Hearing difficulties are common in children, with multiple different causative factors. Broadly, hearing difficulties are divided into conductive and sensorineural hearing loss.
Screening for all newborns is now performed in Australia (see VIHSP website and VIHSP information sheet for more details). Failure to pass two consecutive screening tests whilst in hospital does not infer a hearing problem, although does significantly raise the chances of this. Formal audiology assessment is then suggested after three months of age (see VIHSP information sheet for more details).
Formal audiology screening is commended for any child with suspected hearing loss. This can be done through paediatric services in either Ballarat or Horsham (see below). Audiological screening will determine:
- the level of hearing loss (mild 20-40 dB, moderate 40-60 dB, severe 60-90 dB, profound >90 dB)
- the frequency of hearing loss, and
- tympanometry (A: normal; B: fluid; C: Eustachian tube dysfunction).
Differentials
Middle ear effusion is suggested by otoscopy with a dull light reflex and confirmed with type B tympanometry, sometimes with reduced hearing. It is common and often transient in children, particularly during an upper respiratory tract infections or throughout the winter months. This diagnosis in it’s own right does not require further management providing it is transient (a repeat audiological screening a few months later is suggested), however it does predispose to hearing difficulties and/or acute otitis media.
Inattentive subtype ADHD will often present with perceived hearing problems given the lack of attention children pay to auditory commands. Inattentive subtype ADHD will be accompanied by other symptoms, although a hearing test is required prior to making this diagnosis.
Auditory processing disorder (APD) is a somewhat controversial diagnosis that some consider to be a similar diagnosis to inattentive subtype ADHD. APD is diagnosed through an auditory assessment, with varying programs being marketed to treat this diagnosis.
- A newborn hearing test is only a screening process and does not diagnose a hearing difficulty – formal audiological assessment is suggested after three months in these children.
- Audiology assessment is recommended in any child with suspected hearing loss, to firstly diagnose the problem, as well as determine conductive from sensorineural problems.
- Middle ear effusions do not require antibiotics unless there are signs to suggest acute otitis media (red bulging tympanic membrane often with pus and loss of light reflex; not just an injected membrane).
Conductive hearing loss (CHL)
- Repeat audiology assessment is required to confirm the presence of persistent effusion prior any further management.
- Middle ear effusions do not require antibiotics unless there are signs to suggest acute otitis media (red bulging tympanic membrane often with pus and loss of light reflex; not just an injected membrane).
- Referral for ENT opinion with persistent middle ear effusion is recommended if the child has hearing loss, recurrent acute otitis media or speech difficulties.
- Ventilation tubes (‘grommets’) are generally recommended if this is the case.
Sensorineural hearing loss (SNHL)
- SNHL is not treated with ventilation tube insertion.
- Speech pathology is recommended if there are associated speech difficulties.
- Consideration of artificial hearing devices (e.g. hearing aides, cochlear implant) can be considered after referral to paediatric ENT services.
- Audiology
- See audiology services link.
- See VIHSP information sheet.
- ENT surgeon
- Referral to ENT services is recommended with:
- CHL with persistent effusion as well as hearing loss, recurrent acute otitis media or speech difficulties.
- SNHL if artificial hearing devices are being considered.
- Referral to ENT services is recommended with:
- Paediatrician
- Referral to a paediatric outpatient services is generally only required when
- there is concern regarding an alternate diagnosis (e.g. inattentive ADHD).
- there is concern regarding a syndromic diagnosis or positive family history underlying a diagnosis of hearing loss (particularly SNHL).
- there is concern that speech delay may be related to another cause.
- Referral to a paediatric outpatient services is generally only required when