CHILDHOOD DEAFNESS
Each year, around 840 children are born with a permanent hearing impairment. Until recently, around 50% of these children were not identified until 18 months old, with 25% still left undiagnosed at 3 years old. Late diagnosis can have a devastating effect on language acquisition, communication development, confidence and social skills, which can last a lifetime.

However, if deaf children are identified at an early stage, and appropriate support is given, research shows there is no reason why they cannot develop at the same rate as their hearing peers.

The importance of early diagnosis has been accepted for many years, but it is only now that the technology is available to objectively determine a child's hearing status shortly after birth.

For over thirty years children's hearing was screened in the U.K. using the Infant Distraction Test (IDT) performed by Health Visitors on babies of about 8 months of age. The IDT, which relies on children reacting appropriately to certain types of sounds, lacks the objectivity of technological testing methods and, as a result, fails to identify around half of all hearing-impaired children.

The IDT is gradually being phased out in favour of newer and more accurate screening performed on newborn babies. The new screening is part of the Newborn Hearing Screening Programme which is being rolled out gradually across the country.

Hearing impairment in children
Many children have temporary hearing impairments that are mostly caused by glue ear (Otitis media with effusion).
About 1 in 1,000 babies are born in the U.K. each year with at least a moderate hearing impairment in both ears (bilateral). This translates to about 900 babies born each year with a bilateral hearing impairment. We also know that some children will develop or acquire hearing impairment in early childhood so the figure increases up to at least 1.65 in 1,000 by 9 years of age.
It is possible to obtain more detailed information on childhood hearing impairment, including risk factors for and causes of hearing impairment, by following this link.

What if I suspect my child has a hearing loss?

Children can develop problems with hearing during their early years and, as a parent, you may be one of the first to suspect that something is wrong.

Most cases of hearing loss in infancy are due to temporary conditions such as glue ear which can affect up to 80% of all pre-school children.

Symptoms of hearing loss in children are easily mistaken, but signs can be that the child:-
 

• Doesn't react when called
• Appears inattentive or prone to daydreaming
• Has the television on very loud
• Talks too loudly
• Doesn’t say words properly
• Becomes unsettled at school
• Is often tired, grumpy, frustrated or over-active

If you are concerned about your child's hearing, speak to your family doctor immediately and ask for your child to be referred to the local children's audiology service for an assessment.

What is a ‘cochlear implant?’
Cochlear implants comprise several parts. One part is a set of tiny wire electrodes that form rings around a thin plastic tube about the size of a pencil lead. These electrodes are placed by a surgeon in the inner ear (cross link to inner ear description in ‘causes and treatments of hearing loss’ section). The aim is to by-pass parts of the ear that do not work and to stimulate the nerve of hearing directly with electrical signals. The other parts of a cochlear implant are a microphone and a microchip ‘speech processor’ which are worn behind the ear like an ordinary hearing aid. These parts are connected to a transmitter coil which is worn on the side of the head. The transmitter coil sends signals to the electrodes.
Candidates for cochlear implants are people who are profoundly deaf and who do not benefit from ordinary hearing aids. One group of candidates are people, both adults and children, who lost their hearing after learning spoken language. Most of these people find that an implant helps them to monitor the sound of their own voice, which gives them more confidence when speaking. The sensations generated by an implant combine well with lipreading, and allow users to lipread more accurately, more fluently, and with less effort. Many users can understand some speech without lipreading, particularly if the talker is a familiar person and if there is no background noise. Some users of implants can understand speech when using the telephone.
The other group of candidates are children who were born profoundly deaf. Implantation can help such children to acquire spoken language. The benefits of implantation seem to be greater the younger the age at which children in this group receive implants. It is now common in the U.K. for some profoundly deaf children to receive implants as young as 1-2 years of age.

About 450 cochlear implants are provided annually in the U.K. To date, about 5,000 have been provided in the U.K. and 50,000 internationally.

Further information about cochlear implants can be obtained from the charity Deafness Research UK www.defeatingdeafness.org and from the British Cochlear Implant Group www.bcig.org.
The MRC Institute of Hearing Research conducts an annual survey of the actual and anticipated number of cochlear implants in the U.K. The results can be downloaded from: http://www.ihr.mrc.ac.uk/research/prostheses/outcomes/numbers.php

What are ‘grommets?’
A child with persistent fluid behind the eardrum has “glue ear”, also called “otitis media with effusion” (OME –see question What is glue ear?). In many cases the condition clears up without treatment. However, in severe cases, the child may be referred to the local hospital ear, nose and throat (ENT) department where grommet insertion may be recommended if the glue ear persists. Grommets are tiny bobbin-like ventilation tubes inserted in the eardrums, to keep the fluid away. They do this by making it easier for any new fluid to drain away into the throat and making it difficult for bacteria to grow and cause fluid secretion from the lining of the middle ear. Grommets produce good hearing for as long as the tubes remain in place, but when they fall out (usually in 6-12 months) the problem may return. In those children, repeat operations to re-insert tubes are sometimes performed, but a hearing aid is now commonly offered after about 3 insertions.
In the past, very many children diagnosed with OME received grommets, but the number has reduced steeply in the last 10 years. This has been due to growing realisation by doctors that the benefit was not great enough in many cases to justify giving a general anaesthetic, especially in a condition that mostly corrects itself. However, some children that have been carefully observed and found to have OME and poor hearing for more than 3 months can benefit considerably from grommets. When adenoids are taken out at the same time, the improvement in hearing is slightly greater, but lasts much longer and underlying physical health also benefits.

What is ‘glue ear?’
Most children have occasional fluid behind the eardrum (in the ‘middle ear’) during infancy. This fluid, which can occur in either or both ears, typically causes a mild hearing loss, impairing listening. The fluid usually clears up after a few weeks. If it reoccurs persistently, as it does in about 15% of cases, the child has “glue ear”, also called otitis media with effusion (OME). OME usually occurs on and off until the child is 4 – 5 years old, after which in all but a few cases it gradually declines. The fluid that fills the middle ear comes from the cells that line the middle ear cavity. This happens, often following colds or allergies, when the eustachian tube, joining the middle ear to the back of the mouth, remains closed for long periods. The normal opening of the eustachian tube, equalising pressure on the two sides of the eardrum, is what causes your ears to ‘pop’. A common treatment for OME is to put grommets in the eardrum. These act like an artificial eustachian tube.
OME can cause problems in language development, behaviour and schooling, especially in children who are socially deprived. When fluid causes impaired hearing, parents and other carers should speak directly to the child, ensuring that they have the child’s attention. If the hearing problems persist over more than a few weeks, or the child also has pain or fever (suggestive of an acute infection), he/she should be taken to the family doctor.

What is 'Tinnitus?'

Tinnitus is the medical term for any noise that people hear in one ear, both ears or in their head. These sounds do not come from outside the head, although they may occasionally sound as if they do. People experience tinnitus in many different ways but it is normally described as a ringing sound. However, some people will hear other sounds such as buzzing, humming, whistling, tunes or songs. Sometimes tinnitus noise beats in time with your pulse - this is known as pulsatile tinnitus.

www.rnid.org.uk/information_resources/tinnitus