Paediatric Hearing Loss
Dr Nirmal Patel
MBBS (Hons)(Syd) FRACS (OHNS) MS (UNSW)
Associate Professor of Surgery
(Macquarie University)
Director, Kolling Deafness Research Centre
(University of Sydney)
Summary





Introduction
Conductive Hearing Loss
Sensorineural Hearing Loss
Diagnosis
Treatment
Introduction

Hearing loss is common

1 in 1000 babies have significant
hearing loss at birth

10 in 1000 children have
significant hearing loss at school
(inc. mild and moderate)

80% of all children will have at
least one middle ear infection
And Mild Unilateral Hearing Loss
has an Impact...

Significant reduction in
language acquisition
and speech with
prolonged mild
unilateral hearing
loss.
http://www.cdc.gov/ncbddd/ehdi/documents/unilateral
hl/Mild_Uni_2005%20Workshop_Proceedings.pdf
Paediatric Conductive Loss

Congenital
• Atresia of ear
• Congenital stapes fixation
• Cholesteatoma

Acquired
• Acute and chronic otitis media
Microtia / Atresia
Congenital Cholesteatoma
Paediatric Sensorineural Loss

Sensorineural Hearing Loss (Nerve deafness)
• Genetic and Idiopathic (70%)
• Acquired (30%)
• Low birth weight/ NICU residents
• Hyperbilirubinaemia
• Ear and Head trauma
• Anoxia and Hypoxia
• Ototoxic Drugs and Chemicals
• Infectious Diseases
• Recurrent otitis media
Diagnosis
SWISH
(Statewide Infant Hearing
Screening Programme) aims to
test every child born in NSW and
identify significant hearing loss by
the age of 3 months
Parental
Family
(other carers) clues
physician
Diagnosis

History
✦
Risk factors for SNHL
✦
Auditory milestones:
•
3 months: Startled by loud sounds and
calmed by familiar sounds
•
6 months: ability to localise
•
9 months: respond to name & mimic
environmental sounds
•
12 months: First meaningful words
•
18 months: Vocabulary of 20 words or
more
•
24 months: Small sentences
Diagnosis

Examination
• Local
• Auricle
• Canal
• Tympanic membrane
(pneumatic otoscopy)
• Regional
• Syndromic features
• Tuning Forks
• Difficult under 6 yrs
Diagnosis

Investigations
• Hearing test - refer to
audiologist with children’s
experience
Diagnosis
• Refer to ENT if concerned
• Tests if suspecting SNHL
– Imaging - CT, MRI (dysplasias, large
vestibular aqueduct)
– TFT (Pendred’s syndrome)
– Urinalysis (Alport’s)
• Liase with opthalmologist (Usher’s
Syndrome), geneticist (Connexin 26)
Hart CK, Choo DI Laryngoscope April 2013
Treatment for Conductive Hearing
Loss - Chronic Otitis Media
•
Observation - minimise day care exposure and passive
smoking, reflux disease (prevalence 48%)
•
Autoinflation/ otovent - low cost no adverse effects,
reasonable to consider; cochrane review small studies
no significant benefit.
•
Nasal Steroids, antihistamines,antibiotics - no evidence
to support use. Largest effect when used for 4 weeks
to 3 months.
American Academy Otolaryngology, Pediatrics & Family Physicians Consensus 2005
Miura et al OHNS March 2012
Cochrane Review Oct 2010, Sept 2011 and Sept 2012
Treatment for Conductive Hearing
Loss - Chronic Otitis Media
•
Middle Ear Ventilation Tubes (Grommets) - effect
is small is normal speech and development. Likely
significant effect in either speech/ hearing delayed
child or developmental delayed child. Measures of
disease specific quality of life improve in all studies.
•
Children <24 months untreated have a higher risk
of speech and language delay.
•
Hearing Aids - poor compliance, fluctuating
pathology therefore difficult to fit, damage.
American Academy Otolaryngology, Pediatrics & Family Physicians Consensus 2005
Miura et al OHNS March 2012
Cochrane Review Oct 2010, Sept 2011 and Sept 2012
Bone Anchoured Hearing Aids for
Conductive Hearing Loss
Treatment for Paediatric
Sensorineural Hearing Loss

Hearing assistive techniques
• Preferential seating
• Techniques to use at home

Rehabilitation
• Hearing Aids
• FM systems

Cochlear Implantation
Cochlear Implantation Operation
Video
QuickTime™ and a
decompressor
are needed to see this picture.
Summary

Hearing loss in children is common
and significantly impacts speech and
development even in mild unilateral
loss.

Early diagnosis is the key to
treatment success.
www.HillsENT.com
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