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.



  1. Monica on April 30, 2008 at 4:06 pm

    Thanks for the great article. We are in this process right now and will probably be having tubes put in my 2 year old sons ears. He has a large amount of fluid in his ears that the ENT specialist thought has been there for quite some time. He’s never had an ear infection. The only thing that tipped me off to a problem was his lack of speech. Hopefully tubes will help, but I am also awaiting a speech assessment with our county “Early Start” program.

    This site has been a great resource for me. Thank you for all the helpful information.

  2. michele on February 10, 2009 at 7:55 pm

    Thank you for that article. I wish I had found this site sooner. We are in the midst of this problem right now and had no other symptoms but a speech delay that wasn’t severe enough to qualify us for services but was still noticeable at his early intervention eval. We are in a wait and see pattern with his ENT regarding whether to do tubes or not so in the mean time I am going to start using alot of your exercises with him to help him boost the vocab he does have and hope that tubes will clear up the rest of his issues. We were shocked to hear about his hearing problems bc we have never had an ear infection. Thank you for th egreat info.

  3. Laura on February 10, 2009 at 9:23 pm

    Glad you’re enjoying the site!!! Check out the DVD clips too so you can see the techniques in action. Good luck with him! Laura

  4. Zoran on March 16, 2009 at 12:32 am

    Thank you! I would now go on this blog every day!

    Thank you

  5. Amy on April 12, 2010 at 2:49 pm

    I have enjoyed reading many articles throughout this site, but this one spoke to me more than most. We are going to have my daughter’s audiology appointment next week, to determine if she needs tubes in her ears, or if there is another source to her speech delay. I had to have tubes in my ears as a child, and can still remember when they fell out. I know that if she has to have them, it will bring instant relief.
    It brings peace of mind to know that there are so many other parents with concerns, and that there are resources like this site to answer questions and ease fear.
    Thank you.

  6. sara on April 3, 2011 at 6:19 pm

    my son is 16 months and has had multiple ear infections in a month and a half hes not talking at all. i think this may be due to hearing loss but, his doctor says hes fine. but when i say his name no response no matter how loud im yelling it.

  7. Laura on April 3, 2011 at 10:42 pm

    Sara – Did the doctor do any kind of testing before he declared him to be fine? If not, pursue a hearing test. You can contact a pediatric audiologist for an evaluation, but be sure that you find someone with LOTS of experience testing babies. We usually do try to rule out hearing loss as a reason a baby is not beginning to talk. No words by 16 months is a red flag, and I would hope that his pediatrician would have alerted to that. Does your son pay attention to you at other times? Does he follow very simple directions or play any interactive games with you? If not, then his delays are likely due to lack of engagement and social communication issues and not hearing problems, but you won’t know that until you rule out hearing loss. Good job for being concerned about this now rather than waiting, and waiting, and waiting… You may also want to pursue finding a new doctor who’s more responsive to developmental milestones and a mother’s very legitimate concerns.

    Keep searching the website for ideas for how to work with him at home. The webiste is FULL of very practical ways to begin to teach him how to understand and use words.

    SEEING my DVD Teach Me To Talk may also help you know how to work with him at home to get language going. If he seems to have difficulty understanding language, check out the DVDs Teach Me To Listen and Obey 1. Thanks for your question. Laura

  8. Krystan on July 5, 2011 at 11:57 pm

    Just found your article today, and I am so glad that I did! We are waiting for an appointment to have our daughter’s hearing tested. She is almost 3 years old, and has an extremely limited vocabulary. (maybe 20-25 words) She can “hear” but my concern is that she can only hear in a certain range of tones. I’m anxious for the results of the test – worried that she does have hearing issues, but at the same time, hopeful because then we will know how to help her. I’ve become increasingly frustrated because I’m not sure how to help her, she becomes so frustrated when she can’t get her point accross. She uses some signs and a lot of gesturing and I’m so tired of hearing friends and family tell us to just not give things to her until she talks/asks for them. But just wanted to say thank you for the article hopefully we will find some answers soon!

  9. Heather on September 30, 2011 at 9:08 pm

    My son is 2 years old and he had tubes put in his ears 10 months ago. He still has a limited vocabulary. He talks but its all mumbled. He goes back to ENT in 2 months but I’m worried he needs tubes again because they might of fell out. His doctor said he has a lot of wax in his ears as he did before and that he really can’t see deep into the ear because of the wax. I know what all you mothers are going through and it’s worrisome. Has anyone’s child needed tubes more than once and if so did their speech become normal?

  10. Heather on September 30, 2011 at 9:10 pm

    My son’s attention span is very short also. I’ll try to read to him but he wants no part in it. He’ll pull the book out of my hand and just turn the pages and doesn’t want to hear me read or he’ll get up and walk away. I think it may be that he still can’t hear me correctly.

  11. Tiffany on October 27, 2015 at 12:53 am

    My son is now 5 wks old, and failed his hearing screening at the hospital as well as twice at audiologist. We are now being referred to an ENT, there are so many questions I have asked the audiologist, but he just rambles and doesn’t give clear answers. Our pediatrician has said my son seems to have fluid behind his hears, but audiologist thinks he will be diagnosed with sensorineural hearing loss, as he hears loud sounds just not soft sounds. He was tested at 30dB to 75dB and can hear all but the 30dB, he said his 40 dB was inconclusive. I know my son can hear, he turns his eyes to me when I talk to him, and jumps/moves when he is asleep and hears us talking. Has anyone experienced this type of test result? Is it possible to have fluid in both ears making for the same amount of loss in each ear?? I’m so confused when I leave the audiologists office, his equipment seems outdated and he doesn’t allow my son to be fully asleep and still while testing. I’m worried about “hearing loss” if that’s really what it is, but I really just want answers! Some of you talked about tubes, I had 5 sets as a child and my husband 6 or 7 sets… Could this be a solution to our problem?? Thanks for any input.

    • Laura on October 29, 2015 at 5:26 pm

      Hi Tiffany. If there’s fluid, he probably will need tubes in order to hear those lower dB sounds. With your family history, it’s something that I’d definitely do if it’s recommended. It may be the ONLY solution to this issue for him and I’ve seen TONS of babies do well with no lingering problems after getting tubes.

      As far as the audiologist goes, do you have another option you can pursue since you’re not able to effectively get info. Call the pediatrician and ask for a referral to someone who specializes in pediatrics to get a second opinion. Even if you have to travel to a bigger city, it would be worth it!

      Has he had an ABR – auditory brainstem response – test? With that test he’ll be put to sleep with anesthesia and you will know definitively what he hears without all of those other factors.

      If hearing aids are recommended, do it! I’ve seen children with mild hearing loss have fantastic outcomes.

      It’s fantastic that you’re catching this so early. You sound like a fantastic mom. Keep searching for answers for your little guy!! Hang in there!! Laura

  12. Phebean on December 30, 2015 at 2:10 am

    Hello, thanks for this wonderful site. My son is 4 and the ABR test says he cannot hear (though i can swear he hears when i talk). Can he get tubes too because the Aids won’t just work. (he has cerebral palsy)

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