Un crecimiento anormal de piel en el oído medio detrás de la membrana del tímpano es un colesteatoma. Infecciones repetidas y/o una bolsa de retracción de la membrana timpánica pueden causar que la piel se engrose y forme un saco de expansión. Los colesteatomas generalmente se desarrollan como quistes o bolsas que descaman capas de piel vieja, que crece dentro del oído medio. A lo largo del tiempo, el colesteatoma puede aumentar su tamaño y destruir los huesecillos vecinos del oído medio. La pérdida auditiva, mareos, y parálisis de los músculos faciales son raros, pero pueden ser el resultado del continuo crecimiento del colesteatoma.

¿Por qué se origina un colesteatoma?

Un colesteatoma usualmente se origina debido a una pobre función de la trompa de Eustaquio así como por una infección de oído medio. La trompa de Eustaquio conduce aire desde la parte posterior de la nariz hacia el oído medio para igualar la presión del oído (destapa los oídos). Cuando la trompa de Eustaquio trabaja inadecuadamente, tal vez debido a una causa alérgica, un resfrío o sinusitis, el aire en el oído medio es absorbido por el cuerpo, creando un vacío parcial en el oído. Este vacío succiona formando una bolsa o saco a partir de la membrana timpánica, especialmente en áreas debilitadas por una infección previa. Esto puede desarrollar el saco y transformarse en un colesteatoma. Una forma rara congénita de colesteatoma (presente al nacimiento) puede ocurrir en el oído medio y en otros lugares, como en la proximidad de los huesos del cráneo. Sin embargo, el tipo de colesteatoma asociado a infecciones del oído es el más común.

¿Como se trata un colesteatoma?

Un examen por parte de un otorrinolaringólogo-cirujano de cabeza y cuello puede confirmar la presencia de un colesteatoma. El tratamiento inicial consiste en una limpieza cuidadosa del oído, antibióticos y gotas ópticas. La terapia tiende a detener la supuración del oído controlando la infección. Las características del crecimiento del colesteatoma deben ser también evaluadas.

Un colesteatoma grande o complicado usualmente requiere tratamiento quirúrgico para proteger al paciente de complicaciones graves. Exámenes de audición y equilibrio, radiografías de la mastoides (el hueso del cráneo cercano al oído), y Tomografías de la mastoides pueden ser necesarias. Estos exámenes son realizados para determinar el nivel de audición en el oído y la extensión de la destrucción que el colesteatoma ha causado.
La cirugía es realizada con anestesia general en la mayoría de los casos. El objetivo primario de la cirugía es remover el colesteatoma para que drene el oído y la infección sea eliminada. La preservación o restauración de la audición es el segundo objetivo de la cirugía. En casos de severa destrucción del oído, la reconstrucción puede no ser posible.

La reparación del nervio facial o procedimientos para controlar el mareo son raramente necesarios. La reconstrucción del oído medio no es siempre posible en un solo tiempo quirúrgico, por lo tanto una segunda cirugía puede ser necesaria dentro de los 6 a 12 meses. Esta segunda operación intentará restaurar la audición y, al mismo tiempo, permitirá al cirujano inspeccionar el espacio del oído medio y mastoides buscando partes residuales del colesteatoma.

La cirugía puede hacerse algunas veces en forma ambulatoria. Para ciertos pacientes una noche de internación es necesaria. En algunos raros casos de infección grave se necesitará una hospitalización prolongada para tratamiento antibiótico. El tiempo de licencia laboral común es de una a dos semanas.

Después de la cirugía, el seguimiento en consultorio es necesario para evaluar resultados y para evaluar una posible recidiva. En casos donde se haya creado una cavidad abierta de mastioidectomia, el seguimiento en consultorio cada pocos meses es necesario para limpiar la cavidad mastoidea y prevenir nuevas infecciones. Algunos pacientes necesitarán exámenes periódicos de su oído a lo largo de su vida. El colesteatoma es una condición seria del oído pero tratable que puede ser diagnosticada sólo con un examen médico. Dolor persistente en el oído, supuración, presión en el oído, pérdida de audición, mareos o debilidad de los músculos de la cara deben ser evaluados por un otorrinolaringólogo.

Síntomas y riesgos

Inicialmente el oído puede supurar con feo olor. A medida que la bolsa o saco del colesteatoma se agranda puede causar una sensación de presión o de oído lleno, acompañado de pérdida en la audición. Un dolor detrás o dentro del oído, especialmente de noche puede causar una molestia considerable.

El mareo o la debilidad en los músculos de una mitad de la cara (la mitad del lado del oído infectado) puede también ocurrir. Cualquiera de estos síntomas son buenas razones para buscar una evaluación médica.

El colesteatoma puede ser peligroso y nunca debe ser ignorado. La erosión del hueso puede hacer que la infección se extienda a áreas vecinas, incluyendo el oído interno y el cerebro. Si no es tratado, la sordera, abscesos de cerebro, meningitis y raramente la muerte pueden ocurrir.
Más información acerca del oído.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

An abnormal skin growth in the middle ear behind the eardrum is called cholesteatoma. Repeated infections and/or a tear or pulling inward of the eardrum can allow skin into the middle ear. Cholesteatomas often develop as cysts or pouches that shed layers of old skin, which build up inside the middle ear. Over time, the cholesteatoma can increase in size and destroy the surrounding delicate bones of the middle ear leading to hearing loss that surgery can often improve. Permanent hearing loss, dizziness and facial muscle paralysis are rare, but can result from continued cholesteatoma growth.

What causes a cholesteatoma?

