Hearing loss in children

introduction

Sensory perception Hearing is an important component for children to develop and learn human language. Hearing damage should be treated adequately as soon as possible, as all types of hearing impairment can pose great dangers to the child's language development.

frequency

In Germany around 500,000 children suffer from a hearing disorder that requires treatment. One to two in 1,000 newborns have a relevant hearing loss. There are approximately 7,000 to 8,000 children with profound hearing loss and up to 150,000 children with moderate hearing loss.

Around three percent of all school children suffer from mild hearing loss.

Types of hearing loss

The hearing impairment can be classified based on anatomy, causes, and severity.

Anatomically, the hearing can be roughly divided into:

• The outer ear (auricle and Ear canal) has the task of transmitting the sound signal to the eardrum.
• The eardrum is considered to be the border between the outer ear and the middle ear. Here the sound signal is from a Airborne sound in a Structure-borne noise transformed.
• The middle ear consists of the ossicles hammer, Anvil and stirrup. The structure-borne sound is transmitted to the inner ear.

The special arrangement of the eardrum and the ossicles causes a pre-amplification and a Impedance matching of the acoustic resistance the air on the acoustic resistance of the inner ear fluids. If this did not happen, the sound signal would immediately hit the fluid-filled rooms of the Cochlea meet and one Reflection of the sound energy cause. These sound waves could then no longer be used for the actual hearing process.

The inner ear is responsible for converting the mechanical energy of the sound waves into bioelectrical nerve impulses. These impulses reach the brain stem via the auditory nerve, where the nerve impulses are processed. Then they get into the audiological cortexwhere sound and noise perception, sound and word understanding, acoustic attention and storage of word, music and language content are processed.

In the case of hearing disorders, these anatomical structures can be disturbed individually or in combination. There are Conductive disturbances (Disturbances in sound transmission in the outer or middle ear) and Sensorineural disorders (the stimulus uptake and conversion in the area between Stirrup footplate and first neuron of the auditory nerve is disturbed). Disturbances in the transmission, processing and perception of stimuli can also occur.

Various tests are required to assess the severity of the hearing impairment. That is particularly important Tone audiometry, but also the ability to understand the other person in conversation and the limitations that the patient reports to the doctor play a role in the overall assessment. A table of the severity classification can be found here.

Read more about this under Hearing impairment in children

causes

There are hereditary and non-hereditary causes, or congenital and acquired causes before, during and after birth.

Typical reasons for sound conduction disturbances are:

• Earwax plugs
• Malformations of the outer ear and middle ear
• Inflammation of the ear canal and / or the middle ear
• Trauma such as bleeding or injury
• otosclerotic changes (excessive bone formation in the ossicles in the middle ear)

Typical causes of sensorineural disorders are malformations, syndromic diseasesCirculatory weakness occurring before and after the birth with associated reduced breathing or respiratory arrest, infections or birth trauma. High grade Inner ear hearing loss around 50 percent of these are inherited in childhood. No exact reasons for central hearing impairment can be proven, but presumed drug, alcohol and drug abuse during pregnancy, oxygen deficiency in the birth phase, genetic influences and premature births.

Symptoms

Children with a hearing loss in infancy can stand out due to delayed speech development. There is a delay here because the children do not fully perceive their parents' language.

In addition, if the child does not hear their own language properly, problems with sound formation can arise. Furthermore, a hearing loss in the child can be recognized by the fact that it does not respond to requests or admonitions.

This can easily be mistaken for the child's disobedience. If the hearing loss is severe, children will not respond to sounds made around them. For example, if you snap your finger next to the child's ear, the head will not be turned in that direction.

Deafness in children after otitis media

A otitis media can lead to temporary hearing loss. This hearing loss is mostly reversible. Permanent hearing loss can occur in the case of recurrent otitis media. If these are not treated consistently, scarring can occur in the middle ear, which reduces the sound conduction in the ear.

Deafness in children after a cold

The common cold affects the upper respiratory tract. A swelling of the Tuba Auditiva (Auditory trumpet), which flows into the throat, it can lead to ventilation disorders of the ear. This leads to a temporary hearing loss.

This can also create strong pressure on the ear in question. This pressure leads to increased hearing loss and pain. The pressure can be equalized using the Valsalva maneuver. The Valsalva maneuver involves pressing against the closed nose and mouth. This usually leads to the ears opening.

When the cold subsides, the auditory tubes swell again, so that the ear is better ventilated again. This is how the entire hearing ability is regained.

What are the consequences of hearing loss in children?

In children, the U2 always includes a hearing test to rule out congenital (innate) hearing damage. The hearing test is done because a consequence of the hearing impairment in children is that it is difficult to learn the language. Therefore, attention must be paid to children's hearing during development.

Diagnosis

If risk factors are present, certain hearing tests should be performed to check hearing performance.

Examples of risk factors include:

• intensive medical treatment required after birth
• Presence of hearing loss in the family
• Pregnancy infections
• Suspicion of hearing loss expressed by parents
• Lack of age-appropriate linguistic progress
• bacterial meningitis
• Etc.

In pediatric diagnostics, there are subjective and objective hearing tests. In the subjective examinations, the child is offered a sound stimulus, the examiner observes and then evaluates the child's reaction.

In the case of the objective hearing test, it is advantageous if the child is asleep, since the child does not need to be involved. A sound stimulus is presented that neurobiological reactions are recorded and evaluated by an examiner.

Measurement is one of the most important objective screening methods for newborns otoacoustic signalswhich are thrown back from the inner ear as an "echo" after exposure to sound. Measurement is the gold standard acoustic evoked potentials (BERA= brainstem evoked auditory potenials).

Read more about this under Recognizing hearing impairment in children - does my child hear correctly?

therapy

Therapy depends on the cause of the hearing impairment.

At Conductive disturbances Many mechanical treatments are used. For example, the Ear wax-(Cerumen-)graft vacuumed or rinsed out.

The treatment is more difficult Inner ear hearing loss. It can be like in an adult acute sudden hearing loss an infusion with Rheologica, Novocaine and cortisone are given. As soon as the hearing loss cannot be treated surgically or conservatively, a Hearing aid should be considered (see also: Sudden hearing loss therapy).

At a complete failure of hearing is also at one Inner ear stimulation prosthesis (Cochlear implant = CI) to think. Hearing aids and the Cochlear implant supply are integrated into an overarching treatment concept that also includes care, counseling and guidance for parents and, if necessary, special educational measures.

homeopathy

Schüssler salts are available as homeopathic remedies for people with hearing loss. These are supposed to optimize the cell metabolism and thus reduce hearing loss. Potassium chloride and euphorbium are also available.