Hearing Loss in Children With Down Syndrome
Hearing loss is very common in children with Down Syndrome and can lead to severe language delays. We’ll discuss why exactly children with Down Syndrome are at a higher risk for hearing loss and will have a look at the factors that affect their hearing.
Down Syndrome is a genetic condition that occurs at conception. People with Down Syndrome have an extra chromosome 21, which is why it is also known as Trisomy 21. It is often associated with intellectual disability, characteristic physical features and the increased risk of some health conditions, including hearing loss.
- 36 percent of children with Down Syndrome have hearing loss.
Why Are Children With Down Syndrome Affected By Hearing Loss?
The anatomical ear structure of children with Down Syndrome has characteristics that may predispose them to hearing loss. Most of the hearing loss seen in Down Syndrome is conductive hearing loss. This type of hearing loss is common in children with Down Syndrome because they often have narrow ear canals and fluid in the middle ear.
In children with Down Syndrome, sensorineural hearing loss is less common than conductive hearing loss, but it does occur in higher numbers than other children due to differences in the anatomy of the ear.
Children with Down Syndrome are susceptible to hearing loss because of:
- Narrow ear canals
- Fluid in the middle ear
- Increased incidence of chronic ear diseases
- Differences in the anatomy of the ear
- Weaker immune systems
- Central nervous system abnormalities
Types of Hearing Loss That Occur With Trisomy 21
Conductive Hearing Loss
This is the most common cause of hearing loss in Down Syndrome. Conductive hearing loss is often a temporary hearing loss where sounds cannot pass freely into the inner ear. In children, this often happens because they have a build-up of fluid in the space behind the eardrum.
If your child has ongoing fluid in the middle ear, it may be necessary for ear tubes to be surgically implanted by an Ear Nose and Throat surgeon. Sometimes children may experience conductive hearing loss due to a buildup of earwax which commonly occurs due to the very narrow ear canals seen in Down Syndrome.
Sensorineural Hearing Loss
Sensorineural hearing loss is usually a permanent hearing loss that happens where there is damage in the inner ear. Sometimes there are changes to the hearing organ and it does not send the sound messages to the brain. Other times, the hearing nerve which carries the messages to the brain, is not working.
Some children with Down Syndrome are born with this type of hearing loss and some may develop it as they get older. If your child has sensorineural hearing loss, hearing aids can help.
Mixed Hearing Loss
Is a combination of both conductive and sensorineural hearing loss. In children with sensorineural hearing loss, an additional conductive hearing loss will compound their hearing difficulties.
When Is A Child Tested For Hearing Loss?
The primary goal of pediatric audiology is to ensure that children have adequate speech and language development. Close monitoring and management are required for children with Down Syndrome due to their high risk of hearing loss.
Newborn Hearing Screening
Every newborn baby, including those with Down Syndrome, should have a newborn hearing screen. This will be done before your child is discharged from hospital. Sometimes babies will be referred for a more thorough diagnostic hearing test with an audiologist for further investigations. This is a painless test that is normally performed while your baby is sleeping in your arms.
Ongoing Hearing Assessments
All infants with Down Syndrome will have their hearing tested again at around 10 months of age with a hearing test called. During this test, your baby will be awake and will show what sounds she can hear by turning towards a puppet when sounds are played. If there are no concerns, your child’s hearing should be tested every 6 months until the normal hearing is confirmed in both ears.
If there are concerns, your child will be referred to an ear, nose, and throat specialist.
Once a normal hearing is confirmed in both ears, your child should continue to receive an audiogram every year. More frequent hearing tests will be required if your baby has an abnormal result or there are hearing concerns.
Learning and Speech
Children with Down Syndrome have a range of learning problems that make learning to speak in sentences very hard. These delays in developing may be made worse by hearing loss. A child with a temporary conductive hearing loss may be able to hear well some days and not other days. It will depend on whether or not there is fluid in the middle ear.
This is something we have all experienced from time to time when we have had a bad head cold.
If this fluid persists, it can become a constant mild hearing loss.
This will affect the child’s ability to hear the difference between some consonant sounds. This means that if I said, “bat” the child might think I said “pat.” The child will have to work out what I said based on the context of our conversation and may miss information to help with understanding. Single, short instructions will be easier for the child than longer sentences.
Assessment by an audiologist is important to determine if there would be a benefit to using hearing aids, as well as the need for services of a speech therapist. A lot of children with Down Syndrome benefit from using sign language, even if they do not have a hearing loss. It is vital to understand the impact of the child’s hearing loss in listening in the classroom. Mild hearing losses have been shown to negatively affect children’s progress in school.
Some strategies that should be considered in homes and classrooms to help children with mild hearing loss include:
- Talk to your audiologist regarding the benefit of amplification
- Avoid background noise such as radios, noisy air conditioners and busy hallways.
- Try not to communicate in rooms where sound reverberates and echoes.
- The use of carpeting, study carrels and other simple adjustments will greatly assist a child with hearing loss. It will also help the other children in the room as well.
- Make sure the child can see your face, especially your mouth when you are talking. Similarly at school, when the teacher’s back is turned, what is said may be missed by the child. Another thing to consider is if the child has a vision impairment, can the face be seen clearly at distance?
- It is helpful to do frequent checks to make sure the child has understood the instructions or is following the discussion.
- Use pictures, objects, and gestures to support your words and speak clearly and slowly if the child seems to be having difficulty following you.
In a Nutshell
Many people with Down Syndrome will be affected by hearing loss at some stage in their lives. The hearing loss may be a mild temporary hearing loss or a permanent problem. All children with Down Syndrome must be seen regularly by the family doctor, paediatrician and audiologist. These medical appointments and hearing reviews are vital to support a child’s speech, language and cognitive development.
Are you concerned about your child’s hearing? If you believe that your child may be experiencing hearing loss, book a hearing test with Attune Hearing, Australia’s leading hearing healthcare provider. Find your local Attune clinic and make an appointment today on 1300 736 702!