Getting an Earful
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Screening of newborn babies for hearing loss did not exist two decades ago. Today, two to four of every 1,000 newborns have some hearing problem and half of those have no identifiable risk factors at birth, such as family history of deafness or viral infection during pregnancy.
Before newborn hearing screening, children with deafness were not identified until they were 2 or 3 years old. Late diagnosis meant deaf children likely had delayed speech, learning issues and risk for psychological or social problems.
Unfortunately, people who are deaf and don’t speak normally may be viewed as “dumb” and may face bullying or ostracism.
Today, deafness is usually identified by about 4 months of age, and early intervention helps on every front. But universal newborn screening was only in effect in 38 states at the end of 2008. You are fortunate to live in one of those states.
Screening is non-invasive, painless and takes only a few moments. A few percent of children tested will fail screening but actually have normal hearing (false positive). On repeat screening most of these false positives are found to be normal. Those who still fail screening are referred for further testing. The important thing to remember is that the truly deaf are identified and provided appropriate treatment in the first months, rather than years, of life.
Hearing aids can be started before a child is 1 year old, and the remarkable cochlear implant—a small array of wires implanted inside the head, and communicating with a computer processor outside the skull—can provide hearing for the deaf as early as the second year.
As of 2009, nearly 200,000 implants are in use around the world. Early identification combined with speech therapy, hearing aids or cochlear implants provide the deaf with tools to succeed in our society.
I would be remiss if I did not note that in many cases, acquired deafness was a complication of an infectious disease such as measles, mumps or meningitis. These causes of deafness can now just be stories from the past if children are fully immunized against these diseases.
What about ear infections? As most everyone with children knows—and those of you planning a child will find out soon enough—ear infections (otitis) are an almost inevitable part of childhood. You can reduce the risk by breastfeeding, keeping the baby in an upright position during feedings and banning smokers from the house, but your child is still likely to suffer some ear infections.
Ear infections concerning hearing come in two main varieties: acute otitis media, the child with fever and screaming ear pain, and serous otitis media, the child whose ear feels full, or popping, or just wrong, and says, “what” all the time. (Yes, I realize that many kids with normal hearing say that as well.) Acute otitis is treated with antibiotics, or possibly just pain medications and watchful waiting. Serous otitis, also known as fluid in the middle ear, may occur after antibiotic treatment, or may show with no prior hints. There is no medicinal treatment.
Either problem interferes with normal hearing. Imagine going through your day with your fingers in your ears. That’s what fluid (infected or not) in the middle ear is like. If you are 1 or 2 years old, and actively acquiring speech, but you can’t hear properly, your speech and understanding may be affected. Generally, if fluid has not resolved within three months, it probably won’t without outside help. This is where the ear, nose and throat specialist (ENT) makes his entrance. After three months the fluid is more like jelly and can’t drain. The ENT makes a tiny whole in the eardrum, vacuums out the jelly, and usually puts a miniature sewing machine bobbin-like tube (yes, I can sew) in the hole to keep it open. This (one hopes) prevents more fluid buildup, and buys time until developmental changes in the body resolve the problem. In the future, parents and doctors may look back on ear tubes as antique, and of dubious benefit, but it is what we have now.
A few words about ear wax. It is normal. It is neither dirt nor a sign of a poor upbringing. Don’t mess around inside the ear canal. Although you are unlikely to harm your child with Q-tips, it is definitely possible. With Q-tips you’re only going to push the wax in further. It is very unlikely that the wax is affecting your child’s hearing. This is a good time to leave it to your health care professional. (I just recently took excavating equipment to Brooklyn to clear out Guinness book quantities of wax from my almost-deaf 26-year-old’s ears. But he’s a drummer, and his body was trying to create its own ear plugs to save its hearing. This is the exception, not the rule.)
Although infrequent, children can lose hearing for other reasons, such as head trauma or tumors. Routine, simple and inexpensive hearing screening at annual physical exams or in school should identify such concerns.
Your doctor should always take your concern that your child can’t hear very seriously. You are the parent, and you do know your child. Don’t worry about the occasional “what,” but also don’t be brushed aside if you feel something is wrong.
Dr. Alan Freshman, father of two grown sons, practices at Syracuse Pediatrics. Consult your own physician before making decisions about your family’s health care. Send e-mail to him at firstname.lastname@example.org.