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Pediatric Ear Health

Hearing loss is often a condition associated with aging, however; it’s important to take care of children’s hearing health as well. While hearing issues are generally detected with a newborn hearing screening, there are numerous ailments during childhood that can impact hearing health. At Santa Cruz Ear, Nose and Throat Medical Group, we’re qualified and ready to help your child receive the best ear care in the area!

Ear infection is the most common reason for a parent to seek urgent medical care for their child. By three years old, roughly 90 percent of children will have had at least one ear infection. Persistent infection or persistent fluids in the middle ear can be very painful and may result in a significant hearing loss. Even a mild hearing loss can affect a child's speech and language development.

Ear Infection or Acute Otitis Media (AOM)

Otitis media is an “inflammation of the middle ear.” The infection occurs in the air-filled middle ear space behind the tympanic membrane (eardrum).


Ear infections are significantly more common in younger children, with the highest incidence in the first two years of life. At that age, the Eustachian tubes are very small, and aren't as good at draining middle ear fluid and keeping germs out. Other factors that influence the incidence of ear infections in children are family history, day care attendance, breastfeeding, cigarette smoke exposure, pacifier use and other minor factors.


Infants and children with acute otitis media may have one or more of the following symptoms:

  • Ear pain or pulling on the ear
  • Fever
  • Lack of appetite
  • Vomiting or diarrhea
  • Fussiness or irritability
  • Decreased activity
  • Decreased hearing
  • Sometimes the eardrum bursts (perforates). This releases the infected fluid (mucus) and often relives pain quite suddenly. The ear drains, sometimes for a few days. Most perforations are small and the eardrum usually heals within a few weeks after the infection clears.z

Testing & Diagnosis

Your child’s doctor may use one or more of the following methods to diagnose AOM:

Otoscopy: An instrument called an otoscope provides a view of the external canal and tympanic membrane and can detect:

  • Redness
  • Swelling
  • Blood and/or pus
  • Air bubbles
  • Middle ear fluid
  • Perforated eardrum

Tympanometry: Tympanometry uses a small instrument to measure the air pressure in your child’s ear and determine if there is fluid behind eardrum or if it is ruptured.

Reflectometry: During a reflectometry test a small instrument emits a sound near your child’s ear and indicates if there is fluid in the ear by listening to the sound reflected back from the ear.

Hearing Test: Your doctor or audiologist may perform a hearing test to determine if your child is experiencing hearing loss.

Treatment and Management

The "best" treatment depends on the child's age, history of previous ear infections, severity of the infection and any underlying medical problems. Because ear infections often resolve on their own, treatment may begin with managing pain and monitoring the symptoms. Ear infection in infants, and severe cases in general, often require antibiotic treatment. Long-term problems related to ear infections — persistent middle ear fluid, frequent infections — can cause hearing problems and other serious complications.

Otitis Media with Effusion (OME)

Otitis media with effusion (also called serous otitis media) is a build up of fluid in the middle ear space. Unlike acute otitis media, the fluid is not infected. Fluid may accumulate in the middle ear due to a cold, sore throat or upper respiratory infection. OME usually resolves on its own within four to six weeks, however, in some cases the fluid may persist and cause a temporary decrease in hearing or the fluid may become infected (acute otitis media).

OME occurs more often in the fall and winter months and is most common in children between six months and three years of age. It is commonly under-diagnosed because of its lack of acute or obvious symptoms (compared to acute otitis media).


Otitis media with effusion is usually a result of poor function of the Eustachian tube, the canal that links the middle ear with the back of the throat. When this tube is not functioning properly, fluid cannot drain normally from the middle, causing a fluid build up behind the eardrum.

Reasons the Eustachian tube may not work properly include:

  • An immature Eustachian tube (common in young children)
  • Inflammation of the adenoids
  • A malformed Eustachian tube
  • A cold or allergy that leads to swelling and congestion of the Eustachian tube (swelling prevents the normal flow of air and fluids)

Any child may develop OME, however factors that may increase the risk include:

  • Attending daycare
  • Bottle feeding while lying on the back
  • Exposure to cigarette smoke
  • Absence of breastfeeding
  • History of ear infections
  • Craniofacial abnormalities (e.g. cleft palate)


Signs of OME can vary from child to child, however common symptoms include:

  • Difficulty hearing
  • Tugging or pulling on one or both ears
  • Loss of balance
  • Delayed speech and language development

Symptoms of OME may resemble other medical problems. Always see your child's physician for an accurate diagnosis and to discuss treatment options.

Testing and Diagnosis

To diagnose OME, the physician uses a pneumatic otoscope to detect any reduction in eardrum motion. It has a rubber bulb attachment that pushes air into the ear. Pressing the bulb and observing the action of the air against the eardrum allows the doctor to gauge the eardrum's movement. In patients with OME, an air bubble may be visible and the eardrum is often cloudy and very immobile.

