Childhood hearing loss: how to recognise it and what to do

What is childhood hearing loss?

Childhood hearing loss is any reduction in a child’s ability to hear, from mild to profound, in one or both ears. It may be present from birth — congenital hearing loss — or develop during childhood.

The word “deafness” is generally reserved for more pronounced losses, severe or profound, in which the child cannot access speech at normal volume. But most children with hearing difficulty do hear something. They hear, they simply do not hear everything — and that is precisely what delays recognition of the problem.

What are the warning signs?

In the first months of life:

• Does not startle at loud, unexpected sounds.
• Does not wake or stir with ambient noise.
• Does not turn to locate a sound by six months of age.
• Does not babble, or stops babbling after having started.

From one year onwards:

• Delayed onset of speech, or speaking less than peers of the same age.
• Substituting or omitting speech sounds, so that only the family understands.
• Not responding when called from behind or from another room.
• Turning the television volume up considerably.
• Appearing distracted or inattentive, particularly in noisy settings.

By school age, the complaint that reaches the clinic is often not about hearing at all: it is about inattention, learning difficulty, a child who “daydreams”. It is always worth checking hearing before concluding anything else.

When should a child see an ENT specialist?

Seek assessment whenever:

• The child does not pass, or is referred from, newborn hearing screening.
• Speech is delayed, at any age.
• There is a family history of hearing loss.
• The child has had meningitis, or has received medications that can affect hearing.
• There are recurrent ear infections, marked snoring or mouth breathing.
• There is simply a doubt. Investigating hearing carries no downside.

How is the diagnosis made at Clínica Rhinus?

Assessment combines consultation and testing. During the consultation, the ENT specialist asks about pregnancy, delivery, speech development, family history and previous infections, and examines the ears, nose and throat.

Hearing tests are performed by the speech-language pathologists on our team and selected according to the child’s age and ability to cooperate:

Test	For whom	What it shows
Otoacoustic emissions	Newborns and infants	Whether the cochlea, the hearing organ, is responding
Tympanometry	Any age	Whether there is fluid behind the eardrum and how the eardrum moves
ABR	Any age, including during sleep	The degree of loss, without requiring a response from the child
Play audiometry	From 2 to 3 years	How much the child hears at each frequency, through play
Conventional audiometry	From 4 to 5 years	The degree and type of loss, in detail

None of these tests is painful and none involves radiation.

What are the treatments?

This depends entirely on the cause and the degree of loss. Possible paths include:

1. Loss caused by middle ear fluid. The most common, and usually reversible. Management ranges from clinical follow-up to placement of a ventilation tube, or grommet, when fluid persists and impairs hearing.
2. Loss related to adenoids and tonsils. When obstruction contributes to recurrent ear infections, treating the obstruction is part of the plan.
3. Mild to severe sensorineural hearing loss. Usually involves hearing aid fitting and speech-language follow-up.
4. Severe to profound loss in both ears. When hearing aids are not sufficient, candidacy for a cochlear implant is assessed — a surgically implanted device that stimulates the auditory nerve directly.

What changes with profound hearing loss?

Profound hearing loss is the degree at which a child cannot access speech even with conventional amplification. Assessment takes longer and involves imaging of the ear, speech-language evaluation, and the family’s participation in decision-making.

Clínica Rhinus carries out the diagnostic work-up, the candidacy assessment and the cochlear implant surgery itself, performed by Prof. Aline Bittencourt, who completed a fellowship in advanced otologic and lateral skull base surgery and a PhD in otorhinolaryngology at the University of São Paulo (USP).

Why does timing matter so much?

The first years of life are when the brain organises language from what it hears. Identifying hearing loss early allows intervention to begin within that window. This is not an emergency in the usual sense — it is a matter of not letting months pass while a reasonable doubt goes unanswered.

Sources: Brazilian Association of Otorhinolaryngology and Cervico-Facial Surgery (ABORL-CCF) · Brazilian Society of Otology · Flint PW, Francis HW, Haughey BH, et al. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Elsevier; 2020. · Tratado de Implante Coclear e Próteses Auditivas Implantáveis. 2nd ed. Thieme Revinter. · Bento RF, Bittencourt AG, Voegels RL. Seminários em Otorrinolaringologia. Fundação Otorrinolaringologia.