies (4%).

Others (8%)

Some simple strategies for prevention of hearing loss include:

immunizing children against childhood diseases, including measles, meningitis, rubella and mumps;

immunizing adolescent girls and women of reproductive age against rubella before pregnancy;

preventing cytomegalovirus infections in expectant mothers through good hygiene; screening for and treating syphilis and other infections in pregnant women;

strengthening maternal and child health programmes, including promotion of safe childbirth;

following healthy ear care practices;

reducing exposure (both occupational and recreational) to loud sounds by raising awareness about the risks; developing and enforcing relevant legislation; and encouraging individuals to use personal protective devices such as earplugs and noise-cancelling earphones and headphones.

screening of children for otitis media, followed by appropriate medical or surgical interventions;

avoiding the use of particular drugs which may be harmful to hearing, unless prescribed and monitored by a qualified physician;

referring infants at high risk, such as those with a family history of deafness or those born with low birth weight, birth asphyxia, jaundice or meningitis, for early assessment of hearing, to ensure prompt diagnosis and appropriate management, as required;

Identification and management

Early detection and intervention are crucial to minimizing the impact of hearing loss on a child's development and educational achievements. In infants and young children with hearing loss, early identification and management through infant hearing screening programmes can improve the linguistic and educational outcomes for the child. Children with deafness should be given the opportunity to learn sign language along with their families.

Pre-school, school and occupational screening for ear diseases and hearing loss is an effective tool for early identification and management of hearing loss.

People with hearing loss can benefit from the use of hearing devices, such as hearing aids, cochlear implants, and other assistive devices. They may also benefit from speech therapy, aural rehabilitation and other related services. However, global production of hearing aids meets less than 10% of global need and less than 3% of developing countries' needs. The lack of availability of services for fitting and maintaining these devices, and the lack of batteries are also barriers in many low-income settings.

Making properly-fitted, affordable hearing aids and cochlear implants and providing accessible follow-up services in all parts of the world will benefit many people with hearing loss.

People who develop hearing loss can learn to communicate through development of lip-reading skills, use of written or printed text, and sign language. Teaching in sign language will benefit children with hearing loss, while provision of captioning and sign language interpretation on television will facilitate access to information.

Officially recognizing national sign languages and increasing the availability of sign language interpreters are important actions to improve access to sign language services. Encouraging organizations of people with hearing loss, parents and family support groups; and strengthening human rights legislation can also help ensure better inclusion for people with hearing loss.

WHO response

WHO assists Members States in developing programmes for ear and hearing care that are integrated into the primary health-care system of the country. WHO's work includes:

providing technical support to Member States in development and implementation of national plans for hearing care;

providing technical resources and guidance for training of health-care workers on hearing care;

developing and disseminating recommendations to address the major preventable causes of hearing loss;

undertaking advocacy to raise awareness about the prevalence, causes and impact of hearing loss as well as opportunities for prevention, identification and management;

developing and disseminating evidence-based tools for effective advocacy;

observing and promoting World Hearing Day as an annual advocacy event;

building partnerships to develop strong hearing care programmes, including initiatives for affordable hearing aids, cochlear implants and services;

collating data on deafness and hearing loss to demonstrate the scale and the impact of the problem;

promoting safe listening to reduce the risk of recreational noise-induced hearing loss through the WHO Make Listening Safe initiative; and

promoting social inclusion of people with disabilities, including people with hearing loss and deafness, for example, through community-based rehabilitation networks and programmes.

In 2017, the 70th World Health Assembly adopted a resolution on the prevention of deafness and hearing loss. This resolution calls upon Member States to integrate strategies for ear and hearing care within the framework of their primary health care systems, under the umbrella of universal health coverage. It also requests WHO to undertake a number of actions for promotion of ear and hearing care at global level, including many of those noted above.

(1) Disabling hearing loss refers to hearing loss greater than 40dB in the better hearing ear in adults and a hearing loss greater than 30dB in the better hearing ear in children.

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Over 5% of the world's population - or 466 million people - has disabling hearing loss (432 million adults and 34 million children). It is estimated that by 2050 over 900 million people - or one in every ten people - will have disabling hearing loss.