A cholesteatoma usually occurs because of poor eustachian tube function as well as infection in the middle ear. The eustachian tube conveys air from the back of the nose into the middle ear to equalize ear pressure (“clear the ears”). When the eustachian tubes work poorly, perhaps due to allergy, a cold or sinusitis, the air in the middle ear is absorbed by the body, creating a partial vacuum in the ear. The vacuum pressure sucks in a pouch or sac by stretching the eardrum, especially areas weakened by previous infections. This can develop into a sac and become a cholesteatoma. A rare congenital form of cholesteatoma (one present at birth) can occur in the middle ear and elsewhere, such as in the nearby skull bones. However, the type of cholesteatoma associated with ear infections is most common.

How is cholesteatoma treated?

An examination by an otolaryngologist – head and neck surgeon can confirm the presence of a cholesteatoma. Initial treatment may consist of a careful cleaning of the ear, antibiotics and ear drops. Therapy aims to stop drainage in the ear by controlling the infection. The growth traits of a cholesteatoma must also be evaluated.

A large or complicated cholesteatoma usually requires surgical treatment to protect the patient from serious complications. Hearing and balance tests, and CT scans (3-D x-rays) of the mastoid may be necessary. These tests are performed to determine the hearing level in the ear and the extent of destruction the cholesteatoma has caused.

Surgery is performed under general anesthesia in most cases. The primary purpose of surgery is to remove the cholesteotoma to eliminate the infection and create a dry ear. A second surgery is sometimes necessary both to ensure that the cholesteatoma is gone as well as to attempt reconstruction of the damaged middle ear bones in an effort to improve hearing. In cases of severe ear destruction, reconstruction may not be possible. Facial nerve repair or procedures to control dizziness are rarely required. Reconstruction of the middle ear is not always possible in one operation; therefore, another operation may be performed six to 12 months later. This operation will attempt to restore hearing and, at the same time, allow the surgeon to inspect the middle ear space and mastoid for residual cholesteatoma.

Surgery is commonly performed in an out-patient setting. For some patients, an overnight stay is necessary. In rare cases of serious infection, prolonged hospitalization for antibiotic treatment may be necessary. Time off from work is typically one to two weeks. After surgery, follow-up office visits are necessary to evaluate results and to check for recurrence. In cases requiring the creation of an open mastoidectomy cavity, office visits every few months are needed to clean out the mastoid cavity and prevent new infections. Some patients will need lifelong periodic ear examinations.

Symptoms and dangers

Initially, the ear may drain fluid with a foul odor. As the cholesteatoma pouch or sac enlarges, it can cause a feeling of fullness or pressure in the ear, along with hearing loss. An ache behind or in the ear, especially at night, may cause significant discomfort.

Dizziness, or muscle weakness on one side of the face (the side of the infected ear) can also occur. Any or all of these symptoms are good reasons to seek medical evaluation.

Cholesteatoma is a serious but treatable ear condition, which can be diagnosed only by medical examination. Bone erosion can cause the infection to spread into the surrounding areas, including the inner ear and brain. If untreated, deafness, brain abscess, meningitis and, rarely, death can occur.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Researchers continue to look for help for children and parents of children who suffer from the most common type of ear infection, called middle ear infection or otitis media (OM).

About 62 percent of children in developed countries will have their first episode of OM by the age of one, more than 80 percent by their third birthday, and nearly 100 percent will have at least one episode by age five. In the U.S. alone, this illness accounts for 25 million office visits annually with direct costs for treatment estimated at $3 billion. Health economists add that when lost wages for parents are included, the total cost of estimated treatments mount to $6 billion.

This is a big problem.

Treatments

The usual treatment options for children with middle ear infections include:

  • antibiotics; and
  • surgical insertion of pressure equalizing tubes in the ears. While studies have shown that antibiotics can be helpful in certain cases, excessive use can lead to bacterial resistance, making infections more difficult to treat. Tubes sometimes do not equalize pressure enough or may need reinsertion over time.

What about vaccines?

A vaccine is a preparation administered to stimulate the body’s own defense system to combat specific bacteria or viruses. The first vaccine was introduced in the 18th century for the prevention of smallpox. Today, each vaccine is designed to resemble a particular virus or bacteria (or group of viruses and bacteria). When administered, the vaccine triggers the defense system without actually causing illness. This helps the body to develop a defense (antibodies) against the virus or bacteria so that if they enter the body, you will not get sick. Today, vaccines exist to combat a wide range of viruses and some bacteria.

One of the most common and potentially serious bacteria to cause ear and sinus infections and pneumonia and meningitis is the pneumococcus. Recently a vaccine was developed that is effective against several common strains of pneumococcus.

Your child’s physician will advise you on appropriate vaccines for your child. If the pneumococcal vaccine is offered to your child, you may want to know:

The conjugate pneumococcal vaccine: This latest advance in pediatric healthcare prevents diseases caused by seven of the most common types of pneumococcal bacteria. It is safe and effective. It protects against serious forms of the disease up to 97 percent of the time, depending on the person. The vaccine is given by a needle. The side effects, which are usually minor and temporary, include some redness, swelling or tenderness from the injection, and a mild fever. Serious side effects, including allergic reactions, are quite rare. It can be given to infants, and there is no other vaccine to prevent pneumococcal disease in children less than two years of age. In 2002 the Centers for Disease Control and Prevention and the American Academy of Pediatrics recommended the vaccine for infants and toddlers under the age of five. See http://www.cdc.gov/vaccines for more information.

Conjugate vaccines are effective against otitis media in children under the age of five because they have a polysaccharide component linked to a protein component that an infant’s immature defense system can recognize. Children older than five, whose defense systems have matured, may receive a pneumococcal polysaccharide vaccine without the protein component.

How does this relate to otitis media? Here are issues to consider.

Streptococcus pneumoniae bacteria (commonly known as pneumococcus) are thought to cause 50 to 60 percent of cases of otitis media. Before this vaccine was available, each pneumococcal infection caused:

  • about five million ear infections;
  • more than 700 cases of meningitis;
  • 13,000 blood infections (septicemia); and
  • other health problems including pneumonia, deafness and brain damage.

