Categories: E. N. T - Paediatric

Hearing Loss in Children

Treating hearing loss: A primer

(#my child can’t hear #my child can’t speak #audiometry #hearing aid #cochlear implant)

Hearing loss is a silent but debilitating handicap. If it strikes before language acquisition occurs – before the child is two or three years old – an untreated child with profound loss may never speak. Children with partial hearing loss tend to lag behind their peers in class and may not rise to their scholastic potential. Their vocabulary may be limited and pronunciation impaired. Behavioural backwardness sets in and they tend to have fewer friends and social skills may be poor. When they become adults, they often experience difficulty in the workplace and often don’t reach the potential that they can, avoid friends and especially avoid social gatherings and parties in clubs, pubs, and restaurants because they feel most inadequate in these environs. Psychological issues are common patients with hearing loss. Typically, they don’t have the drive or the incentive to seek help as compared to the working person. Helping them is a big challenge and hence it is important to make a hearing-impaired child socially adequate.

Hearing loss is of two major varieties:

🔨conductive hearing loss-due to impaired conduction of sound from the eardrum to the nerve.

🔨sensorineural hearing loss-due to disorders in the inner ear and the nerve.

An audiologist administers hearing tests and presents a report (audiogram) to determine the type and extent of hearing loss. Ideally (it’s the practice in the developed world) testing is done on a newborn infant before the mother leaves the hospital. If hearing loss is suspected, the child is tested in more detail after a few months and a BERA (Brain stem evoked response audiometry – like an ECG of the hearing brain!) is confirmative around three to six months. In case the child has escaped newborn testing, caregivers may notice that:

📌 the child does not get startled by loud sounds

📌 ignores parental voice unless there is eye contact

📌 babbles but does not articulate words at 6-9 months

📌 do not acquire speech as their peers do

📌behaviour and scholastic issues in older children

The audiologist will administer an age-specific battery of tests in a soundproof environment to such children. Some tests are objective but most are subjective and depend on the expertise and equipment that the audiologist has. Testing a small child is time-consuming too; if your child is advised testing please budget at least half a day at the clinic.

Conductive hearing loss is often treatable; impacted wax in both ears may cause up to 30dB (more than 50%) of hearing loss and relieved in a jiffy! Eardrum perforations, fixity, or loss of one or more of the minute bones that carry the sound from the eardrum to the inner ear are often treated successfully by surgery. Some patients with conductive hearing loss may choose to wear hearing aids while others may need implants in which sound is first digitized, filtered, enhanced, and then delivered as sound to the inner ear. Children with birth defects related to the outer and middle ear are very good candidates for these bone-anchored hearing aids.

Sensorineural hearing loss is more difficult to treat. A portion of children, especially with less than profound hearing loss can be treated with hearing aids that are miniature sound systems – amplifier, mic, and speaker all rolled into one! When a trial with powerful hearing aids does not benefit, a cochlear implant is considered as an option. During the operation, the receiver-stimulator package is implanted in a pocket behind the ear and after a fortnight or so the external sound processor is worn and the implant “switched on”. The implantee needs intensive rehabilitation for several months after surgery because the sound is first digitized by the processor and then transmitted as electrical signals directly to the organ of hearing and nerve; recognition and reproduction of speech need help by the habilitation professional. The results of surgery are astounding; Deaf mutes can speak, go to college, and seek gainful employment in the open market. They are social and fully integrated into the hearing world. Hearing-impaired children or adolescents who have already acquired speech are termed post-lingual; they need less rehabilitation and perform marvellously.

The key to successful treatment of hearing loss is:

☑️ diagnosis – the SRCC Children’s Hospital has experienced doctors and a state of art Audiology Department

☑️ tailoring the treatment to the child’s age and needs

☑️ conductive hearing loss may need medication or surgery

☑️ sensorineural hearing loss may need a hearing aid and cochlear implant

Department of ENT, NH SRCC Children’s Hospital, Mumbai

Narayana Health

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