A pan drops in the kitchen, but your child sitting nearby doesn’t seem to notice. Or your child never responds to your voice when you are speaking from another room. These are signs your child could have hearing loss in one or both ears.
According to the Centers for Disease Control and Prevention, 1 or 2 per 1,000 babies have some hearing loss at birth. The number jumps to 5 per 1,000 for children ages 3-17. “Hearing loss in children is more common than you might expect,” says Leila Mankarious, MD, a Mass General Brigham pediatric ear, nose, and throat (ENT) specialist (also known as an otolaryngologist). She cares for patients at the Mass Eye and Ear Pediatric Hearing Center.
“It’s important to diagnose and treat any type of hearing loss as early as possible. Without the proper treatment, even mild hearing loss can cause children to struggle with speech and language development, schoolwork, and socializing with other children,” says Dr. Mankarious.
Learn about the most common causes of hearing loss in children and what to do if you suspect your child is having trouble hearing.
Hearing loss in children can be mild, moderate, or severe. It can affect one or both ears. Some children are born with hearing loss—in others it develops slowly. Often, the signs are so subtle that parents might not notice right away.
“A surprising number of parents are not able to determine their child has trouble hearing. Mild hearing loss can be easy for parents to miss,” says Dr. Mankarious. “The child might hear part of what a person says, but not full words or all the nuances. The child may rely on sight to know when someone is speaking and read their lips.”
If your child doesn’t respond to your verbal requests, it may be something more than a bad attitude—they may not hear you. Take note of these common signs of hearing loss:
“Even mild hearing loss can affect cognitive, social, and behavioral development. Parents need to be mindful of hearing issues and talk to their child’s pediatrician if they suspect hearing loss,” says Dr. Mankarious.
Physical abnormalities and changes to the tiny parts of the inner, middle, and outer ear can cause hearing loss. Most hearing loss in kids falls into two categories:
Ear infections (otitis media) are one of the most frequent causes of conductive hearing loss. About half of all children experience an ear infection by age 2.
Infants and young children are more prone to ear infections because they tend to catch more colds than adults. In addition, the ear’s natural ventilation system is also less developed in children, and more likely to become blocked from illness-related mucus. Blockages lead to infection, swelling, and trapped fluid in the ear canal.
“Parents shouldn’t panic if their child gets a few ear infections—the effects are generally temporary. But chronic ear infections may lead to hearing loss,” says Dr. Mankarious.
Sensorineural hearing loss is less common than conductive hearing loss, but more permanent, says Dr. Mankarious. “It occasionally gets better, but it’s rare for this hearing loss to improve over time.”
Sensorineural hearing loss is often caused by a defect in the cochlea. This tiny shell-shaped structure in the ear converts vibrations to nerve signals that the brain interprets as sound. Damage to the cochlea can be genetic, but it can also be caused by other factors, such as:
Because early intervention is key, Mass General Brigham screens newborns for hearing loss before they are released from the hospital. The Joint Committee on Infant Hearing, part of the American Speech-Language-Hearing Association, recommends providers follow the “1-2-3 Rule” for babies:
“Hearing tests are not painful, and they are necessary,” says Dr. Mankarious. Infant screening to measure how the ear and brain respond to sound takes only a few minutes. Providers may attach electrodes to your baby’s head or place a small device in their ear. Newborns who don’t pass the screening are referred to an ENT for diagnosis and treatment. The ENT works with an audiologist who performs more tests.
Children are typically screened again by their pediatrician at age 4, and some schools may offer more screening for elementary-age children, says Dr. Mankarious. “In between, there are other developmental milestones that pediatricians track. If children don’t hit those milestones, doctors start to look at hearing loss as one possible cause.”
For toddlers and older children who can follow instructions, hearing tests rely more heavily on behavioral response. Tests can involve play, response to verbal commands, and response to sound while listening through earphones.
Most children with hearing loss will be treated with one of these options:
If your child has chronic ear infections, your provider may suggest ear tubes. These small vents remain in the ear temporarily to help fluid drain properly. Tubes are usually placed around age 1 but can be used in children as young as 3 months in severe cases.
An ENT specialist performs the surgery in an operating room while the child is under anesthesia. The procedure lasts only a few minutes. “The tubes generally fall out on their own in 9 months,” says Dr. Mankarious. “They are about 95% effective. Children who get a set of tubes may not need a second set.”
For conductive hearing loss with anatomical causes, like a closed ear canal or a problem with the bones of the inner ear, doctors often prescribe hearing aids. A hearing aid is a small electronic medical device worn on the outer ear that amplifies sound. It’s customized to your child’s level of hearing loss.
“When the middle ear or ear canal is not formed properly, some conditions can be corrected surgically and some are permanent. If the problem can be addressed with a hearing aid, it’s usually the first choice for treatment to avoid surgical complications,” says Dr. Mankarious.
In cases when hearing aids can’t amplify sound enough, a cochlear implant is an option. These implants work by sending sound directly to the auditory nerve. Implants have two parts:
The sooner a child receives a cochlear implant, the better for their overall development. “Children who receive implants before age 1 do much better in the long run than children who receive implants after age 2,” says Dr. Mankarious.
She stresses that a cochlear implant is just one option for severe hearing loss. Parents concerned about surgical intervention may opt to have their child learn American Sign Language (ASL). Just like verbal language, ASL facilitates development for hearing-impaired children, she says.
Because hearing loss has a significant effect on a child’s development, parents should take steps to protect their children’s hearing:
“As a parent, be persistent and remember timing is key,” says Dr. Mankarious. “It’s essential to address pediatric hearing loss at an early age and provide all the support your child needs.”