Haemophilus influenzae (NTHi) and Moraxella catarrhalis vaccine are two other common bacteria that cause ear and sinus infections. Recently, the National Institutes of Health has issued a license for the first clinical trials for a nontypeable Haemophilus influenzae (NTHi) vaccine. Vaccines to prevent viral infections like the flu that can eventually lead to ear infections should be considered for children with recurring ear infections. These vaccines are usually administered in the fall.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

What You Should Know

  • Children with cochlear implants are more likely to get bacterial meningitis than children without cochlear implants. In addition, some children who are candidates for cochlear implants have inner ear anatomic abnormalities that may increase their risk for meningitis.
  • Because children with cochlear implants are at increased risk for pneumococcal meningitis, the Centers for Disease Control (CDC) recommends that they receive pneumococcal vaccination on the same schedule that is recommended for other groups at increased risk for invasive pneumococcal disease. Recommendations for the timing and type of pneumococcal vaccination vary with age and vaccination history and should be discussed with a health care provider.
  • The Centers for Disease Control and Prevention (CDC) has issued pneumococcal vaccination recommendations for individuals with cochlear implants. These recommendations can be viewed in detail on the CDC website.
    • Children who have cochlear implants or are candidates for cochlear implants should receive PCV13. PCV13 is now recommended routinely for all infants and children (see Table 2 in the CDC March 12, 2010 MMWR issue located at the above website for the number of doses and dosing schedule).
    • Older children with cochlear implants (from age 2 years through age 5) should receive two doses of PCV13 if they have not received any doses of PCV7 or PCV13 previously. If they have already completed the four-dose PCV7 series, they should receive one dose of PCV13 through age 71 months.
    • Children 6 through 18 years of age with cochlear implants may receive a single dose of PCV13 regardless of whether they have previously received PCV7 or the pneumococcal polysaccharide vaccine (PPSV23) (Pneumovax®).
    • In addition to receiving PCV13, children with cochlear implants should receive one dose of PPSV23 at age 2 years or older and after completing all recommended doses of PCV13.
  • The Centers for Disease Control and Prevention (CDC) has issued pneumococcal vaccination recommendations for adults with cochlear implants. These recommendations can be viewed in detail on the CDC website.
    • Adult patients (=19 yrs of age) who are candidates for a cochlear implant and those who have received a cochlear implant should be given a single dose of PCV13 followed by a PPSV23 at least 8 weeks later. A second dose of PPSV23 is recommended for those 65 years of age and older.
  • For those adults who previously have received 1 doses of PPSV23 should be given a PCV13 dose =1 year after the last PPSV23 dose was received. For those who require additional doses of PPSV23, the first such dose should be given no sooner than 8 weeks after PCV13 and at least 5 years after the most recent dose of PPSV23.
    For both children and adults, the vaccination schedule should be completed at two weeks or more before surgery.

Additional Facts

  • According to the Food and Drug Administration (FDA), as of April 2009, approximately 188,000 people worldwide have received cochlear implants. In the United States, roughly 41,500 adults and 25,500 children have received them. In the U.S., there are 122 known reports of meningitis in patients who have received cochlear implants with 64% of these cases having occurred in children.
  • Meningitis is an infection of the fluid that surrounds the brain and spinal cord. There are two main types of meningitis, viral and bacterial. Bacterial meningitis is the more serious type and the type that has been reported in individuals with cochlear implants. The symptoms, treatment and outcomes may differ, depending on the cause of the meningitis.
  • The vaccines available in the United States that protect against most bacteria that cause meningitis are:
    • 13-valent pneumococcal conjugate (PCV13) (Prevnar 13®)
    • 23-valent pneumococcal polysaccharide (PPSV) (Pneumovax®)
    • Haemophilus influenzae type b conjugate (Hib)
    • Tetravalent (A, C, Y, W-135) meningococcal conjugate (Menactra® and Menveo®)
    • Tetravalent (A, C, Y, W-135) meningococcal polysaccharide (Menomune®)
  • Meningitis in individuals with cochlear implants is most commonly caused by the bacterium Streptococcus pneumoniae (pneumococcus). Children with cochlear implants are more likely to get pneumococcal meningitis than children without cochlear implants.
  • There is no evidence that children with cochlear implants are more likely to get meningococcal meningitis, caused by the bacterium Neisseria meningitides, than children without cochlear implants. Health care providers should follow the CDC immunization guidelines for routine meningococcal vaccination.
  • The Haemophilus influenzae type b (Hib) vaccine is not routinely recommended for those 5 years of age or older, since most older children and adults are already immune to Hib. Available information does not suggest that older children and adults with cochlear implants require the Hib vaccine. However, the Hib vaccine can be given to older children and adults who have never received it. Children less than age 5 should receive the Hib vaccine as a routine protection, according to the CDC guidelines for childhood immunizations. Most children born after 1990 have received the Hib vaccine as infants.
  • Health care providers (family physicians, pediatricians and otolaryngologists) and families should review the vaccination records of current and prospective cochlear implant recipients to ensure that all recommended vaccinations are up to date.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

¿Por que la detección temprana de la hipoacusia es importante para su hijo?

Aproximadamente dos a cuatro de cada 1000 niños en los Estados Unidos nacen sordos o hipoacúsicos, haciendo de la pérdida auditiva la alteración más común al nacimiento. Muchos estudios han mostrado que el diagnóstico temprano de la hipoacusia es crucial para el desarrollo del lenguaje, habilidades cognitivas y psicosociales.

El tratamiento es más exitoso si la pérdida auditiva es identificada tempranamente, preferentemente durante el primer mes de vida. Todavía una cada cuatro niños nacidos con severa pérdida auditiva no recibe un diagnóstico hasta la edad de tres años o más.

