Understanding Hearing Loss in Children: A Guide for Parents

Hearing loss in children — whether present from birth or acquired — requires early identification and management to support speech, language, and educational development. The causes range from glue ear and recurrent ear infections to sensorineural hearing loss, and a specialist paediatric ENT assessment with audiometry is the essential first step in establishing the diagnosis and appropriate management plan.

By Dr Vyas M.N. Prasad, FRCS (ORL-HNS) — Consultant Otolaryngologist & Head and Neck Surgeon, Camden Medical Centre, Singapore

• Hearing loss in children is often missed because children cannot accurately report what they are experiencing

• Common causes include glue ear, congenital hearing loss, and recurrent ear infections

• Early identification is critical as hearing directly affects speech development, learning, and behaviour

• This guide helps parents recognise the signs and understand what an ENT assessment involves

Hearing loss in children is more common than many parents realise — and more consequential than it might first appear. A child who is not hearing well is not simply missing sounds. They may be missing the building blocks of speech, the ability to follow instructions, the social cues that come from conversation, and the classroom input that underpins learning.

The good news is that most causes of hearing loss in children are identifiable, and many are very treatable. The key is not leaving concerns unaddressed for too long.

I have been assessing and treating children with hearing problems for over 20 years, with paediatric ENT training at Great Ormond Street Hospital in London. This article explains the common causes of childhood hearing loss, how I assess it, when treatment is needed, and what parents should watch for at home.

Why Hearing Matters So Much in Childhood

Children rely on hearing during a critical window of development. In the early years, hearing is the primary channel through which speech and language are acquired. A child with even mild or fluctuating hearing loss — such as from glue ear — may fall subtly behind in speech, vocabulary, and comprehension, sometimes without the cause being obvious.

The impact extends beyond language. Hearing loss can affect attention, behaviour, social development, and academic performance. Children who are straining to hear in a noisy classroom are using cognitive resources that their peers are directing towards learning.

This is why early identification matters so much. The earlier a hearing problem is found and addressed, the less opportunity there is for it to affect development.

Common Causes of Hearing Loss in Children

Glue Ear (Otitis Media with Effusion)

Glue ear is by far the most common cause of hearing loss I see in children. It occurs when fluid accumulates in the middle ear — the space behind the eardrum — reducing the ear's ability to transmit sound effectively. It is extremely common in young children, often following colds or ear infections, and can affect one or both ears.

The hearing loss from glue ear is typically mild to moderate and fluctuating. A child may hear reasonably well on some days and poorly on others, which can make the problem easy to overlook or attribute to inattention.

Many cases of glue ear resolve spontaneously over a period of weeks to months. However, when fluid persists and hearing is consistently affected, treatment becomes important — particularly during the developmental years when speech and language acquisition are most active.

Middle Ear Infections (Acute Otitis Media)

Ear infections are a normal part of childhood, and most resolve without lasting effect. However, recurrent infections can leave fluid behind, contribute to persistent middle ear problems, or in some cases cause damage to the eardrum or hearing structures. Children with very frequent ear infections warrant specialist assessment.

Congenital Hearing Loss

Some children are born with hearing impairment. This may be detected at birth through the newborn hearing screening programme, which tests hearing in the days after delivery. I do occasionally see children who have failed the newborn hearing screen — while this is not the most common referral I receive, it is an important one, and prompt assessment in these cases is essential to minimise the impact on early development.

Congenital hearing loss may be genetic in origin, or may result from factors during pregnancy such as certain infections. The management depends on the degree and type of loss identified.

Structural and Developmental Causes

Some children have anatomical features — a narrow ear canal, abnormalities of the middle ear bones, or other structural variations — that affect hearing. These are less common but are identified through careful examination and specialist assessment.

Noise-Induced and Acquired Causes

In older children and teenagers, prolonged exposure to loud noise — through headphones or music — can cause gradual hearing loss. This is worth raising with older children who regularly use personal audio devices at high volumes.

How I Assess Childhood Hearing Loss

The Consultation

When a parent brings a child to clinic with hearing concerns, I begin with a thorough discussion. I want to understand when concerns first arose, what specific behaviours have been noticed, whether there have been ear infections or upper respiratory illnesses, and how the child is doing with speech and language development.

Clinical Examination

I examine the ears, nose, and throat directly. For assessment of the ear canal and eardrum, I use a flexible paediatric scope rather than a standard otoscope in many cases. The visualisation this provides is significantly superior — it allows me to see the eardrum and surrounding structures in much greater detail, which is particularly valuable when glue ear or structural abnormalities are suspected.

