Medical Edge Newspaper Column

Treatment for Hearing Loss in Child Depends on the Underlying Cause

July 22, 2011
Dear Mayo Clinic:
My 5-year-old daughter recently had a hearing test at school. She was found to have hearing loss in one ear. What are our next steps? Can it be treated? If not, how will this affect her as she gets older?

Answer:
A range of possibilities exist for what's causing your daughter's hearing loss. To identify the source of the problem, the first step is to have her primary care physician examine her ear. After that, a formal hearing evaluation may be necessary. Treatment for hearing loss depends on the underlying cause.

A visit to her doctor is a good first step because hearing loss in one ear could be due to a simple problem, such as earwax or an object blocking the ear canal. Another common cause of single-sided hearing loss in young children is fluid buildup caused by an upper respiratory infection or allergies. Fluid or some other type of blockage can often be easily identified and treated, restoring hearing to normal.

If one of these simpler problems is not the cause, then a hearing test (audiogram) should be conducted by an audiologist. An audiogram can help determine the type of hearing loss and what part of the ear is affected. Damage or problems within the inner ear, the ear canal or the eardrum can cause hearing loss. Another factor could be that the bones of hearing — the hammer, anvil and stirrup — in the middle ear are not working properly.

After the audiogram, your daughter should see a physician specializing in hearing (otorhinolaryngologist, ENT), who can review the test results and conduct a more thorough ear exam to determine a diagnosis.

When hearing loss is related to middle ear fluid (ear infections or a problem with the eardrum), those issues usually resolve on their own, or they can be treated with medication or surgery. If the exam and audiogram point to an inner ear problem, more testing is usually required, such as head CT or MRI scans, to arrive at an accurate diagnosis.

In children, minor malformations of the inner ear structure can put the ear at risk of hearing loss. In that situation, even though a child's hearing may be normal at birth, the loss may progress later. Many genes are also involved in hearing, and abnormalities in those genes can result in hearing loss, most commonly in both ears. Although surgical or medical therapy can't restore hearing that was lost as a result of inner ear malformations or genetic causes, a hearing aid can be helpful. More serious problems, such as tumors or brain disorders, also can cause hearing loss, but they are very rare. Another consideration is that the specific cause of hearing loss may not be identifiable.

If your daughter's hearing loss cannot be resolved, her daily life may be affected in several important ways. First, when hearing in one ear is damaged, a person can hear sounds but can't determine their origin. That can be a serious safety issue for a child. Second, when we hear with both ears, our brain can filter background noise and focus on sounds we want to hear. Children have to deal with a lot of background noise in places like classrooms, lunchrooms and playgrounds. When hearing in one ear is compromised, environmental noise can significantly interfere with a child's ability to understand what's going on around her.

Fortunately, several devices can help when hearing is permanently damaged. Hearing aids, cochlear implants, and devices that transmit sound from one side of the head to the other are possible options.

Before you think too much about the long-term effects of hearing loss, though, see your daughter's doctor. In many cases, hearing loss in children can be effectively resolved or managed.

— Colin Driscoll, M.D., Otorhinolaryngology, Mayo Clinic, Rochester, Minn.