Pediatric Ear Services

Hearing loss can affect those of all ages, including children. Diagnosing and treating hearing loss in the pediatric population requires different instruments than those used on adults. Children may also suffer from different disorders.

To test the hearing of newborns and infants, subjective tests must be used, as newborns are unable to articulate what they can and cannot hear. Auditory Brainstem Response (ABR) provides information on how well a child’s cochlea and neural pathway is functioning. Electrodes are placed on and around their head to measure their brainwave activity in response to sounds. Otoacoustic Emissions (OAEs) are the barely audible sounds given off by the hairs lining the cochlea. A small probe is placed into the ear and a sound is played to elicit the release of OAEs. If no OAES are detected, this could mean there is a blockage in the ear canal, fluid in the middle ear or damage to the hair cells within the cochlea.

For slightly older children, visual response audiometry and conditioned play audiometry can be used. A sound is broadcast through speakers within a specially designed booth. Depending on the child’s age, they are either taught to turn their head towards an animated toy or video (visual response) or drop a block in a bucket (conditioned play) when they hear a sound. These versions of pure-tone testing cannot discern single-sided hearing loss.

Speech discrimination tests can be performed on children three years of age and older. A series of words is read aloud to the child and they are either asked if they heard the words or they are asked to repeat the words back to the tester. This test may be performed in different environments with different levels of background noise.

Infections of the middle ear are the most common causes of hearing loss of children. An infection is caused by a buildup of fluid within the middle ear. Eustachian tubes are small tubes that connect the middle ear with the back of the throat. These tubes are responsible for regulating pressure and fluid within the middle ear. In children, these tubes are much smaller and sit horizontally, which means they are more likely to get blocked. A common solution to middle ear infections in ear tubes. A simple surgery creates a hole in the child’s eardrum, a small tube is place within the hole to keep it open. This hole helps to prevent fluid from building up, preventing future ear infections. After a few months these tubes usually fall out on their own.


Ear Infections

Causes

Ear infections occur when fluid fills the space between the eardrum and the inner ear. This happens when the Eustachian tube becomes blocked thanks to a virus or bacterium, preventing mucus and pus from draining out of the middle ear. These fluids put pressure on the eardrum, causing pain and discomfort.

Children are especially susceptible to ear infections thanks in large part to anatomy. The structure of their Eustachian tubes, which are still developing until about the age of two, makes them prone to swelling and blockages. Children who attend daycare or school and those who are exposed to tobacco smoke are most at risk.

Symptoms

The first sign of an ear infection may be an increase in irritability. Some children cry inconsolably. You may notice your child pulling or tugging on the ear. In addition to a painful earache that is worse when lying down, symptoms of ear infection include fluid discharge from the affected ear, a feeling of fullness in the ear, difficulty hearing, trouble sleeping, headache, fever, dizziness, vomiting, diarrhea, and a lack of appetite.

An ear infection is easily diagnosed through an examination of your child’s ears with an otoscope. If the ears appear dull or red, contain fluid behind the eardrum or pus inside the middle ear, then an ear infection is likely to blame. A hearing test may be recommended, especially if your child has had ear infections in the past.

Treatment

Many doctors prefer to take a wait-and-see approach when it comes to treating ear infections, especially with younger children. They often clear up on their own without the need for antibiotics or other aggressive forms of medical treatment. Pain can be managed with medications like Tylenol or Motrin (be sure to avoid giving your child aspirin, which has been linked to a dangerous condition known as Reye’s syndrome) or eardrops. Use a warm washcloth pressed to the ear for comforting relief. If the ear infection doesn’t go away on its own and is the result of a bacterial infection, antibiotics will be prescribed.


Ear Wax Removal

Earwax (cerumen) is a yellowish waxy substance produced by healthy ears. Earwax protects the ear from bacteria, water and foreign particles. It also assists in the cleaning and lubrication of the ear canal. Usually, excess wax is removed from the ear canal naturally. If a buildup does occur, the earwax will become hard and block the ear.

Causes

A blockage of earwax is usually caused by an overproduction of earwax or insufficient cleaning. Surprisingly, the most common cause of a blockage is incorrect at-home earwax removal. Often, instead of cleaning out the earwax it is just pushed deeper inside the ear. Earphone usage can also cause wax buildup, as the earphones can prevent earwax from naturally coming out of the ear canal.

Symptoms

Earaches, a feeling of fullness in the ear, hearing loss and ringing in the ear (tinnitus) are all common signs of earwax blockage. If the earwax is not removed an infection can develop. This would include severe pain in the ear that does not subside and a fever. If you are experiencing any of these symptoms, you should talk to your doctor, as these may also be signs of a more serious condition.

