One of the most common reasons children seek medical assistance is due to ear infections. Other ear, nose, and throat related issues include allergies, sleep apnea, recurrent tonsillitis, speech delays to name a few but ear infections is one of the top reasons. In fact, according to the National Institute on Deafness and Other Communication Disorders (NIDCD), five out of six children will have had an ear infection by the time they reach three years old.
An ear infection, or fluid behind the eardrum with no infection, often causes a temporary conductive hearing loss. Other examples of conditions that can result in a conductive hearing loss include a hole in the eardrum, excessive ear wax, and foreign bodies in the ear (yes, this happens more than we think). Due to this, the physician may recommend a hearing test. Other concerns that may result in a referral for a hearing evaluation could be delayed speech/language development, concerns reported by parents, failed school screening, or a history of family hearing loss for example.
HOW COMMON IS HEARING LOSS IN CHILDREN?
Three million children under the age of eighteen have some type of hearing loss according the the American Academy of Otolaryngology, this includes four out of every 1000 newborns. This is why the Newborn Hearing Screening program was developed and is implemented throughout the United States, allowing for quicker identification of children born with hearing loss. This enables the family, working with professionals, to ensure the best outcome for their child. Your child most likely had a hearing screening before they left the hospital to ensure they were hearing well.
WHEN SHOULD I BE CONCERNED ABOUT MY CHILD’S HEARING?
If you notice any of the below, discuss with your child’s primary care provider if a hearing evaluation would be appropriate:
- Doesn’t startle to loud noise
- Turns up the volume on the T.V. or radio excessively high
- Lack of response when call their name
- Difficulties saying words
- Delayed speech/language development
- Difficulties in school
- Repeated earaches, ear pain, or/and head noise
- Difficulty understanding what is being said or consistently inappropriate responses to questions
HOW DO YOU TEST CHILDREN?
If a child is five years old or older, and there are no other issue, they are often able to do a complete evaluation with little problem. Younger children, of course, require more time and different approaches to establish how they are hearing. Each child is unique, so the approach taken is tailored to them. If your child is five years old or younger and/or has special needs, the initial evaluation can take up to one hour long.
Often a questionnaire regarding your child’s development will be completed at the beginning or end of the appointment. It is imperative to have as few distractions as possible during testing to get the best results. We understand that often there will be other family members at the appointment, including siblings. Having a loved one or friend with you to watch any other children during the appointment is very helpful and ensures we have the best opportunity to obtain results with the least amount of distractions.
Tests
Tympanometry/Acoustic Reflex:
This test allows us to determine how well the eardrum is functioning and if there is any fluid or other concerns behind the eardrum. The results can help determine if there is fluid in the middle ear, a hole in the eardrum, or problems with the small bones in the middle ear. Acoustic reflex testing ensures that a muscle responsible for protecting the ear from loud sounds is functioning properly and also be used to help establish your child’s hearing sensitivity when combined with other results. These tests are minimally invasive, a probe is placed in the ear and the pressure is varied, measuring the movement of the eardrum and/or response of the reflex. Crying and/or fussing will prevent completing this test.
Otoacoustic Emissions (OAEs):
If the ear is clear of fluid or other issues of the middle ear, this test may be done. OAEs asses the function of the hair cells of the inner ear responsible for detecting very soft to medium sounds, helping to rule out most hearing losses. Crying, vocalizations, fussing will prevent being able to complete this test.
An important note, if your child is crying or fussing, the above two tests may not be able to be done at the appointment. A parent/caregiver will be with the child throughout testing during the first appointment or if under 6 years old.
Behavioral Hearing Test:
This test is used for infants and/or children who are very shy or having difficulty completing other tests. Standardized norms are used for age appropriate responses. It allows us to determine hearing thresholds (softest sounds a person hears) and compare the results to normative data and other tests to help obtain a complete picture of their hearing. Sounds are presented either in soundfield, through earphones, or bone conduction (a device that delivers sound through the bones of the skull to the ear). There are three categories of behavioral testing:
Behavioral Observation Audiometry:
This approach is used mainly with infants. Often observing behaviors such as sucking, eye widening, and startles in response to sound.
Visual Reinforcement Audiometry:
Typically used with children between five months to two years old. Your child will sit on a parent/caregiver’s lap while we present sounds. As your child responds to the sound, a positive reinforcement (a toy lighting up or moving for example) will be given on the side the sound was presented. Both visual and verbal reinforcement is given and the test presented as a game. Responses are typical turning the head in the direction the sound was presented, looking toward the source of the sound.
Conditioned Play Audiometry:
Typically used with children two and half years and older. Games are used to teach the child to respond to sound. The games could be identifying body parts, pointing to pictures, or dropping blocks.