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Listen up! Don't take your ears for granted. Hearing loss is the third most common health problem in the U.S, and it can affect the quality of your life and relationships. About 48 million Americans have lost some hearing.

Certain conditions, including age, illness, and genetics, may play a role in hearing loss. Modern life has added a host of ear-damaging elements to the list, including some medications and plenty of sources of loud, ongoing noise.

With so many untreatable cases of hearing loss, prevention is the best way to keep hearing long-term. If you've already lost some hearing, there are ways to stay connected and communicate with friends and family.

What Causes Hearing Loss?

Advanced age is the most common cause of hearing loss. One out of three people age 65-74 has some level of hearing loss. After age 75, that goes up to one out of every two people.

Researchers don't fully understand why hearing declines with age. It could be that lifetime exposure to noise and other damaging factors slowly wear down the ears' delicate mechanics. Your genes are also part of the mix.

Noise wears down hearing if it's loud or continuous. The Centers for Disease Control (CDC) reports that about 22 million American workers are exposed to dangerous noise levels on the job. This includes many carpenters, construction workers, soldiers, miners, factory workers, and farmers.

Even musicians, who literally create music for our ears, are at risk for noise-induced hearing loss. Some now wear special earplugs to protect their ears when they perform. The earplugs allow them to hear music without harming their ears' inner workings.

Certain medications can impair hearing or balance. More than 200 drugs and chemicals have a track record of triggering hearing and balance side effects in addition to their disease-fighting abilities.

Sudden hearing loss, the rapid loss of 30 decibels or more of hearing ability, can happen over several hours or up to 3 days. (A normal conversation is 60 decibels.) Sudden hearing loss usually affects only one ear. Although there are up to 3 new cases per every 10,000 people each year, doctors are not able to discover the cause in most cases.

Illnesses such as heart disease, high blood pressure, and diabetes put ears at risk by interfering with the ears' blood supply. Otosclerosis is a bone disease of the middle ear, and Ménière's disease affects the inner ear. Both can cause hearing loss.

Trauma, especially a skull fracture or punctured eardrum, puts ears at serious risk for hearing loss.

Infection or ear waxcan block ear canals and lessen hearing.

Continued

Symptoms and Levels of Hearing Loss

In many cases, hearing fades so slowly you don't notice it. You may think that people are mumbling more, your spouse needs to speak up, and you need a better phone. As long as some sound still comes in, you could assume your hearing is fine. But you may become more and more cut off from the world of speech and sounds.

Doctors classify hearing loss by degrees.

Mild hearing loss: One-on-one conversations are fine, but it's hard to catch every word when there's background noise.

Moderate hearing loss: You often need to ask people to repeat themselves during conversations in person and on the phone.

Severe hearing loss: Following a conversation is almost impossible unless you have a hearing aid.

Profound hearing loss: You can't hear when other people speaking, unless they are extremely loud. You can't understand what they're saying without a hearing aid or cochlear implant.

Early on, high-pitched sounds, such as children's and female voices, and the sounds "S" and "F" become harder to make out. You may also:

Have trouble following a conversation when more than one person speaks at once

Think other people are mumbling or not speaking clearly

Often misunderstand what others say and respond inappropriately

Get complaints that the TV is too loud

Hear ringing, roaring, or hissing sounds in your ears, known as tinnitus

Treatments

It depends on the type and source of your hearing loss. Prompt medical treatment for sudden hearing loss may raise your chance of recovery.

Surgery may reverse hearing loss caused by otosclerosis, scar tissue, or infection, while Ménière's disease is sometimes treatable with medication and a different diet.

Hearing loss caused by infection can often be cleared up with antibiotics.

If you think your hearing loss stems from medication use, talk with your doctor about drug options.

Most people with permanent hearing loss can benefit from a hearing aid. You typically wear these tiny instruments in or behind your ear to make sounds louder. Things do sound different through a hearing aid though, so you should talk with your doctor to set realistic goals.

Continued

Other sound-enhancing technologies include personal listening systems that allow you to tune in to what you want to hear and mute other sounds. TV-listening systems make it possible for you to hear the television or radio without turning the volume way up. Different kinds of phone-amplifying devices as well as captioned phones that let you read what your caller is saying make conversations possible on home and mobile phones.

