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childaudiology.jpgDid you know that no child is too young to have his or her hearing tested? Early diagnosis of hearing loss in children is critical for proper speech and language development. Children acquire a significant amount of language from listening to the speech and language of others. If a hearing loss is present, especially during the first few years of life, the child is deprived much of the language learning opportunity. There are many different causes of hearing loss in children including otitis media (middle ear infections), congenital (present at birth) and acquired. Each of these can have detrimental effects on language acquisition and communication if left unidentified and untreated. As a result, audiological evaluations play a pivotal role in the overall care of children. Irreversible hearing losses can be evaluated and fitted with hearing aids which provides critical auditory input. Diagnosis of hearing loss and fitting hearing aids on children can be a special challenge, but our staff's experience allows us to provide the proper hearing care. Our audiologists are some of the most experienced pediatric audiologists with extensive experience testing hearing in children.

Otitis media is an inflammation in the middle ear (the area behind the eardrum) that is usually associated with the buildup of fluid. The fluid may or may not be infected.  Young children are more prone to this condition than adults, due to the configuration of the eustachian tube. The term "glue ear" may be used, referring to the white fluid behind the drum.

Symptoms, severity, frequency, and length of the condition vary. At one extreme is a single short period of thin, clear, noninfected fluid without any pain or fever but with a slight decrease in hearing ability. At the other extreme are repeated bouts with infection, thick "glue-like" fluid and possible complications such as permanent hearing damage and/or erosion of the tiny bones (the ossicles) connecting the ear drum to the inner ear.

Fluctuating conductive hearing loss nearly always occurs with all types of otitis media. In fact it is the most common cause of hearing loss in young children.

Otitis media is the most frequently diagnosed disease in infants and young children (1). Seventy-five percent of children experience at least one episode of otitis media by their third birthday. Almost one-half of these children will have three or more ear infections during their first 3 years of life (2). Health costs for otitis media in the United States have been reported to be $3 billion to $5 billion per year (3).

Why is otitis media so common in children?

The Eustachian tube, a passage between the middle ear and the back of the throat, is smaller and more horizontal in children as compared to adults. Therefore, it can be more easily blocked by conditions such as large adenoids and infections. Until the Eustachian tube changes in size and angle as the child grows, children are more susceptible to otitis media.

Three tiny bones (ossicles) in the middle ear carry sound vibrations from the eardrum to the inner ear. When fluid is present, the vibrations are not transmitted efficiently from the eardrum through the ossicles and sound energy is lost. The result may be mild or even moderate hearing loss. Therefore, speech sounds are muffled or inaudible.

When fluid is present behind the eardrum, the eardrum becomes thicker and often times retracted into the middle ear space. Because of this it doesn't vibrate as efficiently to conduct sound to the three tiny bones in the middle ear which carry the sound vibrations to the inner ear. As a result, sound energy is lost. The result may be mild or even moderate hearing loss. Therefore, speech sounds are muffled or inaudible.

Generally, this type of hearing loss is conductive and most often temporary and fluctuating. However when otitis media occurs over and over again, damage to the eardrum, the bones of the ear, or even the hearing nerve can occur and cause a permanent conductive or sensorineural hearing loss.

Children learn speech and language from listening to other people talk. The first few years of life are especially critical for this development.

If a hearing loss exists, a child does not get the full benefit of language learning experiences.

Otitis media without infection presents a special problem because symptoms of pain and fever are usually not present. Therefore, weeks and even months can go by before parents suspect a problem. During this time, the child may miss out on some of the information that can influence speech and language development.

How can I tell if my child might have otitis media? Even if there is no pain or fever, there are other signs you can look for that may indicate chronic or recurring fluid in the ear:

  • Inattentiveness
  • Wanting the television or radio louder than usual
  • Misunderstanding directions
  • Listlessness
  • Unexplained irritability
  • Pulling or scratching at the ears
  • Balance problems

A physician should handle the medical treatment. Ear infections require immediate attention, most likely from a pediatrician or otolaryngologist (ear doctor). If your child has frequently recurring infections and/or chronic fluid in the middle ear, two additional specialists should be consulted: an audiologist and a speech-language pathologist.

An audiologist's evaluation will assess the severity of any hearing impairment, even in a very young or uncooperative child, and will indicate if a middle ear disorder is present.

A speech-language pathologist measures your child's specific speech and language skills and can recommend and/or provide remedial programs when they are needed.

As a parent, you are the best person to look for signs that suggest poor hearing. The American Academy of Pediatrics recognizes this when it states, "Any child whose parent expresses concern about whether the child hears should be considered for referral for behavioral audiometry without delay".

Parents should not be afraid to let their instincts guide them in requesting or independently arranging for further evaluation whenever they are concerned about their children's health or development.

Causes of Hearing Loss in Children. Retrieved November 12, 2009, from http://www.asha.org/


Acquired hearing loss is a hearing loss which appears after birth, at any time in one's life, perhaps as a result of a disease, a condition, or an injury. The following are examples of conditions that can cause acquired hearing loss in children are:

  • Ear infections (otitis media)-(see specific section above)
  • Ototoxic (damaging to the auditory system) drugs
  • Meningitis
  • Measles
  • Encephalitis
  • Chicken pox
  • Influenza
  • Mumps
  • Head injury
  • Noise exposure

Causes of Hearing Loss in Children. Retrieved November 12, 2009, from http://www.asha.org/


At Clear Choice Hearing and Balance we provide a full range of pediatric evaluations to assess hearing loss in infants and children of all ages. Our available tests include behavior observed and play audiometry, tympanometry, acoustic reflex, and otoacoustic emissions (OAE). Children can be tested at any age from birth onward. There are two primary categories of hearing testing which are utilized with children. Physiologic tests are those which rely upon non-behavioral responses from the child's auditory system. Behavioral tests are those which rely upon responses from the child to obtain results. The younger the child is the more results are obtained through physiologic measures where the child remains passive.

Physiologic Tests: Used for children from birth and older, dependent upon the abilities and reliability of the child.

  • Otoacoustic Emissions (OAE) is the primary screening tool utilized by hospitals for the Newborn Hearing Screening. A soft probe is placed in the child's ear which delivers a sound to the ear and in return measures the echo response sounds emitted from the inner ear. The results are obtained in a pass/ fail format and do not provide specific information regarding hearing levels. This test not only provides very valuable information for hospital screening but is also routinely utilized in clinical settings.
  • Tympanometry and Acoustic reflexes are tools used to assess middle ear function and identify the presence of fluid (effusion), negative middle ear pressure, ossicular chain (middle ear bones) disruption, tympanic membrane (ear drum) perforation and otosclerosis. A soft probe is placed in the ear which delivers a safe measurable amount of sound and pressure. The middle ear system's response to this sound and pressure is recorded.

Behavioral Tests: Used for children primary ages six months and older.

  • Behavioral Observed Audiometry (BOA) utilized from approximately six months to three years of age-is a test where the infant or child is seated on a parent's lap in a sound treated room. Sounds are presented through speakers and the child's responses, such as heard turning, are observed.
  • Play Audiometry utilized from approximately three years to five years of age-is a test where the child is conditioned to respond to sounds with a play task such as placing a block in a bucket after hearing tones through head phones.
  • Standard Audiometry utilized from five years of age and beyond-is a test where the child is instructed to raise their hand every time they hear the tone through head phones.

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