It is estimated that up to 3 infants per 1,000 born in the United States have significant hearing loss. Studies have shown, however, that significant hearing problems present at birth are often not diagnosed until the child’s second or third year of life. This is unfortunate because the earlier a hearing loss is recognized and treatment is begun, the better the outlook for the child’s learning and for development of speech and language skills.

Because of this situation, it is now recommended that all newborns be given early hearing evaluations. At the time of this writing, many states are in the process, or have completed the process, of passing legislation to mandate such screening. Many hospitals have already instituted newborn hearing screening programs. This is a big step forward toward meeting the goal of early detection and treatment of hearing problems.

Signs of a Possible Hearing Problem

Screening for hearing problems should be a part of your child’s regular checkups right from the start. Before your child is old enough to cooperate with more formal hearing tests, your child’s doctor will be looking for other signs that might indicate a hearing problem. Some of the signs that you and the doctor should look for include the following:

• Your newborn doesn’t startle or jump in response to sudden loud noises.
• Your infant doesn’t turn to the source of a sound or seem to recognize your voice by three to four months of age.
• Your infant babbles and coos in the first few months but then stops making speech sounds.
• Your infant tends to make only vibrating or gargling sounds.
• Your child doesn’t imitate some sounds or say some single words like Mama or bye-bye by 12 months of age.
• Your child’s speech is delayed or difficult to understand.
• Your child’s development is delayed in other areas such as sitting and walking.
• Your child seems to hear certain types of sound but not others.
• Your child has trouble telling where a sound is coming from.
• The quality of your child’s voice is unusual.
• Your child doesn’t notice when people enter the room unless he sees them.
• Your child doesn’t respond when you call or doesn’t listen to your instructions.
• Your child has problems with learning or attention.
• Your child seems to need to watch people’s lips when they speak.
• Your child turns the TV volume up very high.

The doctor will also give particular attention to hearing tests if your child has any of the following risk factors for hearing impairment:

• A history of childhood hearing loss in a family member
• A mother who had a rubella (German measles) or CMV (cytomegalovirus) infection during pregnancy
• A premature birth or severe medical problems at birth
• A history of meningitis (infection of the covering of the brain)
• Frequent ear infections, certain genetic syndromes, or birth defects, particularly those that involve the ears, face, skull, or brain (such as cerebral palsy)

If your child’s doctor suspects your child may have a hearing problem or be at risk for one, of course you’ll want to know why. Your child’s doctor may be able to determine if the problem is congenital (present at birth) or if it developed later as the child grew. Hearing impairment may be hereditary or related to certain pregnancy problems (infections, drugs), prematurity, severe medical problems at birth, meningitis or other infections, repeated ear infections, traumatic injuries to the ears or brain, and certain genetic syndromes or birth defects.Whatever the cause, early detection and treatment are what’s most important.

Managing Ear Infections

Ear infections in young children are common. If your child has symptoms, his ears will be examined. This will also be done at routine checkups. If an ear infection is detected, usually an antibiotic is prescribed. Your child may be examined again after the course of medication is completed to make sure the infection has cleared. If, after treatment, your child’s ear examination findings have not returned to normal as expected, your child’s doctor may perform a test called a tympanogram to evaluate how well the eardrum and the middle ear are functioning.

To perform a tympanogram, the person doing the test places the soft rubber tip of the testing device in your child’s ear to deliver air pressure and sound into the ear. The goal is to see how much of the tone is absorbed or reflected off the eardrum as the pressure changes. This test causes a sensation like the “clogged ears” feeling when going up in an airplane, but it is not painful. An abnormal test result may indicate that there is a persistent collection of fluid behind the eardrum and that the infection may not have cleared completely. If, despite treatment with different doses and/or types of antibiotics, the test result remains abnormal over several weeks, the doctor may refer your child to an ear, nose, and throat (ENT) specialist.

Hearing Specialists

If your child’s doctor thinks that your child might have persistence of fluid in the ear or recurrent infections that might interfere with your child’s hearing, he or she will probably refer your child to a pediatric audiologist or ENT specialist for further evaluation. An ENT specialist is a medical doctor who specializes in the treatment of ear, nose, and throat problems. The doctor will take a medical history and will examine your child to determine if your child is at risk for hearing problems.

About 85 to 90 percent of the children seen by an ENT specialist for recurring or persistent ear problems are also referred to a pediatric audiologist for further testing. Pediatric audiologists are experts in the testing of hearing of infants and children.

Hearing Tests for Children

There are several methods of testing a child’s hearing. The method chosen depends in part on the child’s age, development, and medical status. Here’s an overview of the tests used for screening and evaluating hearing problems at different ages. Screening Tests for the Newborn The technique most commonly used to screen a newborn’s hearing today is called an otoacoustic emissions (OAE) test. This test can be performed shortly after birth as part of the routine newborn screening process. But because some newborns fail due to wax or debris in the ear canal, it’s best to wait until just before discharge from the hospital to perform this test on a newborn.

Another newborn screening test used at some hospitals is an automated auditory brainstem response (ABR) test. The ABR is a bit more thorough than the OAE in that it tests a larger part of the infant’s hearing pathway from the ear to the brain. However, some hospitals do not use it because the results can be more difficult to interpret.