¿Cuando se debe evaluar la audición de un niño?

La primera oportunidad para evaluar la audición de un niño es en el hospital apenas nacido. Si la audición del niño no es evaluada antes de irse del hospital se recomienda su evaluación durante el primer mes de vida. Si los exámenes indican una posible pérdida en la audición se deberá buscar una evaluación más profunda lo más pronto posible, preferentemente entre el primero y los seis meses de vida.

¿Es obligatoria la evaluación de pérdida auditiva?

En los últimos años las organizaciones de salud, incluyendo la Academia Americana de Otorrinolaringología han trabajado para remarcar la importancia de un screening o tamizaje precoz en todos los recién nacidos para buscar pérdida de la audición. Estos esfuerzos han dado sus resultados. En 2003 más del 85 por ciento de todos los recién nacidos en Estados Unidos fueron evaluados buscando pérdida auditiva. De hecho casi todos los estados han realizado leyes que obligan a alguna forma de evaluación de los recién nacidos antes de dejar el hospital. Esto todavía deja a más de un millón de bebes que no son evaluados para pérdida auditiva antes de abandonar el hospital.

¿Como se realiza la evaluación?

Dos exámenes son usados para evaluar la pérdida auditiva en niños y recién nacidos. Ellos son:

A.  Otoemisiones acústicas (OAE) que consiste en colocar un audífono de esponja en el canal auditivo para medir si el oído responde correctamente al sonido. En los chicos con una audición normal, un eco medible se producirá cuando el sonido es emitido a través del audífono. Si no se mide ningún eco puede indicar pérdida de la audición.

B.  Potenciales evocados de tronco (BERA) es un examen más complejo. Audífonos son colocados en los oídos y electrodos se colocan en la cabeza y oídos. El sonido es emitido a través de los audífonos mientras los electrodos miden como el cerebro del niño responde al sonido.

Si alguno de los exámenes indica una potencial pérdida auditiva, el médico sugerirá un seguimiento y evaluación a cargo de un otorrinolaringólogo.

Signos de pérdida de audición en el niño

La hipoacusia puede ocurrir en la infancia tardía, luego que el recién nacido abandonó el hospital. En estos casos, los padres, abuelos y demás personas de que cuidan al niño son frecuentemente los primeros en advertir que algo ocurre con la audición de ese chico. Incluso si su audición fue evaluada en el momento de nacer se debe continuar estando alerta a señales de pérdida auditiva tales como:

  • No reacciona de ninguna forma frente a sonidos intensos e inesperados.
  • No se despierta frente a sonidos de gran intensidad
  • No gira su cabeza en la dirección de la voz que le habla.
  • No es capaz de seguir o entender instrucciones
  • Pobre desarrollo del lenguaje
  • Habla muy fuerte o no usa las habilidades de lenguaje apropiadas para su edad.

Si su niño muestra alguno de estos signos debe indicárselos al médico

¿Qué sucede si mi niño tiene hipoacusia?

La pérdida auditiva en niños puede ser transitoria o permanente. Es importante que la pérdida auditiva sea evaluada por un médico que pueda indagar acerca de los problemas que puedan causar esta hipoacusia, tales como la otitis media (infección del oído), excesiva formación de cera en el oído, malformaciones congénitas o pérdida auditiva genética.

Si se ha determinado que la hipoacusia es permanente, el uso de audífonos puede ser necesario para amplificar el sonido que llega al oído del niño. La cirugía de oído puede ser útil para restaurar o mejorar significativamente la audición en algunos casos. Para aquellos con pérdidas profundas que no se benefician suficientemente con audífonos puede ser considerado un implante coclear. A diferencia de los audífonos, el implante coclear evita las partes dañadas del sistema auditivo y estimula directamente el nervio permitiendo al niño escuchar sonidos más fuerte y en forma más clara.

Usted deberá decidir si su niño se comunicará en forma primaria con lenguaje hablado o de señas y buscar una intervención temprana para prevenir retrasos del lenguaje. Los estudios indican que la rehabilitación de la pérdida auditiva a la edad de los seis meses prevendrá consecuentes retrasos de lenguaje. Otras estrategias de comunicación como la terapia de audición verbal, lectura de labios y lenguaje de señas pueden también ser usadas en conjunto con la terapia con audífonos o el implante coclear o bien en forma independiente.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Why is Early Childhood Hearing Screening Important for Your Child?

Approximately two to four of every 1,000 children in the United States are born deaf or hard-of-hearing, making hearing loss the most common birth disorder. Many studies have shown that early diagnosis of hearing loss is crucial to the development of speech, language, cognitive and psychosocial abilities. Treatment is most successful if hearing loss is identified early, preferably within the first few months of life. Still, one in every four children born with serious hearing loss does not receive a diagnosis until 14 months old.

When Should a Child’s Hearing Be Tested?

The first opportunity to test a child’s hearing is in the hospital shortly after birth. If your child’s hearing is not screened before leaving the hospital, it is recommended that screening be done within the first month of life. If test results indicate a possible hearing loss, get a further evaluation as soon as possible, preferably within the first three to six months of life.

Is Early Hearing Screening Mandatory?

In recent years, health organizations across the country, including the American Academy of Otolaryngology – Head and Neck Surgery, have worked to highlight the importance of screening all newborns for hearing loss. These efforts are working. Recently, many states have passed Early Hearing Detection and Intervention legislation. A few other states regularly screen the hearing of most newborns, but have no legislation that requires screening. So, check with your local authority or hospital for screening regulations.

How Is Screening Done?

