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Hearing Loss and Its Types

Although hearing loss can occur at any age, hearing difficulties at birth or that develop during infancy and the toddler years can have serious consequences.

This is because normal hearing is necessary initially to understand spoken language and later to produce clear speech. Therefore, if your child experiences hearing loss during infancy and childhood, it requires immediate attention. Even a temporary but severe hearing loss during this time can make it very difficult for the child to learn proper oral language.

Most children experience mild hearing loss when fluid builds up in the middle ear from allergies or colds. This hearing loss is usually only temporary; Normal hearing commonly returns once the cold and allergies subside and the Eustachian tube (which connects the middle ear to the throat) drains the remaining fluid back into the throat. In many children, perhaps 1 in 10, fluid remains in the middle ear after an ear infection due to problems with the Eustachian tube.

These children do not hear as well as they should and sometimes have speech delays. Much less common is the type of permanent hearing loss that always compromises normal speech and language development. Permanent hearing loss ranges from slight or partial to complete or total.

Before sharing with you the main types of hearing loss, we’d like to share good news for you, and that is, there exists today so many types of hearing aids that no matter what’s the hearing problem, there’s most likely a proper solution out there. So, please keep that always in mind.

There are two main types of hearing loss:

Conductive hearing loss

When a child has conductive hearing loss, there may be an abnormality in the structure of the outer or middle ear canal, or there may be fluid in the middle ear that interferes with the sound transfer.

Sensorineural hearing loss (also called nerve deafness).

This type of hearing impairment is caused by an abnormality of the inner ear or the nerves that carry sound messages from the inner ear to the brain. The loss may be present at birth or may occur shortly thereafter. If there is a family history of deafness, the cause is likely to be inherited (genetic). If the mother had rubella (German measles), cytomegalovirus (CMV), or another infectious disease that affects hearing during pregnancy, the fetus may have been infected and may lose hearing as a result. The problem can also be due to a malformation of the inner ear. Most often, the cause of severe sensorineural hearing loss is inherited.

Still, in most cases, no other family members on either side will have hearing loss because each parent only carries one gene for hearing loss. This is called an “autosomal recessive pattern,” rather than a “dominant” pattern where other family members on one side would be expected to have hearing loss. The child’s future brothers and sisters are at increased risk for hearing impairment, and the family should seek genetic counseling if hearing loss is determined to be hereditary.

Hearing loss should be diagnosed as early as possible so your child is not delayed in learning language, a process that begins the day he or she is born. The American Academy of Pediatrics recommends that before a newborn baby goes home from the hospital, they should have a hearing screening. In fact, thirty-eight states now have Early Hearing Detection Intervention (EHDI) programs, which mandate that all newborns be screened for hearing loss before they are discharged from the hospital. At any time during your child’s life, if you or your pediatrician suspect she has a hearing loss, insist that she have a formal hearing evaluation right away. Although some family doctors, Pediatricians and well-baby clinics can test for fluid in the middle ear (a common cause of hearing loss), they cannot accurately measure hearing. You must take your child to an audiologist, who can perform this service. You may also be examined by an ear, nose, and throat doctor (ENT; an otolaryngologist).

If your child is under two years of age or is uncooperative during the hearing exam, one of two available screening tests may be administered, which are the same tests used for newborn screening. They are not painful, only take five to ten minutes, and can be done while your child is sleeping or quiet. These are:

  • The auditory brainstem response test, which measures how the brain responds to sound. Clicks or tones are played in the baby’s ears through soft earphones, and electrodes are placed on the baby’s head to measure the brain’s response. This allows the doctor to measure your child’s hearing without having to rely on your help.
  • The otoacoustic emissions test, which measures sound waves produced in the inner ear. A tiny probe is placed just inside the baby’s ear canal, which then measures the response when clicks or tones are played in the baby’s ear. These tests may not be available in your immediate area, but the consequences of undiagnosed hearing loss are so serious that your doctor may recommend that you travel to a location where one of them can be performed. In fact, if these tests indicate that your baby may have a hearing problem, your doctor should recommend a more comprehensive hearing evaluation as soon as possible to confirm if your child has difficulty hearing.


Treatment of hearing loss will depend on the cause. If it’s a mild conductive hearing loss due to fluid in the middle ear, the doctor may simply recommend that your child be re-evaluated in a few weeks to see if the fluid has cleared up on its own. Medications such as antihistamines, decongestants, or antibiotics are not effective in removing fluid in the middle ear.

If there is no improvement in hearing within three months and there is still fluid behind the eardrum, the doctor may recommend a referral to an ENT specialist. If the fluid continues and there is sufficient (even if only temporary) conductive hearing impairment from the fluid, the specialist may recommend that the fluid be drained through ventilation tubes. These are surgically inserted through the eardrum. This is a minor operation and takes only a few minutes, but your child must have general anesthesia for it to be done properly, so he or she will usually spend part of the day in a hospital or outpatient surgery center.

Even with the tubes in place, future infections can occur, but the tubes help reduce the amount of fluid and reduce your child’s risk of repeated infections. They also improve your hearing.

If a conductive hearing loss is due to a malformation of the outer or middle ear, a hearing aid can restore hearing to normal or near-normal levels. However, a hearing aid will work only when it is worn. You need to make sure it is on and working at all times, especially in a very young child. Reconstructive surgery may be considered when the child is older.

Hearing aids will not completely restore hearing to those with significant sensorineural hearing loss, but they will help your child develop spoken language if the hearing impairment is mild or moderate. If your child has severe or profound difficulty hearing in both ears and does not receive any benefit from hearing aids, he or she may be a candidate for a cochlear implant.

Cochlear implants have been approved by the government for children over one year of age since 1990. There is now enough experience with them to say that they work well for the vast majority of children with normal brain function. If your family is considering an implant for your child, Outcomes for developing useful speech are better with an early implant (when younger than three years of age) rather than a later one (after seven years of age). At best, these “cochlear implants” help a person become aware of sounds. They do not restore hearing nearly well enough for a child to learn spoken language without additional help, including hearing aids to amplify sounds, as well as special education and parent counseling. Recently, there have been several cases of serious infections complicating cochlear implants even months after surgery. Several are withdrawing. Because of this, if your child has a cochlear implant, contact your ENT surgeon or pediatrician right away to find out the best next step.

Parents of children with sensorineural hearing loss are usually most concerned about whether their child will learn to speak. The answer is that all children with hearing difficulty can learn to speak, but not all will learn to speak clearly. Some children learn to read lips well, while others never fully master the skill. But speech is only one form of language. Most children learn a combination of spoken and signed language. Written language is also very important as it is the key to educational and vocational success. Learning an excellent oral language is highly desirable, but not everyone who is born deaf can master it. Sign language is the main form of communication between deaf people and the way that many of them express themselves best.

If your child is learning sign language, you and your immediate family need to learn it too. This way you can teach him, discipline him, praise him, reassure him and laugh with him. You should encourage friends and relatives to learn sign language as well. Although some advocates in the deaf community prefer separate schools for deaf children, there is no reason for severely hearing, impaired children to be separated from others because of their hearing loss problem. With proper treatment, education, and support, these children will grow up to be full participants in the world around them.

One Hoolie Mama