Hearing Loss and Evaluation
We see many children ear year at the request of their pediatrician, their nurse practitioner, their audiologist, their speech pathologist or their teacher for a complaint of possible hearing loss.
There are three primary types of hearing loss: conductive, sensorineural or mixed.
(i) Conductive hearing loss means that something is interfering with the “conduction” system for taking sound from the environment and transmitting it to the hearing organ (the “inner ear “). Things that cause this can be ear wax (cerumen), ear fluid (middle ear fluid or effusions), ear infections, cholesteatoma (a skin cyst in the ear), a permanent hole in the eardrum or problems with the hearing bones. This causes the loudness of sounds to drop. This may be easily treated with ear tubes, it may need an eardrum repair, a prosthetic hearing bone, or it may be a permanent loss. It may be aided with a hearing aid or a Baha™, which is an implantable type of hearing aid.
(ii) Sensorineural hearing loss means that the hearing organ (the “inner ear” or “cochlea”) or the hearing nerve may be defective, injured or deteriorating. This causes the loudness of the sounds to drop, and it can cause the clarity of the sounds to drop also. It may be aided with a hearing aid, or it may be so serious that a cochlear implant is an option. A cochlear implant is an electronic device that can be used to send sound information to the hearing nerves instead of relying on the inner ear.
(iii) Mixed hearing loss means that there are problems with both parts of the hearing, and the baseline sensorineural hearing loss can be made worse by fluid in the ears. This can be aided and may mean that ear tubes are needed.
If your child has any of these types of hearing loss, it is important to have a medical evaluation when your child’s hearing loss is confirmed by the audiologist, or if you are having trouble determining how much hearing your child has. The medical evaluation helps determine if ear infections or ear fluid need treatment, if there is a potential for other serious medical problems and if there is an obvious prognosis for worsening of the hearing loss for your child as well as for other family members.
With sensorineural hearing loss, we may suggest some or all of the following tests:
(i) A CT scan or an MRI of the temporal bone. This helps us determine if there are abnormalities in the inner ear (“cochlea”) that will predict possible worsening of hearing loss or preventable worsening of the hearing loss. It helps us determine the candidacy and safety of the ear for potential cochlear implantation.
(ii) An EKG. There are some electrical abnormalities in the heart that are associated with hearing loss. Early treatment of this abnormality can be life-saving.
(iii) An urinalysis. This helps us detect certain types of kidney problems associated with hearing loss.
(iv) An evaluation by an eye specialist, or Ophthalmologist. This helps us looks for changes in the eye that can be linked to hearing loss and it helps make sure that your child’s vision isn’t impaired at the same time and making school harder.
(v) An evaluation by a Geneticist. This helps us to learn more about hearing loss, it helps with research for your own family and for other children with hearing loss, and it can help you prepare for the possibilities of other children in the family having a hearing loss or other related medical problem that requires early treatment.
If you will be moving on towards cochlear implantation, we might also suggest:
(i) A minimum three-month trial with hearing aids to see if they are providing any improvement in hearing.
(ii) A speech evaluation by Shawna Pearce, our implant specialist in Speech Pathology.
(iii) A record of vaccinations, which will need to include complete pneumococcal vaccination in accordance with the CDC guidelines; additionally, we recommend Hib and meningococcal vaccination.
(iv) CT imaging and/or MRI imaging.
(v) Possibly, a developmental pediatrics evaluation.