Jj is for Jottings 87. Fluctuating Hearing Loss.
Fluctuating hearing loss in young children often results in speech and language delays. (For an explanation of the differences between ‘speech’ and ‘language’ see here.) Figures quoted by the Audiometry Nurses Association of Australia Inc suggest that 90% of childhood hearing loss is of the fluctuating kind. For figures for Australian 4-5 year olds having a speech problem from any cause see here.
“Wait a minute – I can’t hear you. I have fluctuating hearing loss. I’ll just cup my ear so I can hear you better.”
CONDUCTIVE HEARING LOSS.
Conductive hearing loss in childhood is usually caused by:
- Ear infections (otitis media).
- Glue ear, which is a build-up of fluid in the middle ear – without an infection. The middle ear is usually air-filled, which allows the ear drum to move and transmit sound waves through the middle ear via the ossicles (bones – the hammer, the anvil and the stirrup) to the inner ear (cochlea). The air gets to the middle ear via the Eustachian tube which connects the middle ear to the back of the nose. With glue ear, the fluid doesn’t allow the eardrum to vibrate nearly so well, and therefore doesn’t “pass on the message” as effectively. Think of the effect of filling a balloon with water as opposed to air.
FLUCTUATING HEARING LOSS.
Fluctuating hearing loss results when a child has an ear infection, with pus build-up behind the ear drum – very painful. The pus has the same effect on the mobility of the eardrum as the fluid. If not treated with antibiotics the eardrum can burst, which can lead to scarring and a less mobile eardrum which, in turn, may result in permanent hearing loss. Otherwise, the child can have normal hearing in between ear infections and voilà – we have a fluctuating hearing loss.
Alternatively, a child can have bouts of glue ear in between times of no middle ear fluid. Result? Fluctuating hearing loss. Glue ear is quite tricky, because there are no medical symptoms, so you are not always aware that the child has a problem. If there is a small amount of fluid in the middle ear, hearing may fluctuate. If fluid has been in the middle ear for some time the fluid gets thick and sticky (hence the term ‘glue ear’) and the hearing becomes more impaired. Sound is distorted and the volume is decreased.
CAUSES OF FLUCTUATING HEARING LOSS.
Just like any other infection, ear infections result from the child’s immune system losing the battle against marauding microorganisms.
Glue ear can be caused by colds, allergies, post viral infections, enlarged adenoids, following middle ear infections, environmental tobacco smoke, and air travel when you have a stuffy nose or cold. So obviously there is an immune system factor operating here, too.
SIGNS OF FLUCTUATING HEARING LOSS.
As mentioned earlier, ear infections are painful and therefore fairly obvious. In children who are too young to communicate their problem, you may see redness of the ear, crying, pulling the ear or – too late – discharge from the ear.
Signs of fluctuating glue ear can be quite subtle, but if the fluctuation persists over time you might see:
- Upset by shouting voices / loud noise
- Poor school performance
- Loneliness
- Bullying behaviour
- Clumsiness
- Can’t remember instructions
- Poor speech/language development
- Disobedience
- Day dreaming.
TREATMENT OF FLUCTUATING HEARING LOSS.
Acute ear infections are treated with antibiotics.
Glue ear requires minimising upper respiratory mucous. This can be assisted by frequent nose-blowing (which in itself can be quite tricky with young children), drinking lots of water and teaching your child to breathe through their nose rather than the mouth.
When glue ear recurs frequently, the ear, nose and throat surgeon may decide to insert grommets – tiny little drain tubes in the ear drum.
Next time we will deal with the effects of fluctuating hearing loss on speech, language and literacy.
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