Hearing loss and deafness in children

Hearing is made possible by the ear picking up sound waves and converting them into neural stimuli. These stimuli are transmitted to the brain for processing, resulting in the person consciously perceiving tones or sounds and recognizing them as spoken language or music. If a person’s ability to perceive spoken language or sounds is limited or non-existent, this is referred to as hearing loss or deafness.

There are various causes of hearing disorders in children. Infections, for example, can trigger hearing impairments or deafness. Various hearing aids or auditory prostheses (cochlear implants) can be used if the triggers cannot be eliminated. If a hearing disorder in children is left untreated it may cause problems with the child’s language development.

Further information about how hearing and speaking work can be found at gesundheitsinformation.de.

There are a number of signs that indicate when a child’s ability to hear is impaired. For example, children with a mild impairment may not understand something someone whispers to them. Children with a moderate hearing impairment can only hear loud sounds and children with severe hearing loss can only hear very loud sounds. Deaf children, however, can only perceive tones and sounds as vibrations. Depending on the cause, this may affect both ears or just one ear.

Hearing disorders in newborns and small children are often not noticed immediately. They are usually noticed when parents realize that their child does not respond or barely responds to sounds. Another sign is when children only notice they are being spoken to when they can also see the face of the person speaking to them.

There are various causes for hearing loss and deafness in children. Developmental hearing disorders may occur prior to birth in some children.

If the hearing disorder is hereditary, other organs may not function properly in addition to hearing, such as the kidneys, eyes, heart or thyroid gland.

Infectious diseases in pregnant women can increase the risk of damage to the unborn child’s hearing. These include cytomegaly, rubella or toxoplasmosis.

Taking certain antibiotics or cancer medication, or consuming drugs and alcohol during pregnancy can also sometimes affect how the baby’s hearing develops. Low oxygen levels during birth can also damage the baby’s hearing.

Hearing disorders that occur after birth are most likely to be caused by infections with bacteria or viruses. Temporary hearing impairment is often due to a buildup of fluid behind the eardrum if the middle ear is not properly ventilated. This can be caused, for instance, by swollen tonsils or middle ear infections. Persistent hearing disorders are rare. They can also occur as a complication of diseases such as meningitis, measles or mumps.

Noise also increases the likelihood of developing impaired hearing. Listening to music through headphones with the volume set too high, for instance, can damage hearing. But hearing disorders can also be caused by loud bangs, for instance when fireworks or toy guns explode too close to a person’s ear. They are rarely caused by head injuries.

Approximately 1 to 3 out of every 1,000 newborns have a moderate or severe persistent hearing disorder in both ears. Roughly the same proportion of children develop a hearing disorder in their lifetime.

Approximately 80,000 children in Germany have severely impaired hearing. The global figure is around 32 million children.

The outlook for a hearing disorder depends on what causes it. If impaired hearing is caused by a middle ear infection, fluid buildup (effusion) behind the eardrum or earwax blocking the auditory canal, the hearing impairment is temporary.

If it is caused by deformities, congenital or acquired damage to the inner ear this will usually lead to permanent hearing impairment or deafness.

Noise can damage hearing. For children and adolescents, listening to music on headphones is a major factor. It is not yet absolutely clear at what volume the risk of hearing impairment rises. That’s because the amount of time the ears are exposed to noise is also important. Experts recommend not spending more than one hour per day listening to music on headphones at over half the maximum volume.

Congenital hearing disorders cannot be prevented. However people can have genetic counseling if

• they wish to have children and at least one partner has had hearing impairment or has been deaf since birth
• they have family members suffering from congenital hearing impairment or deafness

There are some measures that can be taken during pregnancy to prevent developmental hearing disorders in a child. These include:

• not smoking
• not taking drugs or drinking alcohol
• consulting a doctor if you have to take medication that could have harmful effects
• preventing infections with rubella or cytomegalovirus by following hygiene measures getting vaccinated against rubella

Children with congenital hearing impairment or deafness whose hearing disorder is not detected and treated early enough find it difficult or impossible to learn to speak. This can affect many areas of their lives and impair their developmental capacity. The same applies if the hearing disorder develops in their early years and remains undetected.

