Hearing loss in children – a diverse entity

Posted on 30 November 2020

Hearing loss in a child is always cumbersome and could be the result of various medical and para-medical conditions. Some of these presents at birth, whilst others manifest at a later stage.

According to Dr Ludwig de Jager, ENT at Mediclinic Potchefstroom, “The effect of a particular condition (causing hearing loss) on speech development becomes the main reason for concern. The impact on speech development depends on the age group and in a certain sense on the duration of the condition. It speaks for itself that the baby born with hearing loss (who has not yet developed speech) will show differently compared to the child who already acquired language skills and then develops a condition that affects hearing acuity – say for example otitis media.”

 

How can we pick up on hearing loss in the infant?

Dr de Jager believes that the delay or stalling of speech development is an important tell-tale sign that there might be a hearing impediment in the infant.  In developed countries, universal neonatal screening programmes play a significant role in early identification of infants with hearing loss. This unfortunately is not necessarily the case in developing countries. However, as with the well known general neurological developmental milestones (sitting, crawling, and walking) there is also a well formulated roadmap for milestones in speech and language development. For example: initial cooing goes over in babbling by age 6 months. The first word appears roughly at 12 months with steady progression not only in vocabulary but also in grammar and phonology skills so that come 5 years the child should understand time sequences and engage in conversations, easily using sentences of 8 words or more in length. Although robust, this gives parents and healthcare workers a handle by which to fathom speech development and look for help when an abnormality is expected.

Humans have an innate ability to acquire language. However, this can only happen through consistent exposure to sound and language. And this window of magically mastering a complicated skill closes after the age of 5. For this reason, Dr de Jager believes that early diagnosis of infants and children with hearing impairment is critical as speech and language abilities in children with hearing impairment could equal that of their hearing peers if intervention commences timeously.

 

How is hearing loss managed or treated?

“The hearing part of the ear is responsible for converting a sound wave into an electrical impulse which is then sent to the brain via the nerve of hearing,” Dr de Jager explains. “Hearing loss is characteristically divided into two groups: conductive and sensori-neural. In conductive loss, the sound wave literally has trouble reaching the cochlea where the conversion of sound to electricity takes place, sensori-neural hearing loss implies a problem with the cochlea (or conversion mechanism) itself.”

According to Dr de Jager, the type and magnitude of hearing loss will dictate the remedy. Surgery might be indicated for the conductive group. The procedure might be as simple as draining middle ear fluid or involve a complex procedure as in total reconstruction of various parts of the ear. In the sensori-neural group, amplification is the mainstay of treatment. As a rule of thumb conventional hearing aids should provide excellent rehabilitation in the patient with mild to severe hearing loss, but once the loss becomes severe to profound, cochlear implantation is preferred.

Dr de Jager concludes, “We have come a long way in our means to diagnose and manage hearing loss in children over the last few decades. We can just hope that neonatal screening will become a universal obligation. This should not be regarded as a privilege; it is a right. Not recognising hearing loss early in the child has potential tragic consequences, even more so in a third world environment with its inherent limited resources.”

Dr de Jager deals with hearing loss in more detail on The Future of Healthcare.

 

Further reading: Tips to protect your hearing