The most common cause of hearing loss in children is otitis media, the medical term for a middle ear infection or inflammation of the middle ear. This condition can occur in one or both ears and primarily affects children due to the shape of the young Eustachian tube. It is the most frequent diagnosis for children visiting a physician. When left undiagnosed and untreated, otitis media can lead to infection of the mastoid bone behind the ear, a ruptured ear drum, and hearing loss. If treated appropriately, hearing loss related to otitis media can be alleviated.

Otitis Media

Otitis media means “inflammation of the middle ear,” as a result of a middle ear infection. It can occur in one or both ears. Otitis media is the most frequent diagnosis for children who visit physicians for illness. It is also the most common cause of hearing loss in children. Although otitis media is most common in young children, it occasionally affects adults.

Otitis media can be a serious problem because of the severe earache and hearing loss it can cause. Hearing loss, especially in children, may impair learning capacity and even delay speech development. However, if it is treated promptly and effectively, hearing can almost always be restored to normal. In rare cases the infection can spread to nearby structures in the head, especially the mastoid. Immediate attention from a doctor is the best action.

Causes

Blockage of the eustachian tube during a cold, allergy, or upper respiratory infection, and the presence of bacteria or viruses lead to a build-up of pus and mucus behind the eardrum. This infection is called acute otitis media. The build-up of pressurized pus in the middle ear causes pain, swelling, and redness. Since the eardrum cannot vibrate properly, hearing problems may occur. Sometimes the eardrum ruptures, and pus drains out of the ear. More commonly, however, the pus and mucus remain in the middle ear due to the swollen and inflamed eustachian tube. This is called middle ear effusion or serous otitis media. Often after the acute infection has passed, the effusion remains lasting for weeks, months, or even years. This condition allows frequent recurrences of the acute infection and may cause difficulty in hearing.

Symptoms

In infants and toddlers, look for: Pulling or scratching at the ear, especially if accompanied by other symptoms; hearing problems; crying or irritability; fever; and ear drainage.

In young children, adolescents, and adults look for: earache, feeling of fullness or pressure, hearing problems, dizziness, loss of balance, nausea, vomiting, ear drainage, and/or fever.

Hearing Loss

All patients with middle ear infection or fluid have some degree of hearing loss. The average hearing loss in ears with fluid is 24 decibels…equivalent to wearing ear plugs. (Twenty-four decibels is about the level of the very softest of whispers.) Thicker fluid can cause much more loss, up to 45 decibels (the range of conversational speech).

Your child may have hearing loss if he or she is unable to understand certain words and speaks louder than normal. Essentially, a child experiencing hearing loss from middle ear infections will hear muffled sounds and misunderstand speech rather than incur a complete hearing loss. Even so, the consequences can be significant. Long duration hearing loss can lead to a delay in learning important speech and language skills.

Diagnosis

During an examination, the doctor will use an otoscope or microscope to look at and assess the ear. The doctor checks for redness in the ear, and/or fluid behind the eardrum, and to see if the eardrum moves. These are the signs of an ear infection. Two other tests may also be performed:

  • Audiogram- Tests if hearing loss has occurred by presenting tones at various pitches.
  • Tympanogram- Measures the air pressure in the middle ear to see how well the eustachian tube is working and how well the eardrum can move.

Medications

Antibiotic medications are often prescribed by your primary care physician. It is important that all the medications be taken as directed and that you keep any follow-up visits. Often, antibiotics to fight the infection will make the earache go away rapidly, but the infection may need more time to clear up. Other medications that your doctor may prescribe include an antihistamine (for allergies), a decongestant (especially with a cold), or both. Sometimes the doctor may recommend a medication to reduce fever and/or pain. Call your doctor if you have any questions about your or your child’s medication, or if symptoms do not clear.

Surgery

If your child experiences multiple episodes of acute otitis media within a short time or hearing loss, or chronic otitis media lasts for more than three months, your physician may recommend placement of ventilation tubes, also called pressure-equalization (PE) tubes. This is a short surgical procedure in which a small incision is made in the eardrum, any fluid is suctioned out, and a tube is placed in the eardrum. This tube will usually fall out on its own after a period of time, letting the eardrum heal. There is usually an improvement in hearing and a decrease in further infections with PE tube placement.