Causes of Hearing Loss in Children

1. Otitis media (ear Infections)
2. Congenital causes
3. Acquired causes

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 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 occurs most frequently in children. In fact, it ranks second to the common cold as the most common health problem in preschool children. 50% of children have had at least one episode by one year of age. Between one and three years, 35% will have had repeated episodes. For school children, an estimated 5 million school days are missed every year due to otitis media.

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 full benefit of language learning experiences. Consequently, critical delays in speech and language development may occur.

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 hearing the speech and language needed for normal 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:

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 sates, "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.

How can I find an audiologist or speech language pathologist?

Search ASHA's online referral database of certified Speech-Language Pathologists and Audiologists, or contact the American Speech-Language-Hearing Association, 10801 Rockville Pike, Rockville, MD 20852. Phone: 800-638-8255 or 301-897-8682 (Voice or TTY).

Congenital hearing loss (hearing loss that exists or dates from birth)

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 (NIDCD, 1989). 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. Approximately 80% of inherited hearing loss is autosomal recessive.

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. This kind of hearing loss is rare, accounting for only about 2% of hereditary hearing losses.

There are some genetic syndromes where 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), Fetal alcohol syndrome (genetic abnormality), Crouzon syndrome (autosomal donimant), and Alport syndrome (X-linked).

Other causes of congenital hearing loss  that are not hereditary in nature include prenatal infections, illnesses, or 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

Acquired hearing loss

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. Examples of conditions that can cause acquired hearing loss in children are: