Hearing Problems


Hearing problems can be categorized a few ways. For this set of notes it would be classified by parts of the ear – Outer Ear, Middle Ear, Inner Ear

  • Outer Ear
    The job of the outer ear is to collect and channel the sound and concentrate it on the ear drum. If this canal is obstructed in any way, sound transmission is affected. The canal can be blocked by ear wax, foreign body, infection or bony growth. If the size of this canal is too narrow, sound cannot pass through efficiently too. For example, narrowing of the ear canal, absent ear canal, malformed ear lobe. This can be due to genetic codes, infection or cancer.
  • Middle Ear
    The middle ear’s function is to amplify sounds that has been directed to it by the outer ear. Example of problems in this part of the hearing system are middle ear effusion, bony growth, infection, malformation at birth, ear trauma. If the hearing problem is only in this part of the hearing system, there are medical and surgical options available apart from hearing loss.
  • Inner Ear
    If there’s a problem in the outer or the middle ear, there are medical and surgical options available to help manage the problem. But the only help available for inner ear problems are hearing aids or even cochlear implants. Problems in this area can be caused by a few factors such as genetic.

How do I know my child has hearing loss?

  • Child does not respond when he / she is called.
  • Frequent middle ear problems.
  • Asking others to repeat themselves eg . “Huh?” and “What?”
  • Dropping grades in school.
  • Poor speech and language skills.

For more details please visit :
1. http://www.jensenhearing.com/007_HearingLoss.pdf
2. http://www.speechelp.com/Web/Articles/ArticlesPDF/007_HearingLoss.pdf

Caring for a child with tympanostomy tubes

  • Avoid water getting into the ear canals – use properly fitted ear plugs or ear molds.
  • Keep the ear dry at all times.
  • The ENT surgeon together with the audiologist would check the patency of the tubes.
  • A baseline audiogram should be done before the insertion of the tubes and after.
  • Tubes will fall out between 6 to 18 months and ENT followup should be less than 6 months.
  • Complete healing of the ear drums, adequate Eustachian function and better hearing should be established before being discharged from the ENT clinic.

Types of Hearing Assessment by age

  • Otoacoustic Emmission (OAE)
    Most commonly used test for screening hearing in newborns. This test checks for the function of the inner ear. Test results can be influenced by fluid or debris in the ear canal. Babies with normal to mild hearing loss will pass this test.
  • Brainstem Evoked Response Audiometry (BERA)
    This is also known as BSER, BRA, ABR. This tests the hearing function and can be used to estimate hearing levels in babies and children that are unable to give consistent response.
  • Auditory Steady State Response (ASSR)
    ASSR is the latest inovation in hearing assessment technology that allows tone specific test. This would be more accurate than BERA but again it is not a test of hearing but a function of the auditory system.
  • Distraction Test (DT)
    Most often carried out at newborn clinics by trained nurses to screen for hearing loss. The audilogist would also use this test first for children who have good neck support. Test sounds are given through various noise makers.
  • Cooperative Tests
    Simple instructions for the child to follow to gauge listening ability. Not accurate but quick.
  • Visual Reinforcement Audiometry (VRA)
    Involves a specific test equipment set up for the children above 18 months. Sounds are presented via tube phones, headphones or speakers. Child turns to the sound source.
  • Play Audiometry (Play)
    The child’s hearing is tested through simple game activities that require the use of attention to sounds. This requires the child’s cooperation. If the child is not well or tired, the test results can be affected.
  • Puretone Audiometry (PTA)
    This test is done for older children who can give more reliable responses to sound. It involves pressing a button when the child hears a beep tone.

Middle Ear Assessments


This would be the most important and regular test for a child with Down’s Syndrome. It tests the health of the middle ear and can show if there is fluid in the middle ear. This would be important test to check the patency of the tympanostomy tubes. Tympanogram with reports by the audilogist would help the ENT surgeon or the Pediatrician to make decision on the management of the child’s hearing.

Reading an audiogram