Hearing Problems

One of the most common disorders of childhood is inflammation of the middle ear called otitis media. Usually this problem occurs because of improper functioning of the Eustachian tube. This tube, running from the back of the mouth to the middle ear, normally opens during yawning and swallowing and provides fresh air to the middle ear cavity behind the eardrum. This exchange of air is necessary to keep the middle ear functioning properly. Often a cleft of the palate affects the muscles controlling the opening of the Eustachian tube. For children with cleft palate, the Eustachian tube frequently does not open properly and inflammation and/or the accumulation of fluid may result because of the resulting trapped air in the middle ear.

Nearly every child with a cleft palate is likely to experience several bouts of otitis media. Middle ear problems are greatest in young children before they have received surgery to repair their cleft palate. For most children, cleft palate surgery significantly reduces the amount of middle ear problems. For others, however, little change is noticed after surgery. For all children, the likelihood of otitis media decreases as they get older.

Signs of Hearing Problems

It is essential for you to be alert to signs which may indicate that your child has a middle ear problem. These signs include tugging or rubbing an ear, unusual fussiness, and fever. If it is not detected early, an ear infection may create pressure on the eardrum and a severe earache can result. Whenever a middle ear problem is suspected, your child should be taken to a physician for an ear examination and appropriate treatment.

Treatment

Often otitis media will clear up after several days of taking prescribed antibiotics. However, for some children, especially those with a cleft palate, medication alone may not be sufficient. If the child has repeated bouts of otitis media, ventilation tubes may be necessary. In this treatment an ear doctor (otolaryngologist) makes a small surgical incision in the ear drum and inserts a ventilation tube in the hole to keep it open. This tube permits fluid behind the ear drum to drain and also allows fresh air to pass into the middle ear cavity. The ventilating tube is an effective substitute when the Eustachian tube is not functioning normally. A number of factors influence how long a ventilation tube remains in place, six to 12 months is about average.

Hearing Loss

Properly treated otitis media rarely causes permanent damage to the ear, but temporary hearing loss is common. A temporary hearing loss can be a significant problem because repeated episodes of hearing loss in a young child can affect speech and language development. Fluctuating hearing loss resulting from frequent middle ear problems has also been implicated in reducing a child's level of performance in school. Because the degree of hearing loss can fluctuate with the severity of the middle ear problem, in a matter of a few days a child's hearing can decrease from normal hearing to a significant hearing loss. Since a cleft palate increases the chances of otitis media, your child's hearing and ears should be monitored very closely.

Detecting Hearing Loss

It can be difficult to detect ear problems in young infants because sometimes otitis media does not cause much pain. When this happens the only sign of an ear problem may be your child's reduced ability to hear. Of course, a young infant cannot tell us about changes in hearing, so it becomes necessary to do some simple tests at home. Older children should be able to repeat whispered words. If a decrease in hearing is suspected, try making soft sounds behind your child and observe the responses. It is a good idea to do this regularly to develop a feel for how well your child responds when his/her hearing is normal.

Hearing Testing

If a hearing loss is suspected an audiologist can perform more scientific hearing tests. Testing can also help determine whether the Eustachian tubes, ear drums, and ventilation tubes are functioning normally. This testing can be conducted on children of any age. With very young infants, hearing is measured by recording changes in brain waves when sounds are presented. As the child gets older he or she can indicate hearing by making a behavioral response, such as turning the head, putting a ring on a spindle, or pointing to body parts. It is not necessary to wait until your child is two or three years of age before hearing can be evaluated.

Duke Guide to Care of Children with Cleft Conditions

• The Nature of Clefts
• Feeding
• Surgery
• Hearing
• Speech
• Orthodontics
• Psychological Perspectives
• Frequently Asked Questions
• Glossary
• Comprehensive Craniofacial Program Team Member Roles