Hearing Loss in Children

Hearing loss in children causes considerable delay in speech development, as well as serious difficulties in the learning process. Whether by birth or appearing during the first years of life, it has a big difference compared to hearing loss acquired during adulthood.

Indicatively, children with moderate hearing loss will articulate their first word on average at the age of 21 months and subsequently develop a richer vocabulary at the age of 36 months, while children with normal hearing begin to speak at the age of 10 months and enrich their vocabulary at the age of 18 months. Unilateral or bilateral hearing loss causes children to have problems locating sounds, understanding speech – especially in a noisy environment – while their diction is inferior to that of children with normal hearing.

A key factor in preventing the severe effects of hearing loss on speech development is prevention and early diagnosis, which can be carried out even for cases of hereditary hearing loss due to the development of molecular biology and analysis of the human genome.

Early diagnosis of hearing loss in children involves the screening of infants at maternity hospitals during the first days of their life, while re-testing is necessary to diagnose any acquired or progressive hearing loss developed later on.

One of the most common conditions affecting children’s hearing is the presence of fluid in the middle ear.

Normally, the middle ear is filled with air and it is connected to the back of the nose through the Eustachian tube, the role of which is:

• To transfer air to the middle ear.
• To allow the mucus normally produced in the middle ear to escape to the nose, preventing accumulation.

After suffering from a cold, many people experience a temporary inability of the Eustachian tube to remove the mucus produced in response to the viral infection. The result is occlusion of the ear with the following possible consequences: pain, hearing loss, feeling that the patient can hear his own voice (autophony). This condition is called acute secretory otitis media and usually improves after a few weeks without treatment.

Patients who catch colds frequently are allergic or sensitive to environmental pollutants, such as cigarette smoke, there may exhibit continuous mucus production. If the mucus is not duly removed, the middle ear system is obstructed by the mucus trapped inside it. The condition is called “glue ear” – in other words, it is a chronic secretory otitis media.

The concentration of the fluid in the middle ear causes a moderate hearing loss, however, this may cause difficulties in the speech-learning process if the condition begins at a very young age or can lead to the insufficient development of speech and vocabulary skills if the condition occurs at an older age.

Behavioral changes can also be observed and children may be at risk of being distracted, irritable and aggressive, distant or introvert. Established chronic secretory otitis media (CSOM) is rarely painful, but the secretion can be infected and then intense pain and fever develop until the tympanic membrane is breached, discharging the mucous, suppurative secretion (acute suppurative otitis media).

Most children with established CSOM eventually recover without treatment, however, not all recover immediately and there is a small percentage (5%) that start with CSOM and continue to have problems with alterations of the tympanic membrane, which can lead to serious disease (i.e. tympanic membrane perforation and cholesteatoma).

Surgery comprises the reintroduction of air to the middle ear by means of a small venting cannula, approximately 1.5 mm in diameter, which is inserted through a small incision on the tympanic membrane (myringotomy) and allows the air to enter the middle ear cavity, so that the mucus can be drained through the Eustachian tube. In some cases, insertion of the cannula is accompanied by removal of the adenoids. The cannula is slowly discharged by the ear as it heals around it (usually after 6-9 months).