Hearing

Hearing is an important part of learning, speaking, and communicating—right from birth. It’s important to find hearing problems early to prevent delays in learning and communication. About 1 in every 250 children has enough hearing loss that it’s hard for them to develop language. For this reason, all children should get recommended hearing screenings. Many states require all newborns to have a hearing test.

Parents and other caregivers should also watch for signs of a possible hearing problem in children of all ages. Hearing problems can result from earwax blocking the ear canal or fluid from an ear infection in the middle ear. Hearing problems can also come from damage to the eardrum, middle ear bones, hair cells, or auditory nerve.

Hearing is an important part of learning, speaking, and communicating—right from birth. It’s important to find hearing problems early to prevent delays in learning and communication. About 1 in every 250 children has enough hearing loss that it’s hard for them to develop language. This can affect their success in school and their social skills. For this reason, all children should get recommended hearing screenings. Many states require all newborns to have a hearing test. Parents and other caregivers should also watch for signs of a possible hearing problem in children of all ages.

How hearing works: Hearing involves a number of steps, and problems can happen at any one of them. Sounds come into the ear through the ear canal and make the eardrum vibrate. The vibrations are sent to three small bones in the middle ear—the malleus, incus, and stapes. Middle ear infections (otitis media) happen in this part of the ear.

The bones make the vibrations stronger and send them to the inner ear. The sound goes to the cochlea, which looks like a snail shell. It is filled with fluid that ripples from sound vibrations. The ripples make a wave in a membrane (a thin tissue) in the inner ear. Tiny hair cells move in response to the wave, causing an electrical signal that goes to the auditory nerve. This nerve carries the information to the brain, where the signals are interpreted.

Problems can happen with any part of this complex process. The ear canal can be clogged or the middle ear can become infected. Damage can happen to the eardrum, middle ear bones, hair cells, or auditory nerve. A person can also have problems with interpreting sound in the brain.

It is often hard to notice signs of a hearing problem in children before they are 1 year old. We don’t expect infants to listen, speak, and respond as much as we expect it of older children, so a hearing problem might not be obvious until later. But the sooner a hearing problem is found, the sooner it can be treated. With treatment, children won’t have as many delays in learning and speaking.

Below are symptoms of possible hearing loss at different ages. These symptoms don’t necessarily mean a child definitely has a hearing problem, but one is possible.

Symptoms in Infants Under 6 Months Old

• Doesn’t respond to loud noises or look toward a sound
• Doesn’t recognize or respond to parent’s voice
• Doesn’t notice a toy that makes noise
• Doesn’t make babbling or gurgling sounds

Symptoms in Infants 7 Months Old to 1 Year Old

• Doesn’t understand simple words like “shoe” or “eat”
• Doesn’t make different types of sounds when babbling or imitate sounds that you make
• Doesn’t respond to simple requests and commands, like “Stop” or “Come”
• Isn’t trying to say words (like “Dada” or “Mama”) by 1 year old
• Doesn’t try to make noise to get your attention

Symptoms in Children 1 to 3 Years Old

• Isn’t learning and saying new words
• Doesn’t point to parts of the body (like “foot”) or to pictures in a book when you say them
• Doesn’t use different consonant sounds like k, g, f, t, d, and n in words by 3 years old
• Words the child speaks are not understandable

Symptoms in Children Older Than 3 Years

• Can’t hear you call from another room
• Turns the TV or music volume louder than everyone else
• Isn’t speaking in sentences or saying most sounds correctly
• Doesn’t tell stories or give details about experiences at daycare, school, or other places

Take your child to all checkups so a healthcare provider can make sure your child is growing normally. Call your healthcare provider if you notice any symptoms of hearing loss. A child can be tested at any age.

Call right away if your child is no longer responding to sound the way they have before.

Hearing loss can have a number of different causes:

A child may be born with hearing loss

Some hearing loss is congenital, which means a child is born with it. It might be genetic, or it might be the result of something that happened during pregnancy. For example, an infection or a disease like diabetes in the mother can affect a baby’s hearing.

