No child can afford to have fluid in the ears

Half of the children in special education preschools in Israel failed the hearing screening! The audience was shocked and more than a little confused. The study was conducted by the Audiology Department of the Ministry of Education and it sounded like it was done properly. Experienced professionals went into dozens of special education preschool classrooms and screened more than 600 children. They found evidence of hearing loss in 49.5% of the children!

This took place at the annual meeting of the Israeli Speech Hearing Language Association in Tel Aviv last week. I gave a workshop (in Hebrew!) on counseling children with hearing loss meant for speech therapists that – I am glad to report – went smoothly. I sat in a few sessions of research presentations about lots of different issues about hearing loss and language. But this presentation really stole my attention.

We talk about “conductive hearing loss” and “fluid in the ears” very casually. Nah, it isn’t really serious like the sensorineural hearing loss that most of our kids have that is permanent and often quite severe. Or is it? Well, maybe the effects of chronic fluid are not as severe as sensorineural hearing loss but they really do take a toll on children.

Because our kids have a pre-existing hearing loss, they cannot afford to lose any more precious decibels because of fluid. In other words, we need to maximize their hearing by resolving middle ear problems as fast and effectively as we can! Because fluid in middle ear is so common in all kids, it will be common in kids with hearing aids too.

Fluid in the ears, even if it is not infected, makes it harder to hear. The data is clear: fluid backed up in the middle ear causes significant decrease in hearing. Its like turning down the volume on the world. Think about how hard it is watch a TV show when the volume is barely audible. It makes it not worth listening because it is too frustrating and annoying. This is how kids with fluid must feel about listening to everything.

No child can afford to lose hearing capacity due to fluid. I once took my son to an ENT (ear, nose, throat doctor) who told me not to worry, my son “only lost a little hearing because of the fluid.” I asked “what is a little?” and he guessed 10-15 decibels. Well, 10-15 decibels was a bad guess – because it turned out to be 40 decibels, but EVEN 10-15 DECIBELS IS TOO MUCH!!! Especially children with a sensorineural hearing loss, cannot afford to lose another decibel to fluid – not if we can help it!

Parents need to take responsibility if their ENT is not taking the situation seriously enough. Parents may need to see multiple doctors until they find one who understands the seriousness of fluid-related hearing loss. Unfortunately, some doctors do not realize how powerful the effects of fluid are on children’s ability to hear and understand and speak. I have heard doctors say “the fluid will go away in the spring” and “don’t worry, he’ll outgrow it” but they are not right. Each child needs every decibel he or she can possibly get, and each day, each decibel lost has an impact on their language development. Yes, they should know better, but that doesn’t mean that they always do. You need to take responsibility and not really trust anyone who makes promises that he/she can’t realistically keep or minimizes the impact that chronic fluid can have on your child. Ask your audiologist to recommend an ENT who has experience with children with sensorineural hearing loss and a good bedside manner.

Children with chronic fluid in the middle ear need careful supervision from a speech therapist. Even children who do not demonstrate clear delays in language at the moment - are at risk for problems in speech and language development. Even if all the neighbors and every other child you know has fluid problems, it can still have a serious impact on your child. Take your child to an SLP for a complete speech and language evaluation and tell them that you are worried about the effects of chronic fluid. There are specific signs of language difficulties that come from fluid. The speech therapist can tell you when to come back to keep an eye on the child’s development to make sure that he or she does not start to fall behind or develop problems.

Tubes are not a big deal and can make a huge difference. I think that since there was a time when ENTs did too many PE tube operations, they are under pressure not to do the surgery when it is not necessary. Of course, I do not advocate unnecessary surgeries. But if a 20 minute, outpatient procedure can give a child even a few more decibels of hearing – I think that parents need to consider this very seriously. I did. I figured that the risk of complications is low, there are no nerve endings on the eardrum (where the tubes create an opening) meaning that there is no pain, and the child can come home in the afternoon. I calculated that with an experienced and trustworthy surgeon we had little to lose and precious decibels to gain.

Chronic fluid creates a fluctuating hearing loss which can drive a child crazy! Can you imagine if the volume is never constant? You hear differently every day, some days better, some days worse and you can never predict how things are going to be. It is incredibly emotionally draining to cope with that constant volatility in hearing. For young children, who cannot tell us what is troubling them, this can mean irritable moods and a lack of interest in listening (because it is simply too exasperating). We want to minimize the barriers that might prevent listening as much as we possibly can.

Do not be fooled – a child with a sensorineural hearing loss can have a conductive hearing loss too. Because young children are not always the most reliable people to test, their hearing testing outcomes can fluctuate. Bone conduction testing is necessary to make sure that changes in hearing results are not due to conductive, middle ear causes. Tympanograms should be done whenever hearing testing is done. Ask your audiologist about these tests.

I suppose that there ought to be a fairness rule – stating that kids who already have a hearing loss don’t deserve fluid. I am 100% in favor of that rule – but I am afraid we are no match nature. All we can do is our best to treat chronic fluid and eliminate this problem that may be preventing our children hearing as well as they possibly can. But I think that all parents (and children) are allowed to complain that it is not fair. Sometimes it isn’t fair, but that’s how it is.

“God grant me the serentity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” Reinhold Niebuhr

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