'Please, Miss - I can't hear'
By Sheila Lavery
An incredible 80% of children under the age of eight experience temporary deafness, yet childhood hearing problems remain notoriously difficult to detect. Make sure you can spot the signs.
Identifying the problem
While it can be difficult to recognise hearing problems in young children, they generally tend to react in one of two ways, says Louise Williams, audiology adviser for the National Deaf Children's Society (NDCS): 'Either they become frustrated, angry and naughty, or they are quiet and withdrawn.
A child's progress at school also starts to suffer - he may start to daydream because he can't hear the teacher; he may not participate as well as he used to or lose interest in lessons. Frequently saying, 'What?', 'I didn't hear you', or complaining of buzzing in the ears are also potential signs. At home he may sit too close to the television or turn the volume up high.
Pre-schoolers with hearing problems are likely to have poor speech. By the age of three, a hearing child has a vocabulary of 700 words, but a hearing impaired three-year-old with undetected hearing loss will know fewer than 25 words.
Common conditions
Deafness - Every year around 840 babies are born deaf, although one quarter of them remain undiagnosed by the age of three. Infectious diseases such as measles, German measles, mumps, or meningitis can damage the nerves of the inner ear. One third of permanent childhood hearing impairment is caused by meningitis.
CAPDs - Some children develop central auditory processing disorders (CAPDs), possibly triggered by early episodes of glue ear. Children with CAPDs have difficulty in hearing speech even though their hearing may otherwise appear normal. They may also have mild learning disabilities.
Glue ear - The most common cause of temporary deafness in childhood is glue ear caused by ear infections, passive smoking and frequent colds are, contributing to fluid build-up in the middle ear.
Causes of glue ear:To hear well the middle ear needs to be full of air. The Eustachian tube normally drains any excess fluid down the throat and allows air to move into the middle ear. However, children younger than seven can have poorly developed tubes, or infection can cause the walls of the tubes to stick together so the fluid pools in the middle ear. The result is like listening to the world with your fingers in your ears.
Who should you see
Your GP or the practice nurse can do some hearing tests at the surgery. However, Williams of NDCS advises asking for a referral to an audiologist at your local hospital or community audiology clinic, who has specialist training and experience in working with children.
Audiologists use a number of tests depending on your child's age and individual problems. Pre-schoolers may be asked to listen to a variety of sounds as part of a game, or respond to sounds played through headphones.
To test for glue ear the audiologist places a small probe in the ear canal for about 30 seconds.
In testing for CAPDs the audiologist may record the electrical activity of the brain or the echo in the middle ear and examine the child's history before making a diagnosis.
Treatment options
Traditionally, antibiotics have been prescribed for glue ear but increasingly GPs are adopting a 'wait and see policy' to see if it clears up on its own. However, if your child has repeated episodes, which can occasionally result in a burst ear drum, then antibiotics are likely to be prescribed.
Some children benefit from homeopathic treatment or paediatric osteopathy. But, if the problem persists your child may need to have grommets fitted, tiny plastic tubes, which help to drain fluid from the middle ear.
A variety of hearing aids can improve the hearing of children with glue ear. Children with permanent and profound hearing loss may find that a cochlear implant, a hearing aid that is surgically implanted, is a better alternative.
Helping your child at school
- Inform your child's school and class teacher that your child has a hearing problem.
- Arrange for him to sit near the teacher, so he can hear better and can ask for things to be repeated without embarrassment.
- Ask his teacher to get your child's attention before speaking and to look him straight in the face when talking so your child can pick up on visual clues.
Advise teachers and friends to use their normal rhythm and volume of speech as shouting distorts the voice.
School policy
Ask the school about its policy on communication modes for deaf children. As most hearing-impaired children are educated in mainstream schools, the school has a duty to help your child communicate effectively.
Hearing aids are often enough for most children, but if your child also has a Statement of Special Educational Needs, specifying his individual problem, he could receive extra help. A classroom assistant could act as his communicator, he could receive speech and language therapy, or be helped by the school's SEN (special educational needs) co-ordinator.
Most children with cochlear implants need support by teachers of the deaf. If there isn't one on the school staff a peripatetic teacher of the deaf, employed by the local education authority (LEA), can travel to the school when needed. If you are dissatisfied with what your school is offering, contact your LEA and ask to speak to the Sensory Support Team or speak to the NDCS education advisers.
School aids
Even a child with mild hearing loss can have problems distinguishing a teacher's voice from the buzz of background noise. He could find it helpful to use a radio aid, which brings the teacher's voice closer. The teacher wears a transmitter with a microphone and your child connects a special receiver to his hearing aid. The NDCS will loan you a radio aid for up to three months, if you'd like to try it out.
Computers are also valuable learning aids for deaf children. Talk to the school or the NDCS Technology Team about which programmes would be most suitable for your child.
Sheila Lavery is a health writer and mother of two daughters, aged eight and five. She lives in Essex.
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