Two tests are used to screen infants and newborns for hearing loss. They are otoacoustic emissions (OAE), and auditory brain stem response (ABR). Otoacoustic emissions involves placing a sponge earphone in the ear canal to measure whether the ear can respond properly to sound. In normal-hearing children, a measurable echo should be produced when sound is emitted through the earphone. If no echo is measured, it could indicate a hearing loss.

Auditory brain stem response is a more complex test. Earphones are placed on the ears and electrodes are placed on the head and ears. Sound is emitted through the earphones while the electrodes measure how your child’s brain responds to the sound.

If either test indicates a potential hearing loss, your physician may suggest a follow-up evaluation by an otolaryngologist.

Signs of Hearing Loss in Children

Hearing loss can also occur later in childhood. In these cases, parents, grandparents and other caregivers are often the first to notice that something may be wrong with a young child’s hearing. Even if your child’s hearing was tested as a newborn, you should continue to watch for signs of hearing loss, including:

  • Not reacting in any way to unexpected loud noises,
  • Not being awakened by loud noises,
  • Not turning his/her head in the direction of your voice,
  • Not being able to follow or understand directions,
  • Poor language development, or
  • Speaking loudly or not using age-appropriate language skills.
  • If your child exhibits any of these signs, report them to your doctor.

What Happens If My Child Has a Hearing Loss?

Hearing loss in children can be temporary or permanent. It is important to have hearing loss evaluated by a physician who can rule out medical problems that may be causing the hearing loss, such as otitis media (ear infection), excessive earwax, congenital malformations or a genetic hearing loss.

If it is determined that your child’s hearing loss is permanent, hearing aids may be recommended to amplify the sound reaching your child’s ear. Ear surgery may be able to restore or significantly improve hearing in some instances. For those with certain types of very severe hearing loss who do not benefit sufficiently from hearing aids, a cochlear implant may be considered. Unlike a hearing aid, the implant bypasses damaged parts of the auditory system and directly stimulates the hearing nerve, allowing the child to hear louder and clearer sound.

Research indicates that if a child’s hearing loss is remedied by age six months, it will prevent subsequent language delays. You will need to decide whether your deaf child will communicate primarily with oral speech and/or sign language, and seek early intervention to prevent language delays. Other communication strategies such as auditory verbal therapy, lip reading and cued speech may also be used in conjunction with a hearing aid or cochlear implant, or independently.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Why Is Early Childhood Hearing Screening Important For Your Child?

Every day in the United States, approximately 1 in 1,000 newborns (or 33 babies every day) is born profoundly deaf with another two to three out of 1,000 babies born with partial hearing loss, making hearing loss the number one birth defect in America. Many studies have shown that early diagnosis of hearing loss is crucial to the development of speech, language, cognitive and psychosocial abilities. Treatment is most successful if hearing loss is identified early, preferably within the first month of life. Still, one in every four children born with serious hearing loss does not receive a diagnosis until age three or older.

Why is it Important to Have My Baby’s Hearing Screened Early?

The most important time for a child to be exposed to and learn language is in the first three years of life. In fact, children begin learning speech and language in the first six months of life. Research suggests that those who have hearing impairment and get intervention have better language skills than those who don’t. The earlier you know about deafness or hearing loss, the sooner you can make sure your child benefits from strategies that will help him or her learn to communicate.

How Early Should I Have My Baby’s Hearing Screened?

The first opportunity to test a child’s hearing is in the hospital shortly after birth. If your child’s hearing is not screened before leaving the hospital, it is recommended that screening be done within the first month of life. If hearing loss is suspected, make sure an otolaryngologist orders tests for your baby’s hearing by three months of age. If hearing loss is confirmed, it’s important to consider the use of hearing devices and other communication options by six months of age.

Is Early Hearing Screening Mandatory?

In 2003, more than 85 percent of all newborns in the United States were screened for hearing loss. In fact, some 39 states have passed legislation requiring some form of hearing screening of newborns before they leave the hospital. This still leaves more than a million babies who are not screened for hearing loss before leaving the hospital.

How Is Screening Done?

Two tests are used to screen infants and newborns for hearing loss. They are:

Otoacoustic Emissions (OAE):

Involves placement of a sponge earphone in the ear canal to measure whether the ear can respond properly to sound. In normal-hearing children, a measurable “echo” should be produced when sound is emitted through the earphone. If no echo is measured, it could indicate a hearing loss.

Auditory Brain Stem Response (ABR):

Earphones are placed on the ears and electrodes are placed on the head and ears. Sound is emitted through the earphones while the electrodes measure how your child’s brain responds to the sound.

Signs of Hearing Loss in Children

Hearing loss can also occur later in childhood, after a newborn leaves the hospital. In these cases, parents, grandparents and other caregivers are often the first to notice that something may be wrong with a young child’s hearing. Even if your child’s hearing was tested as a newborn, you should continue to watch for signs of hearing loss. including:

  • Not reacting in any way to unexpected loud noises
  • Not being awakened by loud noises
  • Not turning his/her head in the direction of your voice
  • Not being able to follow or understand directions
  • Poor language development
  • Speaking loudly or not using age-appropriate language skills

If your child exhibits any of these signs, report them to your doctor.

What Happens If My Child Has Hearing Loss?

Hearing loss in children can be temporary or permanent. It is important to have hearing loss evaluated by a physician who can rule out medical problems that may be causing the hearing loss, such as otitis media (ear infection), excessive earwax, congenital malformations or a genetic hearing loss. If it is determined that your child’s hearing loss is permanent, hearing aids may be recommended to amplify the sound reaching your child’s ear. Ear surgery may be able to restore or significantly improve hearing in some instances.

For those with certain types of profound hearing loss who do not benefit sufficiently from hearing aids, a cochlear implant may be considered. Unlike a hearing aid, a cochlear implant bypasses damaged parts of the auditory system and directly stimulates the hearing nerve and allows the child to hear louder and clearer sound.

