Hearing impairment refers to any degree of hearing loss, mild to severe, and can occur when there is a problem with a part of the ear, including the inner, middle, and outer ears, or the nerves needed for hearing.
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Hearing impairment in newborns most commonly results from cytomegalovirus infection or genetic defects and in older children results from ear infections or excessive earwax.
If children do not respond to sounds, have difficulty talking, or are slow starting to talk, the cause may be hearing impairment.
A handheld device or a test that measures the brain’s responses to sounds is used to test hearing in newborns, and various other techniques are used for older children.
If possible, the cause is treated, but hearing aids may be needed.
If hearing aids are not effective, a cochlear implant or bone-anchored hearing aid can sometimes be helpful.
Untreated hearing impairment can impede a child's verbal, social, and emotional development.
Hearing impairment is relatively common among children. In 2020 in the United States, hearing loss was found in about 2 out of every 1,000 infants screened for hearing loss, whether or not they had symptoms. About 2% of children report they have trouble hearing. Hearing impairment is slightly more common among boys.
Not recognizing and treating impairment can seriously impair a child’s ability to speak and understand language. The impairment can lead to failure in school, teasing by peers, social isolation, emotional difficulties, and problems in adulthood.
(See also Hearing Loss in adults.)
Causes of Hearing Impairment in Children
The most common causes of hearing loss in newborns are
When a baby is infected with CMV in the uterus, it is called congenital CMV infection. Congenital CMV infection is the most common congenital viral infection in the United States. Infected newborns can be born with hearing loss and many other problems. Hearing loss can also develop later in children who were infected immediately before, during, or shortly after birth. Screening for CMV is being gradually incorporated into newborn screening examinations in the United States and internationally.
Genetic defects are also common causes. Some genetic defects cause hearing loss that is evident at birth. Other genetic defects cause hearing loss that develops over time.
The most common causes of hearing loss in infants and older children are
In older children, other causes include head injury, loud noise (including loud music), use of certain medications that can damage the ears (such as aminoglycoside antibiotics or thiazide diuretics), certain viral infections (such as mumps), tumors or injuries affecting the auditory nerve, injury by pencils or other foreign objects that become stuck deep in the ear, and, rarely, a malfunction of the body's immune system that causes the body to attack its own tissues (autoimmune disorder).
Risk Factors for Hearing Impairment in Children
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Symptoms of Hearing Impairment in Children
Parents may suspect hearing impairment if the child does not respond to sounds or if the child has difficulty talking or has delayed speech.
Less severe hearing impairment can be more subtle and lead to behavior that is misinterpreted by parents and doctors, such as the following:
Children sometimes ignore people who are talking to them.
Children are able to talk and hear well at home but not in school because mild or moderate hearing impairment may cause problems only in the midst of the background noise of a classroom.
In general, if children are developing well in one setting but have noticeable social, behavioral, language, or learning difficulties in a different setting, they should be screened for hearing impairment.
Screening for and Diagnosis of Hearing Impairment in Children
For newborns, routine hearing screening tests
For older children, a doctor's evaluation and tympanometry
Imaging tests
Sometimes genetic testing
Because hearing plays such an important role in a child’s development, many doctors recommend that all infants be screened for hearing impairment by the age of 3 months.
Most states in the United States require that newborns undergo routine screening tests to detect hearing impairment. Newborns are usually screened in 2 stages. First, newborns are tested for echoes produced by healthy ears in response to soft clicks made by a handheld device (evoked otoacoustic emissions testing). If this test raises questions about a newborn’s hearing, a second test is done to measure electrical signals from the brain in response to sounds (the auditory brain stem response test, or ABR). The ABR is painless and usually done while newborns are sleeping. It can be used in children of any age.
If results of the ABR are abnormal, the test is repeated in 1 month. If hearing loss is still detected, children may be fitted with hearing aids and may benefit from placement in an educational setting responsive to children with impaired hearing.
If doctors suspect the child has a genetic defect, genetic testing can be done.