Cochlear implants are used mainly with young children, but they're becoming more popular among older adults with profound hearing loss.

Living With Hearing Loss

For starters, set up your home so your rooms are well lit and places to sit face each other. When people talk, watch their mouths move as well as their facial expressions.

Remove avoidable sources of background noise. For instance, turn off the TV when no one's watching it.

Let people know what they can do to help you understand them better:

Get your attention before they start talking.

Make sure you can see their lips moving.

Speak clearly, but don't shout.

Take Good Care of Your Ears

Hearing loss is often permanent, so do what you can to protect one of your most valuable natural assets.

Wear earplugs when you're around sounds as loud or louder than traffic. Lawn mowers, power sanders, vacuums, and most concerts are all loud enough to harm unprotected ears. When possible, move away from the source of the noise. For example, cross the street or cover your ears when you walk past a loud road construction site.

If you work in a noisy workplace, talk to your employer about ear safety. The National Institute for Occupational Safety and Health (NIOSH) recommends that employers install barrier walls or mufflers in noisy plants to protect their workers' hearing.

Sources

SOURCES:

American Academy of Audiology: "Hearing and Hearing Loss" and "Facts About Hearing Loss."

American Speech-Language-Hearing Association: "The Prevalence and Incidence of Hearing Loss in Adults;" "Causes of Hearing Loss in Adults;" "Ototoxic Medications (Medication Effects);" and "Adult Aural/Audiologic Rehabilitation."

National Institute on Deafness and Other Communication Disorders: "Hearing Loss and Older Adults;" "Sudden Deafness;" "Quick Statistics;" and "Presbycusis."

National Academy on an Aging Society: "Hearing Loss: A growing problem that affects quality of life."

National Institute for Occupational Safety and Health. "Work-related Hearing Loss."

American Tinnitus Association: "How Loud is Too Loud?"

FDA: "Questions and Answers about Viagra, Levitra, Cialis, and Revatio: Possible Sudden Hearing Loss."

American Academy of Otolaryngology-Head and Neck Surgery: "Hearing Loss."

University of California, San Francisco Medical Center: "Hearing Loss."

UpToDate: "Meniere disease."

Hearing Loss Association of America: "Basic Facts About Hearing Loss."

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Hearing Loss: Causes, Symptoms, and Treatment

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Listen up! Don't take your ears for granted. Hearing loss is the third most common health problem in the U.S, and it can affect the quality of your life and relationships. About 48 million Americans have lost some hearing. Certain conditions, including age, illness, and genetics, may play a role in hearing loss.

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Current as of June 2017
En español | In Spanish

If you're looking for information about disabilities in infants, toddlers, children, and youth with disabilities, you've come to the right place! The Center for Parent Information and Resources (CPIR) offers information and connections to the full spectrum of disabilities in children, including developmental delays and rare disorders.

Use the links below to learn about typical developmental milestones in childhood, specific disabilities and disorders, and the disability categories in our nation's special education law (IDEA) that qualify a child for special education services.

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Developmental Milestones
This section of the website explores the typical developmental stages and milestones that pediatricians and others use to monitor children's growth and progress over time. Learn about the sequence and timing of a typical child's earliest development and access resources to learn more.

Categories of Disability under IDEA Law
The IDEA includes 14 primary terms under the main definition of "a child with a disability." These federal definitions guide how states define who is eligible for a free appropriate public education under special education law.

Fact Sheets on Specific Disabilities
Find brief, but detailed fact sheets on specific disabilities. Each fact sheet defines the disability, describes its characteristics, offers tips for parents and teachers, and connects you with companion resources and disability organizations that offer more information and assistance.

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Current as of June 2017 En español | In Spanish If you're looking for information about disabilities in infants, toddlers, children, and youth with disabilities, you've come to the right place! The Center for Parent Information and Resources (CPIR) offers information and connections to the full spectrum of disabilities in children, including developmental delays and rare disorders.

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This is "NDCS - BCC Supporting Achievement" by ndcs on Vimeo, the home for high quality videos and the people who love them.

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Hearing aids do not help everyone with hearing loss. A cochlear implant may be an option. An audiologist can help you find out if a cochlear implant will help you.