You will need to decide whether or not your deaf child will communicate primarily with oral speech and/or sign language, and seek early intervention to prevent language delays. Research indicates that habilitation of hearing loss by age six months will prevent subsequent language delays. Other communication strategies such as auditory verbal therapy, lip reading and cued speech may also be used in conjunction with a hearing aid or cochlear implant, or independently.

Is My Baby’s Hearing Normal?

If you think that your child has hearing loss, you might be right. The following checklist will assist in determining whether or not your child might have a hearing loss. Please read each item carefully and check only those factors that apply to you, your family or your child.

During pregnancy did…

  • Mom have German measles, a viral infection or flu?
  • Mom drink alcoholic beverages?

Did your newborn baby (birth to 28 days of age)…

  • Weigh less than 3.5 pounds at birth?
  • Have an unusual appearance of the face or ears?
  • Have jaundiced (yellow skin) at birth and had an exchange blood transfusion?
  • Stay in neonatal intensive care unit (NICU) for more than five days?
  • Receive an antibiotic medication given through a needle in a vein?
  • Have meningitis?
  • Fail newborn hearing screening test?

Did your infant baby (29 days of age to two years)…

  • Received an antibiotic medication given through a needle in a vein?
  • Have meningitis?
  • Have a neurological disorder?
  • Have a severe injury with a fracture of the skull with or without bleeding from the ear?
  • Have recurring ear infection with fluid in ears for more than three months?

Does one or more individual(s) of your family…

  • Have permanent or progressive hearing loss that was present or developed early in life?

Response to the Environment (Speech and Language Development)

My Newborn (Birth to 6 months)…

  • Does not startle, move, cry or react in any way to unexpected loud noises
  • Does not awaken to loud noises
  • Does not freely imitate sound
  • Cannot be soothed by voice alone
  • Does not turn his/her head in the direction of my voice

My Young Infant (6 through 12 months)…

  • Does not point to familiar persons or objects when asked
  • Does not babble or babbling has stopped
  • By 12 months is not understanding simple phrases such as wave “bye-bye” or “clap hands” by listening alone

My Infant (13 Months through two Years)…

  • Does not accurately turn in the direction of a soft voice on the first call
    Is not alert to environment sounds
  • Does not respond on first call
  • Does not respond to sounds or does not locate where sound is coming from
  • Does not begin to imitate and use simple words for familiar people and things around the home
  • Does not sound like or use speech like other children of similar age
  • Does not listen to TV at a normal volume
  • Does not show consistent growth in the understanding and the use of words to communicate

If your child has one of more of these indicators you should take him or her to a physician, preferably an otolaryngologist, for an ear examination and a hearing test. This can be done at any age, as early as just after birth.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Three million children under the age of 18 have some hearing loss, including four out of every thousand newborns. So, every parent and caregiver should be watchful of the signs of hearing loss in his or her child and seek a professional diagnosis. Hearing loss can increase the risk of speech and language developmental delays.

Indicators for Hearing Loss

During pregnancy

  • Mother had German measles, a viral infection or flu.
  • Mother drank alcoholic beverages.

Newborn (birth to 28 days of age)

  • Weighed less than 3.5 pounds at birth.
  • Has an unusual appearance of the face or ears.
  • Was jaundiced (yellow skin) at birth and had an exchange blood transfusion.
  • Was in neonatal intensive care unit (NICU) for more than five days.
  • Received an antibiotic medication given through a needle in a vein.
  • Had meningitis.
  • Failed newborn hearing screening test

Family

  • Has one or more individuals with permanent or progressive hearing loss that was present or developed early in life.

Infant (29 days to 2 years)

  • Received an antibiotic medication given through a needle in a vein.
  • Had meningitis.
  • Has a neurological disorder.
  • Had a severe injury with a skull fracture, with or without bleeding from the ear.
  • Has recurring ear infections with fluid in ears for more than three months.

Response to the Environment

(speech and language development)

Newborn (Birth to 6 Months)

  • Does not startle, move, cry or react in any way to unexpected loud noises.
  • Does not awaken to loud noises.
  • Does not freely imitate sound.
  • Cannot be soothed by voice alone.
  • Does not turn his/her head in the direction of your voice.
  • Does not point to familiar persons or objects when asked.
  • Does not babble, or babbling has stopped.
  • By 12 months does not understand simple phrases by listening alone, such as “wave bye-bye,” or “clap hands.”

Infant (3 months to 2 years)

  • Does not accurately turn in the direction of a soft voice on the first call.
  • Is not alert to environmental sounds.
  • Does not respond on first call.
  • Does not respond to sounds or does not locate where sound is coming from.
  • Does not begin to imitate and use simple words for familiar people and things around the home.
  • Does not sound like or use speech like other children of similar age.
  • Does not listen to TV at a normal volume.
  • Does not show consistent growth in the understanding and the use of words.

Hearing tests: How, when, and why

If you suspect that your child may have hearing loss, discuss it with your doctor. Children of any age can be professionally tested.

Tests for newborns and infants under one year

Hearing tests are painless, and they normally take less than a half hour.

Newborns are tested with either the otoacoustic emissions (OAE) test or the automated auditory brainstem response (AABR) test. During the OAE test, a microphone is placed in the baby’’s ear. It sends soft clicking sounds, and a computer then records the inner ear’’s response to the sounds. In the AABR test the child must wear earphones. Sensors are placed on his/her head to measure brain wave activity in response to the sound.

For infants over six months of age, the diagnostic auditory brainstem response and the visual reinforcement audiometry (VRA) tests are commonly used. The diagnostic auditory brainstem response test is similar to the AABR test, but it provides more information. The VRA test presents a series of sounds through earphones. The child is asked to turn toward the sound, then he/she is rewarded with an entertaining visual image.