Because of this, babies’ hearing is routinely tested immediately after birth to detect and treat congenital hearing disorders as soon as possible.

Since babies cannot tell you whether they can or cannot hear something, tests such as the tuning fork test are not very useful for early detection (screening) purposes. Doctors therefore measure sensory cell (receptor) or brain activity when tones are played to children. The results are used to determine how well their hearing is working.

For more information on routine hearing tests for newborns, visit gesundheitsinformation.de.

If a child is suspected of having a hearing impairment or being deaf, the doctor will first conduct an examination of the ears. They will use an otoscope to find out whether the ear canal is inflamed or there are problems in the middle ear.

A number of different hearing tests are used to find out what type of hearing disorder is involved and how severe it is. For example, tones are played to the children at increasing volumes and they make a sign when they can hear something. The time they take determines how good or poor their hearing is.

With small children it helps to make the tests into a game. In some tests the doctor places a vibrating tuning fork on the child’s head and then adjacent to the ears in a defined sequence. This is used to record how long the children hears the tone when the tuning fork is struck. These tests can be used to determine not just whether the child’s hearing is worse in one ear than the other but also whether the cause lies in the middle ear or the inner ear.

Further tests and examinations are often required to determine what the precise cause is and what the possible treatments are. For example, one test involves measuring the vibrations of the eardrum. This method is called tympanometry.

If the hearing impairment is caused by a buildup of fluid in the middle ear it can be cured by draining the fluid. Other causes can sometimes be treated directly as well to reverse the hearing loss.

If the hearing loss cannot be cured, hearing aids can help. These amplify the sound waves and direct them into the inner ear. Some residual hearing is necessary for them to work.

In cases of full deafness, or where hearing aids do not help, a cochlear implant may be considered. This is a device that enables auditory stimuli to be perceived. Hearing aids or cochlear implants can be supported by transmission systems, which send acoustic information directly to the hearing aid. For example, these systems can be paired with a microphone in the classroom. The statutory health insurance providers will usually cover the costs. Educational support may also be available for the children.

Further information about treating a hearing disorder, for example when a hearing aid is useful, is available on gesundheitsinformation.de.

When parents are told that their child has a hearing disorder they will usually be very upset and worried about the development and future of their child. And their everyday routine will be dominated by lots of appointments for tests, treatment and rehab, particularly in cases of a severe hearing disorder. This can sometimes require traveling long distances to specialist clinics.

Information can be of enormous help at this stage: parents need to be given the opportunity to obtain detailed advice from doctors and get information materials about the specific hearing disorder that provide clear and balanced explanations of the various treatment options.

In addition to professional medical advice it is essential to have the support of friends or family members. Speaking to other parents of children suffering from hearing loss or deafness can often be a great help, too.

A child with a hearing loss or deafness can develop just as well as a child without a hearing disorder. Many parents find it helpful to know that. However there are a number of challenges that need to be overcome to ensure this: if the child finds it hard to communicate this may mean, for example, that it can feel left out at a normal school or when pursuing hobbies or sport.

Hearing aids or auditory prostheses can make it easier to communicate. However patient training and lots of encouragement is needed to ensure they work well. This requires time and energy.

At the same time, it can also make you feel more closely connected to your child and find it easier to appreciate learning outcomes or generally become more relaxed. Some parents also find it gives them the energy to advocate actively for better conditions for their own child and other people with hearing disorders.

If you suspect your child shows signs of hearing loss or deafness you should first of all consult your family doctor. He or she can then make a referral to a specialist if required.

Self-help groups are one way of networking with other people who know the difficulties, feelings and practical problems that are associated with hearing impairment and deafness. Information and advice services can also provide help.

You can search for suitable self-help services via a database on the website of the National Contact and Information Point For Encouraging and Supporting Self-Help Groups (Nationale Kontakt- und Informationsstelle zur Anregung und Unterstützung von Selbsthilfegruppen – NAKOS).