Treatment and Management

Treatment for OME depends on many factors and varies for each child. You should discuss treatment options your child's physician or healthcare provider.

Monitoring: In most cases the fluid in OME resolves on its own within 4 to 6 weeks and medical treatment is not needed.

Medications: Middle ear fluid in OME is usually not infected so antibiotics are not needed. However, if an upper respiratory infection accompanies the OME, antibiotics may be required.

Ear tubes/myringotomy: When OME persists more than two to three months and there is concern that decreased hearing may be affecting speech development or school performance, ear tubes (myringotomy tubes) may be recommended.

A myringotomy is a surgical procedure that involves making a small incision in the eardrum to drain the fluid and relieve middle ear pressure. A small tube is placed in the eardrum to allow air to enter (ventilate) the middle ear and to prevent fluid from accumulating. Hearing is restored once the fluid is drained. The tubes usually fall out after six to twelve months.

Surgical removal of adenoids: If your child's adenoids (lymph tissue located in the space above the soft roof of the mouth) are infected, removal of the adenoids may be recommended.

Childhood Tinnitus

Tinnitus is the perception of sound (ringing, buzzing, hissing, roaring, etc.) without the presence of an external source of sound. Tinnitus appears to be twice as common in children with hearing loss compared to children with normal hearing. Although it is as common in children as in adults, children generally do not complain of tinnitus. One belief is that a child with tinnitus considers the noise in the ear to be normal, as it has usually been present for a long time. Continuous tinnitus can be annoying and distracting, and in severe cases can cause anxiety and interfere with your child’s ability to lead a normal life.


Like people of all ages, children who are exposed to loud noises are at a higher risk for tinnitus. Exceptionally loud recreational events (e.g. car races, music concerts, sports events) can damage children’s hearing; hearing protection devices should always be worn.

Causes of tinnitus in children could also be the result of ear infections, a build-up of wax in the ear canal, trauma to the head or neck, a misalignment in the jaw joints or a side effect of certain medications. Some children with tinnitus outgrow the condition; others carry it into adulthood believing that the noise or noises are normal.


Research has shown that behavior problems exhibited by children with tinnitus include poor attention and concentration, depression, insomnia, restlessness and lack of focus. In severe cases children can suffer from hearing difficulty resulting in poor grades at school.

Testing and Diagnosis

If you think your child has tinnitus, discuss it with your pediatrician. If he/she does not have a specific ear problem (e.g. middle ear inflammation with discharge), it may be necessary to have your child referred to an otolaryngologist (ear, nose and throat specialist) or audiologist to assess ear function and hearing.

There is no specific test to diagnose tinnitus. Instead, the physician will ask questions about when the noise started, how often they hear it, how loud it is and how much it is affecting their everyday life. Depending on the nature of the tinnitus, your physician may order a hearing test, a CT scan or MRI.

Treatment and Management

With most people diagnosed with tinnitus, including children, there is no known underlying medical cause. As a result, there is no specific medication or operation to ‘cure’ the problem. However, management can help reduce its impact on everyday life. Here are some steps you can take if your child is diagnosed with tinnitus:

  • Reassurance: Many children find it comforting to have their tinnitus explained carefully and to understand ways to manage it and cope. You can explain that tinnitus is a common condition that many other children, and adults as well, experience. Some children indicate that their tinnitus gets worse when they are under stress; work with your child to find ways to manage stressful situations. Ask your physician to describe the condition to your child in terms they can understand. If managed carefully, childhood tinnitus may not be a serious problem.
  • Sound generators (background noise): Sound therapy that makes tinnitus less noticeable, has been used to treat adults, and can also be used with children. ‘Masking’ the noise with quite background noises helps some people by diverting their attention away from the noise inside their ears. The sound can be environmental, a quiet fan or low background music. If tinnitus occurs on a regular basis, with sound therapy a child’s nervous system can adapt to the condition.
  • Hearing aids: If you child has tinnitus accompanying a hearing loss, hearing aids can help improve the tinnitus. Hearing aids pick up sounds hearing impaired children may not normally hear, which in turn will help their brains filter out their tinnitus. It may also help them by taking the strain out of listening. Straining to hear can make your child’s brain focus on the tinnitus.

Other forms of treatment attempt to reduce the stress caused by the tinnitus noise and can include relaxation therapies, anti-anxiety medicines and cognitive behavioral therapy (CBT).

Pediatric Hearing Loss and Hearing Aids

Hearing loss among children affects the development of their speech and language skills. Children with mild hearing loss can appear as though they are hearing normal, making it easier not to take the problem seriously. Studies show, however, that even children with a mild hearing loss can significantly improve their speech and language skills by wearing hearing aids. And, the longer children with mild hearing loss wear hearing aids, the better their speech and language skills develop.


Approximately three to four in every 1,000 newborns have significant hearing impairment. Hearing loss can be inherited or can be caused by illness or injury. Interestingly, about 90 percent of children with congenital hearing loss are born to hearing parents who are the carriers of recessive genes. The cause of congenital hearing loss is unknown in 20-30 percent of cases.

Prenatal illnesses account for five to 10 percent of the cases of congenital hearing loss and includes infections during pregnancy such as rubella, cytomegalovirus, herpes or syphilis or toxins consumed by the mother during pregnancy. Premature babies, with a birth weight of less than three pounds, or that require certain life-sustaining drugs, are also at risk for hearing loss.

After birth, traumas to the head or childhood infections, such as meningitis, measles or chicken pox, can cause permanent hearing loss. Certain medications are ototoxic (known to cause permanent hearing damage), such as the antibiotic streptomycin and related drugs, and can be the cause of a child's hearing impairment. Ear infections like otitis media may cause a decrease in hearing and can lead to permanent hearing loss if left untreated.


The signs and symptoms of hearing loss are different for each child. If you suspect your child might have hearing loss, ask your pediatrician for a hearing screening as soon as possible. Even if your child has passed a hearing screening before, it is important to watch for the following signs:

Infants and babies:

  • Does not startle to loud noises nearby
  • Does not turn toward the source of a sound after 6 months of age
  • Does not single words by 12 months, and simple 2-word sentences by age 2
  • Does not respond to familiar voices; shows no reaction when spoken to
  • Seems to hear some sounds but not others


  • Delayed speech development
  • Unclear speech
  • Does not follow directions. This can be mistaken for not paying attention or ignoring, but could be the result of a mild or severe hearing loss
  • Often says, “Huh?”
  • Turing the TV volume too high

Testing and Diagnosis

Hearing screening can tell if a child might have hearing loss. Hearing screening is easy and is not painful. It usually takes only a few minutes. In fact, babies are often asleep while being screened.

Infants and babies: All babies should have a hearing screening no later than 1 month of age. Most newborns have their hearing screened before leaving the hospital. If a baby does not pass a hearing screening, it is important to get a full hearing evaluation as soon as possible.

Children: Children should have their hearing tested before they enter school, or any time there is a concern about your child’s hearing during the preschool years. Children who do not pass the hearing screening need a full hearing evaluation as soon as possible.

Treatment and Management

Thanks to modern technologies, most hearing loss can be helped. Hearing aids make sounds louder and can be worn by infants as young as four weeks. It is important to work with your audiologist to evaluate your child’s needs and discuss options. Since very young children are unable adjust their own hearing aids, the hearing aids selected for infants must be easy for parents and caregivers to manipulate and monitor.

As your child grows and develops, and can respond to more sophisticated testing, hearing aids are adjusted accordingly. Therefore, hearing aids that can be easily adjusted for frequency response, the amount of amplification and the maximum limits of amplification are best. These devices are typically digital hearing aids.

It is important to understand that, as a child grows, ears grow too. This means that earmolds will need to be remade on a regular basis — more often when children are very young and less often as they get older and their ears grow are not growing as fast.

In educational and home settings, children frequently connect their hearing aids to assistive technology systems. Therefore, the hearing aid prescribed should include special features that will allow for this connection (e.g. telecoil and direct audio input capability).

Hearing Aid Types

Several types of hearing aids are available; the appropriate type depends on your child's individual needs and skills. In-the-ear (ITE) styles are usually reserved for adults and older children. The behind-the-ear (BTE) hearing aid is the type of hearing aid most commonly recommended for infants and young children for a variety of reasons, including:

  • Ability to accommodate various types of earmolds and a wide variety of hearing loss
  • Earmolds detach and can be easily remade as the child grows
  • Earmolds are easy to handle and can be easily clean
  • Listening checks and adjustments are easy for parents and caregivers
  • BTE styles can include direct audio input or a telecoil, so it can be used with other listening devices
  • The soft earmold material is safer and more comfortable for tiny ears

Hearing aids must be set carefully for each child. When choosing what hearing aids are needed for a child, the audiologist will consider important information, including:

  • The degree (severity) and type of hearing loss
  • Durability of the hearing aid
  • Manufacturer’s service
  • Hearing aid's ability to connect to assisted devices used in school

Once hearing aids are selected, the audiologist will carefully program the hearing aids based on the results of your child’s hearing tests. One of the best and most accurate methods for fitting hearing aids on a young child is called real ear measurement, which tests hearing aid fit with a probe-microphone. This test enables the hearing specialist to make minute adjustments that can have a significant impact on your child’s listening experience.

If you’re concerned with your child’s hearing health, schedule a visit with one of our caring professionals today to see what we can do for you!

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