Treatments

In order to diagnose a buildup of earwax, your doctor will need to look in your ear with a special magnifying instrument called an otoscope. Once diagnosed, your doctor can remove the wax buildup a few ways: with a small curved instrument called a curet, through suction or by flushing out the wax using a water pick or warm water. If this continues to be a problem, wax-removal medications may be recommended.

As long as your ear is healthy and does not have tube or a hole in it, at-home treatments can be helpful to manage earwax buildup. An eyedropper can be used to apply a few drops of baby oil, mineral oil or hydrogen peroxide into the ear canal; this is done to soften the wax. Once soft, after an hour or a few days, the wax is ready to be removed. A rubber-bulb syringe can be used to gently squirt warm water into the ear canal. Once the water has drained out of the ear, the ear should be dried with a towel. This procedure can be repeated several times until the wax has been removed.


Foreign Objects in the Ear

Children are curious creatures, which is why it’s not unusual for a toddler to be brought to an ENT for removal of a foreign object (like food, toys, bugs, etc.) from the ear.

In general, foreign objects in the ear are nothing to be concerned about. Likely, the child will experience minor discomfort. However, a child should be brought to the doctor immediately if they appear to be experiencing hearing loss, pain, nausea, bleeding or other discharge.

The biggest risks a foreign object can pose are infection and ruptured eardrum. If the ear becomes infected, treatment usually includes antibiotic drops. If the eardrum is damaged, the physician may recommend a wait-and-see approach or minor surgery for severe ruptures.

If you notice a foreign object in your child’s ear, see if it can be easily removed. If it isn’t, then it should be removed by a professional who may use suction, magnets or irrigation to flush it out.

A follow-up appointment will likely be recommended after an object is removed. If you notice continued drainage, bleeding or discomfort in your child after your appointment, call the doctor right away.


Congenital Abnormalities

Congenital ear deformities are birth defects that affect the shape, function and position of the ear. It is estimated that 5 percent of the population is born with an ear malformation. Two of the most frequent conditions are microtia (small ears) and protruding ears.

Microtia occurs when the ears are underdeveloped and smaller than normal. Most children born with this condition have a normal inner ear, but the outer ear structures – including the opening – may be missing. This causes hearing difficulty, and makes it hard to determine directionality. It is most common in males and is more likely to affect the right ear than the left. Surgery to correct the ears usually takes place in stages, but must wait until the ear has stopped growing (around the age of 6). The surgeon uses cartilage, typically from the ribcage, to construct a new outer ear structure. A total of two to four surgeries is usually required.

Protruding ears are those that stick out more than 2 centimeters from the side of the head. Prominent ears are more of a cosmetic concern than a medical issue, and may be corrected through the use of ear molding or surgery. Ear molding is a technique to mold deformed ears into a normal shape by manipulating the still-soft cartilage of an infant through the use of orthodontic molding materials. This procedure works best within the first three to six weeks; after this point, the ear cartilage stiffens and can no longer be molded. A procedure known as otoplasty can be used to surgically correct protruding ears. Again, it is preferable to wait until the ears have stopped growing before performing the operation. During an otoplasty, an incision is made behind the ears, and cartilage is used to create an antihelical fold that serves to “pin” the ears back.


Pediatric Hearing Loss

Hearing loss isn’t confined to older adults: children of all ages can experience a loss of hearing. Roughly 3 out of 1000 babies are born with hearing loss, and its prevalence is increasing in adolescents. Noise-induced hearing loss is largely responsible for this increase. If you suspect your child is having difficulty hearing, seek medical attention as soon as possible. Delaying can have a strong effect on a child’s learning and development.

Causes

There are three main causes of hearing loss in children. Congenital factors contribute to children who are born with hearing problems because of genetic issues, prenatal problems, or premature birth. Otitis media (ear infection) is a very common childhood ailment that occurs when fluid accumulates in the middle ear. This can cause difficulty hearing and, in severe cases, may lead to permanent hearing damage. Acquired hearing loss is triggered by illnesses, physical trauma, exposure to loud noises, and medications.

Symptoms

How can you tell if your child might have a hearing loss? There are a number of signs that should prompt you to have your child’s hearing tested ASAP. These include:

• A delay in speech and language.
• Failure to respond to loud noises or your voice.
• Poor academic performance.
• Frequent ear infections.
• Disorders associated with hearing loss (i.e. Down syndrome or autism).
• Family history of hearing loss.

Treatment

There are numerous options for treating hearing loss in children, depending upon the type and severity of their condition. Your child’s doctor may take a wait-and-see approach when it comes to otitis media; chronic cases may be treated with medications or ear tubes that are inserted surgically and allow fluid to drain from the ears.
Permanent hearing loss can be treated with hearing aids, cochlear implants, and other hearing devices that enable a child to communicate.

The earlier you act, the less chance of your child experiencing speech of learning difficulties as the result of a hearing impairment.

Call (913) 663-5100 for more information or to schedule an appointment.