Paediatric ENT: does my toddler have a hearing problem?
Written in association with:Hearing loss in children can either be present from birth (congenital) or can develop after birth and throughout childhood (acquired). As your baby grows there are some signs of hearing loss to look out for. Fortunately, leading ENT surgeon Professor Owen Judd is here to explain the causes of hearing loss and how it presents in little ones.
What are the causes of hearing loss in children?
Congenital hearing loss can be caused by abnormal development of the hearing system as an embryo and may be due to genetic abnormalities or many different syndromes. This type of hearing loss can also be caused by infections in the womb, which is often why pregnant mothers are advised on avoiding certain exposures to infections during pregnancy.
Acquired hearing loss is more common. This can either be due to an infection of the ear or trauma. However, the most common type of hearing loss in a child is a conductive hearing loss caused by glue ear.
What is glue ear?
Glue ear is an extremely common condition affecting 80% of all people at some point during their childhood, and at any one point in time 20% of all children will have glue ear.
This condition occurs due to blockage of a small ventilation tube called the Eustachian tube, which passes from the back of the nose to space behind your eardrum (the middle ear space). The Eustachian tube acts to allow air into the middle ear space and keep the eardrum and the tiny bones of hearing moving normally. The tube can become blocked very easily in children (especially toddlers) as they have a soft tissue mass in the back of their noses called the adenoids. These swell up when children get colds and coughs and physically block the Eustachian tube.
The result of this blockage is that air cannot pass into the middle ear and it fills with fluid. With time this fluid becomes thick and sticky, like glue, hence the name. The fluid stops the eardrum and bones of hearing from moving and causes a conductive hearing loss.
What are the signs of a hearing problem in my toddler?
Children may present with a hearing loss in different ways. Young children may not be able to simply say, “I can’t hear” and so we need to look out for more subtle signs of a hearing loss, which includes:
- Language delay
Very young children may show signs of loss by not developing speech and language at the appropriate rate. A good rule of thumb is to know that by age two children should be able to form two-word sentences (2 words at 2 years). If this seems delayed, your child may have a hearing loss. However, don’t forget that all children develop at different rates and this may be normal for your child. Try to avoid comparing them to older siblings.
- Poor pronunciation
Speech pronunciation issues may also be noticed, as the child may not be hearing words correctly to copy them accurately.
- Lack of response
Not responding to instructions or when their name is called can often be a sign of hearing loss. If this only happens occasionally, your child may simply be concentrating on something else (selective hearing), but if this is a regular occurrence or that they don’t respond to something you would expect them to (like offering sweets or a toy) then this may be a sign that they cannot hear.
- Increasing TV or games volume
If your child cannot hear the TV or electronic games and is constantly requesting the volume to be turned up, this could be a sign. Interestingly, over-sensitivity to noise can also be a sign of hearing impairment.
- Nursery or teacher concerns
Sometimes if a toddler goes to a nursery, it may be the nursery staff or childminder that picks up on a problem, especially if they are acting differently to other children in a group. As children grow and move to mainstream schools, hearing loss may also be picked up by teachers, or it may be noted that your child is falling behind others in the class.
If you feel you child is displaying any of these signs, or you are generally concerned about their hearing, then visit your GP who may be able to organise a hearing test for your child.
