Hearing loss can be congenital, meaning present at birth, or acquired, due to an illness during childhood. It can significantly impact speech, language, learning, behaviour and social development.
Hearing loss may be:
- Conductive (sound is not transmitted effectively through the outer or middle ear)
- Sensorineural (dysfunction of the cochlea, auditory nerve or central auditory pathways)
- Mixed (combination of conductive and sensorineural hearing loss)
Conductive Hearing Loss
Conductive hearing loss occurs when sound cannot pass efficiently from the outer ear to the inner ear. Causes include:
- Otitis media with effusion (glue ear)
- Acute otitis media
- Perforated tympanic membrane
- Impacted ear wax
- Foreign body in the ear canal
- Congenital ear canal abnormalities (e.g., ear canal atresia, with absence or closure of the ear canal)
- Ossicle abnormalities (e.g., malformation of the malleus, incus or stapes)
TOM TIP: The most common cause of hearing loss in children is glue ear. Look for a young child with delayed speech, mishearing, poor concentration or behavioural issues, often after recurrent ear infections. This suggests conductive hearing loss due to otitis media with effusion.
Sensorineural Hearing Loss
Sensorineural hearing loss occurs due to problems with the cochlea, the auditory nerve, or the central auditory pathways. Causes include:
- Congenital infections, particularly cytomegalovirus (CMV) or rubella
- Genetic causes (e.g., GJB2 mutation or Pendred syndrome)
- Prematurity
- Birth asphyxia
- Neonatal jaundice (kernicterus)
- Meningitis
- Head trauma
- Ototoxic medications (e.g., gentamicin)
- Noise exposure
Presentation
Hearing loss may present with:
- Not responding to sounds or their name
- Delayed speech and language development
- Mishearing words or needing repetition
- Turning the television volume up
- Difficulty following instructions
- Behavioural problems or poor concentration
- Poor school performance
- Social withdrawal
Children with unilateral hearing loss may still develop speech, but can struggle with localising sound and hearing in noisy environments.
Newborn Hearing Screening
The Newborn Hearing Screening Programme involves an automated otoacoustic emission (AOAE) test. The process takes a few minutes per ear. An earpiece is inserted into the ear, and clicking sounds are played. The device detects otoacoustic emissions (sounds) that are produced by the cochlea in response to this stimulation.
Reduced or absent otoacoustic emissions suggest a possible hearing problem, prompting referral for further testing (e.g., an automated auditory brainstem response test).
Newborn screening does not detect all types of hearing loss, and children can develop hearing loss later in childhood.
Assessment
Assessment involves:
- History from parents, nursery or school
- Otoscopy to assess the ear canal and tympanic membrane
- Audiometry testing
- Tympanometry (if a middle ear effusion is suspected)
Management
Management options for conductive hearing loss, depending on the underlying cause, include:
- Removing wax or foreign body
- Treating acute otitis media where indicated
- Grommets for persistent glue ear with hearing loss
- Hearing aids
- Bone conduction hearing devices (transmit sounds directly to the cochlea by vibrating the skull bone)
Management options for sensorineural hearing loss include:
- Hearing aids
- Cochlear implants (bypass damaged cochlear hair cells and directly stimulate the auditory nerve)
- Speech and language therapy
- Sign language
- Educational support (including from specialist Teachers of the Deaf)
Last updated June 2026
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