Hearing Tests

Formal hearing assessment is an essential part of the workup, and I arrange this through specialist paediatric audiologists. The specific test used depends on the child's age:

• Newborns and very young infants — auditory brainstem response (ABR) testing, which does not require the child's active participation

• Toddlers — visual reinforcement audiometry or play audiometry, adapted to the child's developmental stage

• Older children — pure tone audiometry, the standard hearing test used in adults

I work with audiologists who specialise in paediatric testing, ensuring the assessment is both accurate and appropriate for the child's age. In some cases, audiology is arranged before the ENT consultation; in others, I examine the child first and then direct the audiological assessment based on my clinical findings.

Treatment: When Is It Needed?

Watchful Waiting for Glue Ear

Because glue ear so often resolves on its own, I do not rush to intervene. For a child presenting with glue ear for the first time, I typically recommend a period of watchful waiting — usually around three months — to allow natural resolution. During this time, I monitor the child's hearing and development.

If fluid persists beyond three months and is causing meaningful hearing loss, the balance shifts towards treatment.

Grommets

Grommets — small ventilation tubes inserted into the eardrum — are the standard surgical treatment for persistent glue ear. They allow air into the middle ear, preventing fluid accumulation and restoring hearing almost immediately. The procedure is performed under general anaesthesia and takes only a few minutes. Most children go home the same day.

Grommets are one of the most commonly performed procedures in paediatric ENT. In my experience, the improvement in hearing — and the knock-on effect on speech, behaviour, and school performance — can be very significant, particularly in children who have been struggling for some time.

Adenoidectomy

Enlarged adenoids can contribute to glue ear by obstructing the Eustachian tube, which normally ventilates the middle ear. In children with recurrent glue ear or significant nasal obstruction, adenoidectomy — removal of the adenoids — may be recommended alongside grommets.

Hearing Aids and Cochlear Implants

For children with permanent or significant sensorineural hearing loss, hearing aids or cochlear implants may be appropriate. I co-manage these children with specialist paediatric audiologists, ensuring the ENT and audiological aspects of their care are coordinated.

What Parents Should Watch For

Children — especially younger ones — cannot always tell you that they are not hearing well. Parents and caregivers are often the first to notice. Signs that warrant an ENT assessment include:

• Not responding to sounds or their name being called, particularly when they cannot see you

• Delayed speech development or unclear speech for their age

• Asking for repetition frequently, or mishearing words

• Turning up the volume on screens or devices

• Appearing inattentive or easily distracted — particularly in noisy environments

• Behavioural changes, frustration, or withdrawal that seems out of character

• Recurrent ear infections — three or more in a year

• A newborn who has failed the hospital hearing screen

• A child who has passed a hearing screen but about whom you still have concerns

  
  

Trust your instincts. Parents spend more time with their children than anyone else, and a persistent sense that something is not quite right is always worth investigating.

As Featured in The Business Times

The importance of early diagnosis and appropriate management of childhood hearing loss has been discussed in The Business Times. I would encourage parents who want to read further to take a look at the article.

👉 Read the Business Times article on childhood hearing loss

Frequently Asked Questions

My child passed the newborn hearing screen — can they still develop hearing loss? Yes. The newborn screen tests hearing at birth, but hearing loss can develop later — from glue ear, infections, or other causes. Passing the newborn screen does not mean hearing should never be checked again if concerns arise.

How do you test hearing in a baby or toddler who can't follow instructions? Specialist paediatric audiologists use tests specifically designed for young children that do not require active participation — such as auditory brainstem response (ABR) testing for infants, or play-based tests for toddlers. I arrange the appropriate test based on your child's age.

How long should I wait before seeking assessment? If you have concerns, do not wait. There is no minimum duration of symptoms required before seeking an opinion. Early assessment is always better than delayed assessment when a child's development may be affected.

Will my child need surgery? Not necessarily. Many children with glue ear resolve without any intervention. Where surgery is recommended — such as grommets — I explain the reasons clearly and ensure parents feel fully informed before any decision is made.

Do I need a referral? No. You can contact the clinic directly to arrange a consultation. I also accept referrals from GPs, paediatricians, and other specialists.

Seeking Assessment

If you have any concerns about your child's hearing — at any age — an ENT assessment is a sensible first step. Early evaluation allows for a clear diagnosis, appropriate hearing tests, and timely treatment where needed.

Find out more about Children's ENT care at Absolute ENT, or contact the clinic directly to arrange a consultation.

Dr Vyas M.N. Prasad is a UK- and fellowship-trained Consultant Otolaryngologist and Head & Neck Surgeon based at Camden Medical Centre, Singapore. He trained in paediatric ENT at Great Ormond Street Hospital, London, and has over 20 years of experience managing ENT conditions in children of all ages, including hearing loss.