A 7-year-old female came to clinic for her health supervision visit. She had a history of recently identified unilateral, moderate, conductive hearing loss that was found during a school hearing screening. She had a history of recurrent otitis media when she was younger. The father stated that they were ordering her a hearing aid but he was concerned about potential complications and wanted to know more about them. The family history was positive for hearing loss in a great grandfather when he was old.
The pertinent physical exam had normal vital signs and growth parameters were in the 50-90%. Her physical examination was normal. The diagnosis of a healthy child with a moderate hearing loss was made. The pediatrician said that he didn’t know exactly what the complications were but not having the hearing aid fitted properly, possible skin infection and wax build up seemed to be likely. He recommended that the father talk again with the audiologist either before or during her next appointment so he understood the common potential problems and how to use the device properly.
Hearing loss can range from profound deafness to fairly minor loss. The causes vary based on age, type of loss (sensorineuronal or conductive, about half of hearing loss in children has a genetic cause), degree and audiometric configuration. Sensorineuronal hearing loss involves the cochlea and neural connections to the brain and auditory cortex. Conductive hearing loss involves structures from the external ear to the oval window. Deafness is defined as a hearing loss > 90 dB. Hearing loss can affect the living and learning of children more than many people realize. “A child with a mild hearing loss can miss up to 50% of what is being said in the classroom.” Therefore it is important to screen for hearing loss. A differential diagnosis of hearing loss can be found here.
People with hearing loss or deafness will use different hearing equipment and have different preferences for communication. Use of spoken language is usually a person’s first choice, but they may use lip-reading, a signed language, hearing equipment or a combination of these. Signed languages may need an in-person or video-type interpreter, but there are technologies being developed that are trying to use automated translation. There are also technologies which directly connect hearing aids to radios/televisions/computers or to other equipment within a work environment or home (e.g. telephone, doorbell). It is important to ask the person their communication preferences and provide appropriate communication before, during and after appointments. Other tips for the provider during the visit are the same for any other good communication interaction: get the person’s attention, face the patient without the face or mouth covered, the provider’s face should have good lighting, make sure the topic of conversation is understood, reduce background noise, and continue to try to communicate even when it may be difficult.
Intra-aural or air conduction hearing aids don’t restore sounds but help to magnify the sound and allow people to hear better than they could otherwise. They do not work right away, unlike eyeglasses, as the brain needs to adapt to the improved sound.
Possible complications of intra-aural hearing aids include:
- Comfort and skin irritation – Ill-fitting devices can cause pain or skin irritation that can be improved with proper fitting
- Headache and tinnitus often improve with more time as the brain gets used to the improved sound
- Pruritus caused by cerumen accumulation – keep cerumen moving by cleaning out ears with spray/drops which also help moisturize the canal.
- Feedback of sound – sounds like whistling/cracking. Usually brief but if consistent or frequent may need an audiologist to evaluate
- Poor sound quality or improper volume level – may need the audiologist to evaluate, can use a programmable hearing aid, device may need cleaning or batteries
- Loss of device
Possible complications of bone conduction hearing aids in studies in adults cite <10% for major complications and <25% for minor complications. In a retrospective chart review of pediatric cases, complications were more common than adults with 44% needing revision surgery (e.g. surgical skin interventions, fixture problems), and 53% had minor complications, mainly skin infections and skin overgrowth.
Questions for Further Discussion
1. What are the hearing screening recommendations in your location?
2. What types of hearing screening tests are used and what are their pros/cons?
3. List some genetic syndromes which have hearing loss as a major sign?
4. What are the hearing risks of using earbuds and headphones?
5. How much do hearing aids cost?
- Symptom/Presentation:Hearing Problem
- Specialty: Otolaryngology | Speech and Hearing
- Age: School Ager
To Learn More
To view pediatric review articles on this topic from the past year check PubMed.
Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews.
Information prescriptions for patients can be found at MedlinePlus for these topics: Hearing Aids and Hearing Disorders and Deafness.
To view current news articles on this topic check Google News.
To view images related to this topic check Google Images.
To view videos related to this topic check YouTube Videos.
Hearing Aids Side Effects. Hearing Direct. Published September 6, 2017. Accessed October 26, 2020. https://www.hearingdirect.com/blog/hearing-aids-side-effects.html
Chan KH, Gao D, Jensen EL, Allen GC, Cass SP. Complications and parent satisfaction in pediatric osseointegrated bone-conduction hearing implants. Laryngoscope. 2017;127(9):2165-2170. doi:10.1002/lary.26469
Easson A, Walter S. Hearing-impaired young people – a physician’s guide. Clin Med (Lond). 2017;17(6):521-524. doi:10.7861/clinmedicine.17-6-521.
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa