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Hearing Impairment Treatment & Management

  • Author: Rahul K Shah, MD, FACS, FAAP; Chief Editor: Glenn C Isaacson, MD  more...
Updated: Jun 19, 2015

Medical Care

Conductive hearing loss

Manage conductive hearling loss (CHL) due to otitis media or its sequelae with a course of appropriate antibiotics. Patients with 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.

Sensorineural hearing loss

Sensorineural hearing loss (SNHL) cannot be medically treated.[34] In mild-to-moderate hearing loss, 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 school should determine 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 with moderate-to-profound hearing loss, hearing aids may correct up to 40-60 dB. Beyond that, 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 may 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.

There are two main goals of amplification. The first is to provide language. 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 older children, speech recognition should be part of this testing. For young children, the goal is to optimize auditory input without causing pain. If the hearing aids are painful to use, children will avoid using them. If amplification is successful in providing improved spoken language comprehension without pain, its use in and out of school should be encouraged.

The second goal of amplification is to provide environmental cues. The use of hearing aids helps to connect young children to their environment, helps to maximize auditory language development if it helps them to hear any speech sounds, and uses auditory pathways to the brain, which may prevent the brain from “ignoring” them (as it does in cortically blinded laboratory animals). The ability to hear environmental sounds is important for safety and some general functioning. Important safety cues include car or truck horns, alarms, or even someone yelling “stop.” Functional cues might include class bells, oven timers, doorbells, or someone calling their name loudly.

Older children may choose not to use their hearing aids because they “don’t look cool.” Rather than making this a significant ongoing argument, parents should be reasonable. For example, if their child is succeeding in school, the hearing aids may not offer a substantial language benefit to their child’s functioning. Additionally, the child is likely safe in the classroom, so benefit might be gained by letting the child “win.” If the child prefers not to wear the hearing aids after school, parents should respect this decision if the child is participating in safe activities when he or she does not have increased risk of harm because of missed environmental cues.

There is no medical disadvantage for children choosing to not use hearing aids. In fact, many deaf adults use their hearing aids selectively or not at all because they find the extraneous noises and distortions they hear are more bothersome than helpful. They may decide to use their hearing aids only when they anticipate a particular benefit.


Surgical Care

Conductive hearing loss

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.

Sensorineural hearing loss

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.




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.


Consulting an audiologist is essential for evaluating patients for hearing aids and for fitting them.


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, or other subspecialty consultants

Consulting these subspecialists is recommended if an identifiable syndrome implicates involvement of the visual, renal, cardiac, or any other organ system (eg, a deaf child with hematuria should see a nephrologist to check for Alport syndrome).

Similarly, if involvement of an organ system is anticipated because a child is diagnosed with a particular syndrome, a specialist may need to be involved (eg, a deaf child may benefit from aggressive ophthalmologic screening for the development of retinitis pigmentosa as in Usher syndrome, or simply because vision is so important to communication that mild losses in visual acuity should be managed promptly).

Occasionally, a specialist may be able to identify abnormalities that may lead to the diagnosis of a specific syndrome that would not be seen without specialized equipment (eg, ophthalmologist for a funduscopic examination or cardiologist for ECG and/or echocardiography).

Because almost any organ system is potentially related to hearing loss, there is no need to consult every subspecialist for each child with hearing loss. As noted earlier, even routine ECG testing for prolonged a QT interval or laboratory testing for the development of nephritis or changes in blood urea nitrogen and creatinine are not recommended universally.

Experts in managing hearing loss

Consult physicians with expertise in caring for patients with hearing loss, if available in your community. 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 educational 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 more neutral. However, there is a clear bias in the literature towards spoken language as the outcome measure defining success, and relatively good literature about the success of an all-sign-language education (even the literature on reading ability can be questioned).


Long-Term Monitoring

Follow-up of the interventions is as important in hearing impairment as in any other disability or medical condition. Physicians too frequently relegate the care of children who are deaf to audiologists and educators. Children who are deaf need ongoing referrals to an audiologist to monitor the progression of their hearing loss and to refit hearing aids to match changing losses and/or growth of their ears.

Pediatricians should monitor the child's linguistic and social development. They should ask about language and school performance. The child's placement in school may not be optimal for his or her abilities. For instance, a child who is not successfully learning lip-reading cannot learn math or science. Pediatricians should ask how the child is doing in school and in the family, how family members interact with the child, and how the parents discipline or instruct the child.

Children who cannot communicate with those around them may be frustrated and, therefore, act out or display withdrawal behaviors. These behaviors may be misinterpreted as being a behavioral or psychological problem rather than being reactions to the child's environment or situation.

Children who are deaf or hard of hearing are at particular risk for abuse. Physical abuse may be inflicted by parents who are frustrated because their child is not acting as they expect. Also, children who perpetrators perceive as being unable to report misconduct are at high risk for sexual abuse. Furthermore, most children with hearing impairment have no physical disabilities and may be attractive to a potential perpetrator. Deaf children may be socially isolated because of the communication barrier, they may be susceptible to individuals who give them special attention. Watch for physical signs of abuse or for behavioral manifestations of child abuse.

Contributor Information and Disclosures

Rahul K Shah, MD, FACS, FAAP Associate Professor of Otolaryngology and Pediatrics, Associate Surgeon-in-Chief, Medical Director, Peri-operative Services, Children's National Medical Center, George Washington University School of Medicine and Health Sciences; Attending Physician, Department of Otolaryngology, Children's National Medical Center

Rahul K Shah, MD, FACS, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American College of Medical Quality, American Association for Physician Leadership, American College of Surgeons, Triological Society, Massachusetts Medical Society, Phi Beta Kappa

Disclosure: Nothing to disclose.


Michael Lotke, MD Pediatric Clinical Educator, Mount Sinai Hospital–Chicago/Sinai Children’s Hospital; Assistant Professor, Department of Pediatrics, Rosalind Franklin University of Medicine and Science

Michael Lotke, MD is a member of the following medical societies: American Academy of Pediatrics, American Public Health Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

John E McClay, MD Associate Professor of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Dallas, University of Texas Southwestern Medical Center

John E McClay, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Glenn C Isaacson, MD FACS, FAAP, Professor of Otolaryngology-Head and Neck Surgery and Pediatrics, Temple University School of Medicine

Glenn C Isaacson, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Bronchoesophagological Association, American College of Surgeons, The Triological Society, Society of University Otolaryngologists-Head and Neck Surgeons, American Society of Pediatric Otolaryngology

Disclosure: Received honoraria from Covidien for consulting.


Orval Brown, MD Director of Otolaryngology Clinic, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center at Dallas

Orval Brown, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Bronchoesophagological Association, American College of Surgeons, American Medical Association, American Society of Pediatric Otolaryngology, Society for Ear, Nose and Throat Advances in Children, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

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Cochlear malformations. Neural foramen on the right is absent. Right arrow indicates a rudimentary vestibule. On the left is a severe cochlear malformation (large arrow). Small arrow indicates the internal auditory canal.
Cochlear implant electrode passing through the facial recess to the scala tympani.
Table 1. Some Syndromes Associated with Deafness
Organ or System Syndrome Inheritance Pattern Hearing Loss Obvious Physical Abnormalities
External ear DiGeorge sequelae Sporadic CHL Yes
Branchio-oto-facial syndrome AD CHL Yes
Townes-Brocks syndrome AD SNHL Yes
Miller syndrome AR CHL Yes
Bixler syndrome AR CHL Yes
Cardiac Coloboma, heart disease, atresia choanae, retarded growth, and ear anomalies (CHARGE) syndrome AD, AR, X linked, sporadic SNHL, mixed Yes
Jervell Lange-Nielson syndrome AR SNHL No
Limb-oto-cardiac syndrome AR CHL Yes
Renal Alport syndrome AD, AR, X linked SNHL Yes or no
Branchio-oto-renal syndrome AD SNHL, CHL Yes
Kearns-Sayre syndrome Sporadic SNHL Yes
Epstein syndrome AD SNHL No
Barakat syndrome AR SNHL No
Mental (retardation) Noonan syndrome Sporadic SNHL Yes
Killian/Teschler-Nicola syndrome Sporadic SNHL Yes
Cockayne syndrome, type I AR SNHL Yes
Gustavson syndrome X linked SNHL Yes
Dermatologic Waardenburg syndrome AD SNHL Yes
Lentigines, ECG, ocular, pulmonary, abnormal, retardation, and deafness (LEOPARD) syndrome AD SNHL Yes
Senter syndrome AR SNHL Yes
Black locks with albinism and deafness (BADS) syndrome AR SNHL Yes
Davenport syndrome AR SNHL Yes
Endocrine and/or metabolic Pendred syndrome AR SNHL Yes or no
Johanson-Blizzard syndrome AR SNHL Yes
Refetoff syndrome AR SNHL Yes
Wolfram syndrome AR SNHL Yes or no
Kallmann syndrome AD, AR, X linked SNHL, mixed Yes or no
Facial Goldenhar syndrome AD, AR CHL, SNHL Yes
Frontometaphyseal dysplasia X linked Mixed Yes
Escher-Hirt syndrome AD CHL Yes
Levy-Hollister syndrome AD SNHL Yes
Ophthalmologic Usher syndrome AR SNHL Yes or no
Marshall syndrome AD SNHL Yes
Alström syndrome AR SNHL Yes
Harboyan syndrome AR SNHL Yes or no
Fraser syndrome AR CHL Yes
Jensen syndrome X linked SNHL No
Orthopedic Klippel-Feil sequelae Sporadic CHL, SNHL Yes
Stickler syndrome AD CHL, SNHL, mixed Yes
Craniometaphyseal dysplasia AD, AR CD Yes
Oto-spondylo-megaepiphyseal dysplasia (OSMED) syndrome AR SNHL Yes
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