A child can develop hearing loss after an infection

A middle ear infection, called otitis media, is the most common cause of hearing loss in children. Ear infections are more common in children than adults because the Eustachian tube, which connects the middle ear to the throat, is small and can get blocked easily. A middle ear infection can clog the middle ear with fluid, which might be thin and clear or thick like glue.

Ear infections cause hearing loss because sound vibrations don’t pass through the ear as well when fluid is in the middle ear. This can lead to temporary hearing loss. If a child gets many ear infections, it can damage the eardrum, the bones in the middle ear, or the auditory nerve. This can cause permanent hearing loss.

A child can develop hearing loss from injury, illness, or loud noise

Children can develop hearing loss as a result of a head injury or illness. Some illness that can cause hearing loss include meningitis, measles, chicken pox, flu, and mumps. Sometimes children have blocked hearing from a buildup of earwax.

Children can also have hearing loss from exposure to loud noise through headphones or in the environment. Sometimes this hearing loss isn’t noticeable until the child is older.

Screening is brief test to find out if a child may have a hearing problem. They type of screening test given depends on the child’s age.

• Screening for babies. All newborns should have a hearing screening shortly after birth. It’s important to do this screening because it can be hard to tell if a baby has hearing loss from symptoms alone at this age. Babies who are born in the hospital usually have a hearing screening while they are still in the hospital. The tests are simple and painless, and often done while the baby sleeps. One of the tests measures echoes in the middle ear that happen when sound goes into the inner ear. Another test puts sensors on the baby’s head to check for brain activity in response to sound.
• Screening for older children. School-age children usually get their hearing checked in school with a tone test. The child has to raise a hand or press a button when they hear tones. Children don’t need a full hearing test from an audiologist unless the test shows a possible hearing problem, or a parent or doctor notices symptoms.

If the screening test shows possible hearing loss, your child may see a specialist for more testing. A healthcare professional who specializes in testing and treating hearing loss is called an audiologist (aw-dee-OL-uh-jist). Your child may be given:

• Full hearing test. The child may do more tone tests, or have hearing function tests like those given to newborns.
• Imaging tests, like x-ray or MRI. An x-ray or MRI may be used to see the structures in the ear. It helps the doctor see, for example, if the child could benefit from surgery or a cochlear implant.

Some hearing loss is temporary and goes away when the ear infection is treated or earwax is removed.

Below are treatments for other types of hearing loss:

• Hearing aids. Hearing loss can often be treated with hearing aids. Hearing aids make sounds louder and make it easier to hear when there is background noise.
• Cochlear implants. A cochlear implant is an option for children with severe hearing loss caused by damage to the hair cells in the cochlea (the inner ear). One part of the device is put into the inner ear with surgery. The other part stays outside the ear, often behind the ear like a hearing aid or in a shirt pocket.
• Hearing Assistive Technology (HATS). These devices can help children with milder hearing loss, or can be used together with cochlear implants or hearing aids. For example, an FM system can make the teacher’s voice louder and background noise quieter so the child can hear better at school.
• Rehabilitation. A therapist will give the child training to adjust to hearing loss and help them use their devices (like a hearing aid or hearing assistive technology).

Sometimes hearing loss is present from birth or the result of an illness and can’t be prevented. But you can reduce the risk of hearing loss in children by taking these steps:

• Take care of yourself during pregnancy and go for all of your prenatal care appointments.
• Make sure your child gets immunizations (shots). Many childhood diseases that can cause hearing loss can be prevented with these).
• Do your best to protect your child from noise-related hearing loss. Avoid loud concerts or bring earplugs for your child. Check the volume of your child’s headphones or ear buds. The highest volume is too loud for children.

American Speech-Language-Hearing Association, “Causes of Hearing Loss in Children”

National Institute of Deafness and Other Communication Disorders, “Your Baby’s Hearing and Communicative Development Checklist”

National Institute of Deafness and Other Communication Disorders, “How Do We Hear”