eMedicine Specialties > Pediatrics: Surgery > Otolaryngology
Hearing Impairment: Treatment & Medication
Updated: Jul 21, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
Treatment for CHL
Manage CHL due to otitis media or its sequelae with a course of appropriate antibiotics. A patient with a serous otitis media for longer than 3 months benefit from myringotomy and removal of the fluid in the middle ear. Ventilation tubes may ultimately be necessary. If the hearing loss continues, amplification with a hearing aid may be needed. Speech therapy is rarely necessary unless the loss is prolonged and cannot be corrected with amplification.
CHL that results from obstruction of the auditory canal because of cerumen or a foreign body should be treated by removing the obstruction.
Treatment for SNHL
SNHL cannot be medically treated.6 Amplification with hearing aids is used to give the child as much auditory input as possible. Speech therapy may be beneficial. If the child requires special schooling, the program determines how much speech training is routinely part of the school day. Preferential seating and use of FM systems should be discussed with the patient's family and teachers.
In older children and in adults, goals for amplification may be as much as 40-60 dB or whatever achieves a nominal hearing level. The limiting factor is the physical sound pressure exerted on the tympanic membrane, which becomes painful after a certain threshold. Young children with small ear canals perceive pain at amplification volumes as low as 10-15 dB. Modern hearing aids can selectively amplify a specified range of frequencies more than others rather than all frequencies equally.
After the hearing aid is fitted by using proper molds, the hearing aid is tested to see how well it matches the goals for loudness at various frequencies. With an older child, speech recognition can be part of this testing. For a young child, the most important goal is to optimize auditory input without causing pain, which can cause the child to avoid using the hearing aid.
Young children should use their hearing aids because the stimulus helps to connect them to their environment and because it maximizes auditory language development. Older children may choose not to use their hearing aids. Parents should be reasonable. For example, if their child is succeeding in school, the hearing aids may not offer a substantial language benefit. If the child prefer not to wear the hearing aids after school, parents should respect this decision.
No medical disadvantage occurs if children choose to not use hearing aids. In fact, many deaf adults use their hearing aids selectively or not at all because they find that the extraneous noises and distortions they hear are more bothersome than helpful. They may use their hearing aids only when they anticipate a particular benefit.
Surgical Care
Some causes of CHL may be managed or aided surgically.
Children with persistent chronic or recurrent otitis media with resultant effusions may benefit from the placement of myringotomy tubes to ventilate the middle-ear space to prevent negative pressure in this area. If otitis results in the destruction or fixation of the ossicles, surgery may improve ossicular function.
Cholesteatoma is a surgical disease.
Bone-anchored hearing aids (BAHAs) may be useful in some patients. Examples are patients with microtia, those with anotia who are awaiting auricular reconstruction, and patients with persistent otorrhea who cannot use a hearing aid.
SNHL cannot be treated with surgical means other than cochlear implantation. Cochlear implantation may be an option in some children, but it should not be mistaken for a cure. Cochlear implants are discussed in the Cochlear implants section below.
Consultations
- Otolaryngologist: Consulting an otolaryngologist is imperative if the child has CHL. An otolaryngologist can provide advice pertaining to medical and potential surgical interventions. Consultation is also recommended if the child has profound SNHL and is a potential candidate for cochlear implants. The otolaryngologist is a crucial member of the multidisciplinary team needed to help patients with profound SNHL.
- Specialists in early intervention: Early intervention programs are essential to help parents understand how to raise a deaf child or one hard of hearing. Such programs are also needed to begin discussing and implementing language and/or educational programs.
- Audiologist: Consulting an audiologist is essential for evaluating patients for hearing aids and for fitting them.
- Geneticist: Consultation with a geneticist is recommended if the cause of deafness may be syndromic or if the family history suggests a hereditary pattern.
- Ophthalmologist, nephrologist, cardiologist: Consulting these subspecialists is recommended if an identifiable syndrome implicates involvement of the visual, renal, or cardiac organ system or if involvement of an organ system is suspected because a particular syndrome is or may be present.
- Experts in managing hearing loss: Consult physicians with expertise in caring for patients with hearing loss. Some physicians have developed expertise in the field of deafness and may be available for consultation. They can offer information about associated medical conditions if present, as well as perspective about language and education, use of hearing aids and cochlear implants, and other equipment. The literature is filled with debates about the most appropriate venues for children who are deaf or hard of hearing. Many people involved in early intervention are affiliated with a particular program because it matches their personal biases. Physicians with expertise in deafness may be neutral.
Medication
No medical therapy is specifically available for deafness. Only some etiologies of CHL may be managed medically.
More on Hearing Impairment |
| Overview: Hearing Impairment |
| Differential Diagnoses & Workup: Hearing Impairment |
 Treatment & Medication: Hearing Impairment |
| Follow-up: Hearing Impairment |
| References |
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References
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Further Reading
Keywords
hearing loss, deaf, deafness, hard of hearing, hard-of-hearing, conductive hearing loss, CHL, sensorineural hearing loss, SNHL, mixed hearing loss, American Sign Language, ASL, English Sign Language, Signed English, SE, Signing Exact English/Seeing Essential English, SEE, Signing Exact English, SEE 1, Seeing Essential English, SEE 2, lip-reading, lipreading, lip reading, total communication, voice and sign language, brainstem audio-evoked response, BAER, automated auditory brainstem response, ABR, AABR, otoacoustic emissions, OAEs, audiometry, otosclerosis
cholesteatoma, glomus tympanicum, glomus jugulare, schwannomas of the facial nerve, hemangiomas, encephalocele, Waardenburg syndrome, Gernet syndrome, Winter syndrome, Rosenberg syndrome, Turner syndrome, Klinefelter syndrome, DiGeorge syndrome, Townes-Brocks syndrome, Miller syndrome, Bixler syndrome, coloboma, heart disease, atresia choanae, retarded growth, ear anomalies, CHARGE syndrome, Jervell Lange-Nielson syndrome, limb-oto-cardiac syndrome, Alport syndrome, branchio-oto-renal syndrome, Kearns-Sayre syndrome
Epstein syndrome, Barakat syndrome, Killian/Teschler-Nicola syndrome, Noonan syndrome, Cockayne syndrome, Gustavson syndrome, LEOPARD syndrome, Senter syndrome, BADS syndrome, Davenport syndrome, Pendred syndrome, Johanson-Blizzard syndrome, Refetoff syndrome, Wolfram syndrome, Kallmann syndrome, Goldenhar syndrome, frontometaphyseal dysplasia, Escher-Hirt syndrome, Levy-Hollister syndrome, Usher syndrome, Marshall syndrome, Harboyan syndrome, Fraser syndrome, Jensen syndrome, craniometaphyseal dysplasia, OSMED syndrome, cytomegalovirus, CMV, herpes, rubella, syphilis, toxoplasmosis, varicella, meningitis, mumps