Tests for older children and adults

Children between two and four years old are tested through conditioned play audiometry (CPA). The children are asked to perform a simple play activity, such as placing a ring on a peg, when they hear a sound. Older children and adults may be asked to press a button or raise their hand.

All children should have their hearing tested before they start school. This could reveal mild hearing losses that the parent or child cannot detect. Loss of hearing in one ear may also be determined in this way. Such a loss, although not obvious, may affect speech and language.

Hearing loss can even result from earwax or fluid in the ears. Many children with this type of temporary hearing loss can have their hearing restored through medical treatment or minor surgery.

In contrast to temporary hearing loss, some children have nerve deafness, which is permanent. Most of these children have some usable hearing. Few are totally deaf. Early diagnosis, early fitting of hearing aids, and an early start on special educational programs can help maximize the child’’s existing hearing.

Please note that this article is not a substitute for an ear examination or a hearing test.

What you should do

If you have checked one or more of these indicators, your child might have hearing loss and you should take him or her for an ear examination and a hearing test. This can be done at any age, as early as just after birth.
If you did not check any of these factors but you suspect that your child is not hearing normally, even if your child’’s doctor is not concerned, have your child’’s hearing tested by an audiologist and when appropriate, have his or her speech evaluated by a speech and language pathologist. The test will not hurt your child.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Travel is an important part of our lives. Whether for business or vacation, traveling can be as stressful as it is enjoyable, and for more than 20 million people in the U.S. with hearing loss, travel can be especially difficult.

What are common problems?

  • Inability to hear or understand airline boarding and in-flight announcements
  • Difficulty making reservations
  • Inability to hear hotel room telephones, someone knocking on the door, or warning signals such as smoke alarms
  • Difficulty using public telephones, hotel phones, cell phones, etc.
  • Inability to hear or understand scheduled events such as planned activities, tours, museum lectures and live performances
  • Lack of oral and/or sign language interpreters
  • Lack of accommodations for hearing dogs

What arrangements can be made?

  • Try to make all travel arrangements in advance. Once transportation arrangements have been made, request written confirmation to ensure that information is correct. Always inform the ticket representative that you are hearing-impaired.
  • If possible, meet with a travel agent to allow the opportunity for lip reading, or if necessary, written exchange to help confirm travel plans. Agents can contact airlines, hotels and attractions to make necessary reservations.
  • Travel information and reservation services are also available on the internet. Be sure to print copies of important information such as confirmation numbers, reservations and maps. Keep copies of travel arrangements, including confirmation numbers, easily available.
  • Arrive early at the airport, bus terminal or train station. Tell the agent at the boarding gate that you are hearing-impaired and need to be notified in person when it’s time to board.
  • Check the display board repeatedly while waiting in the terminal to confirm your flight destination and departure time as there may be delays or the departure gate may change. Confirm the flight number and destination before boarding.
  • Inform the flight attendant that you are hearing-impaired and request that any in-flight announcements be communicated to you in person. Consider reserving aisle seats so that you may easily communicate with the flight staff.
  • Do not be afraid to ask for help from fellow travelers – most are more than willing to offer assistance.

How should hearing aids be handled when traveling?

  • If you wear a hearing aid, be sure to pack extra batteries and tubing. These may be difficult to obtain in some places.
  • Strongly consider taking a dehumidifier for drying your hearing aids each night to prevent moisture problems, especially if your destination has a warm, humid climate.
  • To prevent loss, avoid storing your hearing aid equipment in checked luggage. Keep an extra set of batteries in a separate piece of luggage to prevent total loss of hearing aid use.

What other resources are available?

  • Many major airlines and transportation companies have Telecommunications Device for the Deaf (TDD) services to assist passengers.
  • Hand-held personal communication devices (e.g., cellular phones and smartphones) provide the ability to send and receive text messages without the need to access public resources. Ask your travel agent or check your reservation website to see if this option is available.
  • All public telephones should now have a “blue grommet” attachment to the handset indicating it is compatible with the “T’ switch or telephone program in hearing aids. Some public phones have an amplifying headset, or you can purchase a pocket amplifier from your audiologist or hearing aid dispenser. Cellular phones have solved many of these problems. All manufacturers have models that are also compatible with your hearing aid. You can search the internet by typing in “HAC phones” (hearing aid compatible) to get more information.
  • Smartphones often have applications for travelling. Such programs or email programs can store reservation information. Some applications offer real-time alerts for changes in flight plans, and others have maps that can provide directions.

What other devices are helpful?

  • Telephone amplifiers and induction couplers can be attached to public or hotel phones and can help increase the volume of the telephone. Induction couplers also make the telephone compatible with your hearing aid telecoil. Telephone manufacturers produce handsets such as the G6 and G66, which plug easily into any modular telephone. Using your own compatible cellular phone, however, not only eliminates these problems, but is also less expensive.
  • There are small portable visual alert systems available that flash light when the telephone rings or fire alarm sounds. These can be transported and easily installed in hotel rooms. In the U.S. they should be provided if you ask.
  • FM listening systems can provide direct amplification in large areas using radio frequency. They can help the hearing-impaired traveler listen to lectures, tours, etc., by simply having the speaker use a transmitter microphone, broadcasting the presentation over the radio waves to the receiver.
  • Portable infrared systems can be used with hotel televisions and radios. These transmit sound via invisible infrared light to a listener’s receiver.
  • Portable wake-up alarms can be used to flash a light or vibrate a bed or pillow. A cellular phone can also work as a vibrating alarm.
  • Portable TV band radios can be tuned to compatible TV channels and listened to through an earphone. You can set the volume to suit yourself and watch TV without disturbing others, or you can turn on the closed captioning (CC) feature of the TV so that you can read the dialogue. There may be a (CC) button on the TV remote control, or you may have to activate closed captioning through the TV’s menu options.