In older children, several techniques are used to diagnose hearing impairment:
Asking a series of questions to detect delays in a child’s normal development or to assess a parent’s concern about language and speech development
Examining the ears for abnormalities
For children aged 6 months to 2 years, testing their response to various sounds
Testing the response of the eardrum to a range of sound frequencies (tympanometry), which may indicate whether there is fluid in the middle ear
After age 2 years, asking children to follow simple commands, which usually indicates whether they hear and understand speech, or testing their responses to sounds using earphones
Imaging tests are often done to identify the cause of hearing loss and guide prognosis. Magnetic resonance imaging (MRI) is done for most children. If doctors suspect bone abnormalities, computed tomography (CT) is done.
After a child is diagnosed with a hearing impairment, doctors continuously monitor that child's hearing status to look for and treat changes in hearing.
Treatment of Hearing Impairment in Children
Treating the cause when possible
Hearing aids, cochlear implants, or bone-anchored hearing aids
Sign language
Treating reversible causes of hearing loss and ear defects can restore hearing. For example, ear infections can be treated with antibiotics or surgery, earwax can be manually removed or dissolved with ear drops, and cholesteatomas can be surgically removed. Children may be given a hearing aid for a temporary loss of hearing.
Most often the cause of a child’s hearing loss cannot be reversed, and treatment involves use of a hearing aid to compensate for the impairment as much as possible.
Hearing aids
Hearing aids are available for infants as well as older children. There are many different kinds.
These devices are effective for most children with sensorineural hearing loss. Sensorineural hearing loss occurs when sound reaches the inner ear, but either sound cannot be translated into nerve impulses (sensory loss) or nerve impulses are not carried to the brain (neural loss). Bluetooth and other wireless technologies allow for connectivity between hearing aids and external devices, such as smartphones.
If hearing loss is mild or moderate or affects only one ear, a hearing aid or earphones can be used.
Children who have hearing impairment can use an FM auditory trainer in noisy environments. This device is not a hearing aid, but it transmits sound in noisy environments such as a classroom. With an FM auditory trainer, the teacher speaks into a microphone that sends signals to an FM receiver worn by the child which then sends the signals on to the child's hearing aids.
Cochlear implants
Cochlear implants (a surgically implanted system that sends electrical signals directly into the auditory nerve in response to sounds) may be used for children whose hearing loss is sensorineural and cannot be managed with hearing aids. Cochlear implants can help children communicate and develop language and help them integrate into the hearing world.
DR P. MARAZZI/SCIENCE PHOTO LIBRARY
Bone-anchored hearing aids (BAHAs)
BAHAs are hearing devices that use vibrations through the bones in the skull to send sounds to the inner ear. These devices can be held in place against the skull with a headband or can be surgically implanted into the skull or under the scalp.
BAHAs may be used for children whose hearing loss is conductive and cannot be managed with other hearing aids but whose nerves needed for hearing are fine. Conductive hearing loss occurs when something blocks sound from reaching the sensory structures in the inner ear. The problem may involve the external ear canal, the eardrum, or the middle ear. BAHAs may be used in people over 5 years of age.
Other therapies
Children may also require therapy to support their language development, such as being taught a visually based sign language.
People in deaf communities are proud of their rich culture and alternative forms of communication. Many deaf people oppose surgery for the treatment of severe hearing impairment on the grounds that it may deny children membership in the deaf community. Families who wish to consider this approach should discuss it with their doctor.
Although doctors do not fully understand how COVID-19 infection affects hearing, vaccination against the virus that causes COVID-19 infection might help protect children from developing balance and hearing disorders.
Prognosis for Hearing Impairment in Children
Children whose hearing impairment is not recognized and not treated can have seriously impaired speech and understanding of language. The impairment can lead to educational, social, and psychological challenges and may affect whether a person can find and keep a job and advance in a workplace later in life.
Children whose hearing impairment is recognized and treated can reach their full language and speech potential. Early intervention programs can help young children with hearing loss learn communication and other important skills.
More Information
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