Introduction
Hearing loss in children is particularly important due to the effects on developing language and speech and performance in school. Hearing aids should be fitted early if severe deafness is present
Most hearing loss is due to middle ear disease.
At risk children
Refer for audiological assessment
- Premature birth
- Low birth weight
- Intraventricular haemorrhage
- Neonatal jaundice
- Neonatal hypoxia
- Aminoglycoside use
- Failure of distraction testing
- Parental suspicion
- Abnormal or delayed speech
- Hearing loss within the family
Causes
Otitis media with effusion (glue ear)
- Commonest cause of acquired conductive hearing loss in children. Also causes otalgia
- Peaks 3-6 years of age (1/3 of children suffer at some point in this age group)
- After age of 11 is rare
- Associated with upper respiratory tract infections
- Caused by Eustachian tube disfunction; tube is horizontal and short in young children and opens near adenoids; liable to occlusion
- Increased risk if have cleft palate or Down’s syndrome
- Tympanometry produces a flat trace; shows that the tympanic membrane is immobile
- Rx;
- Short term; trimethoprim and amoxicillin
- Long term; adenoidectomy, grommet insertion
- Grommets may have to be placed multiple times. Once in place they tend to last for up to 12 months.
- Grommets can cause tympanosclerosis (white patches on the membrane). These should not affect hearing unless particularly large or involving the ossicles.