 

Will I need to take my hearing aids out for security screening?

In most cases, hearing aids worn on the ears will not set off of the alarms during security screening at airports. Keeping the hearing aids on will allow you to communicate with the security officers during screening, if necessary. It is ok to ask a security officer if it would be advisable to take your hearing aids off; however, body-worn hearing aids and personal listening devices may contain enough metal parts that they should be packed in your carry-on bag. The security scanner will not harm your hearing aids or other related devices.

Lodging

  • Carry printed copies of lodging reservations, dates and prices.
  • Inform the receptionist at the front desk that you are hearing-impaired. This is very important in case of emergency.
  • Certain major hotel chains now provide visual alerting devices to help the hearing-impaired traveler recognize the ring of the telephone, a knock on the door or a fire/emergency alarm. Contact the hotel in advance to make the necessary arrangements.

There are many things that hearing-impaired people can do to help make their travels safe, comfortable and enjoyable. Don’t avoid travelling because of hearing loss. Planning ahead and informing your fellow travelers, transportation hosts and hotel clerks that you are hearing-impaired are a few suggestions to help your trip run smoothly. Lastly, obtain any necessary devices – and enjoy yourself!

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Ear problems are the most common medical complaint of airplane travelers, and while they are usually simple, minor annoyances, they may result in temporary pain and hearing loss. Make air travel comfortable by learning how to equalize the pressure in the ears instead of suffering from an uncomfortable feeling of fullness or pressure.

Why do ears pop?

Normally, swallowing causes a little click or popping sound in the ear. This occurs because a small bubble of air has entered the middle ear, up from the back of the nose. It passes through the Eustachian tube, a membrane-lined tube about the size of a pencil lead that connects the back of the nose with the middle ear. The air in the middle ear is constantly being absorbed by its membranous lining and re-supplied through the Eustachian tube. In this manner, air pressure on both sides of the eardrum stays about equal. If, and when, the air pressure is not equal the ear feels blocked.

The Eustachian tube can be blocked, or obstructed, for a variety of reasons. When that occurs, the middle ear pressure cannot be equalized. The air already there is absorbed and a vacuum occurs, sucking the eardrum inward and stretching it. Such an eardrum cannot vibrate naturally, so sounds are muffled or blocked, and the stretching can be painful. If the tube remains blocked, fluid (like blood serum) will seep into the area from the membranes in an attempt to overcome the vacuum. This is called “fluid in the ear”, serous otitis or aero-otitis. Uncommon problems include developing a hole in the ear drum, hearing loss and dizziness.

The most common cause for a blocked Eustachian tube is the common cold. Sinus infections and nasal allergies are also common causes. A stuffy nose leads to stuffy ears because the swollen membranes block the opening of the Eustachian tube.

How can air travel cause hearing problems?

Air travel is sometimes associated with rapid changes in air pressure. To maintain comfort, the Eustachian tube must open frequently and wide enough to equalize the changes in pressure. This is especially true when the airplane is landing, going from low atmospheric pressure down closer to earth where the air pressure is higher.

Actually, any situation in which rapid altitude or pressure changes occur creates the problem. It may be experienced when riding in elevators or when diving to the bottom of a swimming pool. Deep sea divers, as well as pilots, are taught how to equalize their ear pressure. Anybody can learn the trick too.

How to unblock ears?

Swallowing activates the muscles that open the Eustachian tube. Swallowing occurs more often when chewing gum or when sucking on hard candies. These are good air travel practices, especially just before take-off and during descent. Yawning is even better. Avoid sleeping during descent because swallowing may not occur often enough to keep up with the pressure changes.

During descent, if yawning and swallowing are not effective, pinch the nostrils shut, take a mouthful of air and direct the air into the back of the nose as if trying to blow the nose gently – you should feel a pressure buildup but do not let the air out of your mouth The ears have been successfully unblocked when a pop is heard. This may have to be repeated several times during descent.

Even after landing, continue the pressure equalizing techniques and the use of decongestants and nasal sprays. If the ears fail to open or if pain persists, seek the help of a physician who has experience in the care of ear disorders. The ear specialist may need to release the pressure or fluid with a small incision in the ear drum.

For some people, these techniques may not work. If you fly frequently and have chronic issues with pressure or pain, you doctor may recommend placing small pressure equalization tubes.

How to help babies unblock their ears?

Babies cannot intentionally pop their ears, but popping may occur if they are sucking on a bottle or pacifier. Feed the baby during the flight, and do not allow him or her to sleep during descent. Children are especially vulnerable to blockages because their Eustachian tubes are narrower than in adults.

Is the use of decongestants and nose sprays recommended?

Many experienced air travelers use a decongestant pill or an over-the-counter nasal spray an hour or so before descent. This will shrink the membranes and help the ears pop more easily. Travelers with allergy problems should take their medication at the beginning of the flight for the same reason. However, avoid making a habit of over-the-counter nasal sprays. After a few days, they may cause more congestion than relief.

Decongestant tablets and sprays can be purchased without a prescription. However, they should be avoided by people with heart disease, high blood pressure, irregular heart rhythms, thyroid disease or excessive nervousness. Such people should consult their physicians before using these medicines. Pregnant women should likewise consult their physicians first.

Tips to prevent discomfort during air travel

  • Consult with your surgeon on how soon after ear surgery it is safe to fly.
  • Postpone an airplane trip if a cold, sinus infection or an allergy attack is present.
  • Patients in good health can take a decongestant pill or nose spray approximately an hour before descent to help the ears pop more easily.
  • Avoid sleeping during descent.
  • Chew gum or suck on a hard candy just before take-off and during descent.
  • When inflating the ears, do not use excessive force. The proper technique involves only pressure created by the cheek and throat muscles.
  • These tips may also be used for people who scuba dive.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery