Ear Infections & Hearing Assessments in Toddlers

One of the standard recommendations during the diagnostic process for a late talking toddler is an audiological or hearing assessment.  If a baby can’t hear, he’s not going to learn to talk.  Now with universal hearing tests mandatory at birth in the United States, very few children with significant hearing losses are missed at birth. 

However, your child’s ability to hear can become compromised during infancy and toddlerhood by the presence of fluid in his or her middle ear.  Fluid is most often present during an ear infection, but fluid can also be present without any other symptoms. 

When a toddler has fluid in his ears, he does not hear words and sounds normally.  Speech sounds muffled, like he’s swimming underwater.  He may know that someone is talking to him, but have no clue what they are saying.  Can you imagine the challenge that presents when a toddler is trying to follow your verbal directions, much less learn to talk?          

Maintaining the ability to hear consistently is the key to learning how to understand and use words.  Parents should judiciously monitor hearing ability in children, especially those with frequent ear infections.  I am not one to overuse antibiotics, but if your child’s pediatrician is very laid back about the presence of fluid and treating ear infections AND your child is not learning language, you should consider taking a more aggressive approach.  Begin by asking for a referral to have your child’s hearing tested.  

The professional who is best qualified to test hearing in babies, toddlers, and preschoolers is a pediatric audiologist.  This person has at minimum a masters degree, but most often a doctorate in audiology.  You can usually find them in private practice in the yellow pages, at an ENT’s office, or in a children’s hospital.    

Many parents wonder how a toddler’s hearing can be accurately assessed.  Listed below are very basic explanations of the procedures that are most often used:

1.  Tympanograms - This test is performed by inserting probes that are like ear plugs into the ear test to measure middle ear function and detect the presence of any fluid in the middle ear.  Some kids hate it, especially those who are touch-defensive or who’ve had bad experiences with doctors checking their chronically infected ears.  Most don’t mind.  Parent holds you while audiologist does the test one ear at a time.

2.  Sound Field/Booth Testing - Toddler sits with mom or dad inside a dark “booth” or room.  When the audiologist plays the tone, the baby looks toward the speaker and an animal/light/some kind of visual spectacle lights up to “train” a kid to look toward what he hears.  It works remarkably well for alert and responsive children.  I have had lots of children on my caseload “fail” the test because they weren’t reliably responsive.  When that happens, the audiologist recommends ….

3.  An  ABR - Auditory Brain Stem Response Test - This test is usually performed in a hospital setting because it requires anesthesia so that the brain’s response to sound can be measured.  It’s scary for parents because of their child being “put to sleep,” but the test is accurate because the kid doesn’t have to “participate.”

4.  Referral to an ENT (Ear Nose & Throat Doctor) - If your child has had chronic ear infections, he may need tubes put in his ears to keep the fluid from staying lodged in his middle ear.  This procedure is done as an outpatient in a children’s hospital and does require anesthesia since it is surgery.  Most parents reports that it’s a very quick process with their children back home and playing within a couple of hours.  Most of the time tubes stay in place for a year or two and then fall out on their own.  You’ll know when the tubes are working because you’ll sometimes notice the drainage leaking out, but this is a good thing because it’s not keeping him from hearing.  This is the best treatment for a language or speech delayed child with chronically infected ears.  If he can hear, there’s a much better chance he’s going to learn to understand, talk, and be understood.          

 —————————————————————————————————————————————–Hearing loss should always be ruled out as a reason for speech-language delay.  Most of the time, it’s not the problem, but I’d hate to be the parent or therapist that missed hearing loss!  For many children with mild to moderate losses and no other issues, pop the hearing aids in and go!  I’m not minimizing the plight of hearing impaired children, but it’s sometimes easier to treat (relatively speaking of course) than lots of other things that could be a reason for a language delay or disorder, particularly if the loss is not severe, and there are no other issues.             I must also add that even minimal hearing loss that goes untreated can end up to be a “big deal.”  Children with even mild hearing losses at high frequencies have difficulty learning the high frequency consonants such as /s/.  In English the sound /s/ carries so much meaning.  It changes verb tenses, makes nouns plurals, and adds possessives. Make sure your child can hear consistently!  Aggressively monitor his or hear ability to hear by being aware of middle ear fluid.  Many times fluid remains in a child’s ear after a cold or allergy episode.  Be consistent with your follow-up appointments at the pediatrician and ENT. 

Bottom line - If a child can’t hear or understand, he is not going to talk.