Hearing loss means hearing sounds less clearly or not hearing sounds at all. It can affect 1 or both ears and may range from mild to total hearing loss. Some types of hearing loss can improve with treatment. Other types are permanent.
Some people are born with hearing loss. Others lose hearing over time due to damage caused by illness, injury, loud noise, or as a side effect of treatment.
Hearing loss can affect speech, relationships, learning, and development. Early support can make daily communication easier.
There are 3 main parts of the ear:
Outer ear
Sound waves enter through the outer ear, which works like a funnel. It directs sound to the eardrum. The eardrum separates the outer and middle ear.
Middle ear
The middle ear is an air-filled space. Three small bones, called the malleus, incus, and stapes, form a chain. They pass sound vibrations from the eardrum to the inner ear.
Inner ear
The inner contains fluid-filled cochlea. Tiny sensory hair cells line the cochlea. These cells turn sound vibrations into nerve signals. The auditory nerve carries these signals to the brain. The brain then processes the sound.
Hearing loss looks different in each person. Some signs are easy to notice. Others are not. Talk with your care team if your child has signs or symptoms such as:
- Trouble hearing or understanding sounds, especially in noisy places
- Not responding to sounds or speech
- A change or delay in speech
- Turning up the volume on devices
- Ringing in the ears
- Turning their head to hear better or use a “good ear”
- Balance problems
- Trouble following directions or keeping up with schoolwork
Hearing loss can have many causes. It may be present at birth or develop over time.
Common causes of hearing loss include:
- Certain chemotherapy medicines, especially drugs containing platinum like cisplatin and carboplatin
- Other medicines that can damage hearing
- Radiation to the ear, brain, nose, throat, sinuses, or cheekbones
- Surgery affecting the ear, brain, or auditory nerve
- Tumors that press on parts of the ear or hearing nerve
- Infections, such as ear infections or certain illnesses
- Genetic conditions or family history of hearing loss
- Loud noise over time or a sudden loud sound
- Injury to the ear or head
- Problems with how the ear forms or works
Risk may be higher if your child was born early (premature) or with a low birth weight. Higher exposure to loud noise also increases the risk.
Types of hearing loss
There are 3 main types of hearing loss. The type depends on where the problem is in the ear. Knowing the type can help guide care and treatment.
Conductive hearing loss
Conductive hearing loss happens when sound cannot move through the outer or middle ear. This can make sounds seem soft or “muffled.” Conductive hearing loss is often caused by:
- Fluid in the ear
- Earwax buildup
- Ear infections
- Problems with the eardrum or middle ear bones
Conductive hearing may improve with treatment.
Sensorineural hearing loss
Sensorineural hearing loss happens when there is damage to the inner ear (sensory) or auditory nerve. This damage affects how sound signals travel to the brain.
There are 2 types of sensorineural hearing loss:
- Sensory hearing loss occurs when the cochlea or the hair cells inside the ear are damaged.
- Neural hearing loss occurs when there is damage to the hearing nerve or to the part of the brain that processes sound.
Sensorineural hearing loss may be caused by:
- Damage to hair cells in the inner ear
- Injury or illness
- Certain medicines
- Aging
- Loud noise
Sensorineural hearing loss may get worse over time. This type of loss is often permanent.
Mixed hearing loss
Mixed hearing loss is a combination of conductive and sensorineural hearing loss. This means there is a problem in both the outer or middle ear and the inner ear.
Treatment depends on the cause and may include medicine, devices, or other support.
Unilateral hearing loss (1 ear): Hearing loss can affect 1 ear or both ears. When it affects only 1 ear, it is called unilateral hearing loss. Unilateral hearing loss can be conductive, sensorineural, or mixed.
People with unilateral hearing loss may have trouble:
- Telling where sound is coming from
- Hearing in noisy places
- Following conversations
Hearing Loss and Childhood Cancer
Hearing loss is a possible side effect of some childhood cancers or cancer treatments. Certain medicines, radiation, surgery, or the tumor itself can damage the ear, resulting in hearing loss.
- Chemotherapy: Chemo medicine can travel into the fluid of the cochlea, where it is absorbed by hair cells. When sensory hair cells are damage, vibrations reach the hair cells, but they can’t send the sound signals to the brain. High-pitch sounds are often affected first.
- Radiation therapy: Radiation can harm hair cells or damage nerves or brain areas that interpret sounds. Children who get radiation doses higher than 30 gray (Gy) are at higher risk.
- Surgery or tumors: Surgery, tumor pressure, or swelling can also cause damage to the nerves or brain areas involved in hearing.
Learn more about Hearing Problems After Childhood Cancer.
Diagnosis of hearing loss
An ear exam should be part of your child’s regular checkups. Your provider will use a tool called an otoscope to look inside your ear. This helps them check for signs of infection, fluid, or earwax that could affect hearing loss.
Audiologists are trained professionals who diagnose and treat hearing problems. They use hearing tests to check how well your child hears.
Hearing tests may be done if there are:
- Signs of hearing loss
- Risk factors for hearing loss
During a hearing test, your child will usually wear earphones. Sounds are played at different volumes and pitches. The audiologist checks what sounds your child can hear in each ear. Test results are compared to the levels expected for normal hearing.
Audiologists can also use an Auditory Brainstem Response (ABR) to test how the brain responds to sound. This test is often used for very young children or people who cannot follow testing instructions.
Other tests may include:
- Speech audiometry to test how well you hear words and sentences
- Tympanometry to see how the middle ear and eardrum move
Based on symptoms and test results, the audiologist may recommend follow-up testing, monitoring, or ongoing care.
Treatment for hearing loss
Hearing loss can be treated with different services and devices. The type of treatment used depends on:
- What caused the hearing loss
- How severe it is
Treatment and support for hearing loss may include:
- Hearing aids: Hearing aids make sounds louder and clearer. Children often wear behind-the-ear (BTE) devices. These devices are easy to adjust and allow for growth. Teens and adults may use smaller devices that fit inside the ear.
- Cochlear implants: Cochlear implants are devices placed during surgery. They help send signals to the auditory nerve (the hearing nerve). Cochlear implants do not work for all types of hearing loss.
- Hearing Assistive Technology Systems (HATS): Also called assistive listening devices, these devices help in different settings, such as at home, at school, or in public. Examples include frequency modulation (FM) systems, loop systems, phone amplifiers, and alerting devices. Some make sound easier to hear. Others change sound into a different form, such as text.
- Communication support: Speech reading, sign language, and interpreters can help with communication in school and daily life.
An audiologist can help match your child with services and devices that fit your child’s needs. The right support can help improve communication and independence.
Other support for hearing loss
Children with hearing loss may benefit from speech and language therapy. A speech-language pathologist (SLP) can help with speech delays and communication skills.
Work with your child’s care team and school to set up an Individualized Education Program (IEP) if needed. An IEP can give your child extra support and classroom accommodations, such as listening devices, note-taking help, captioning, or preferred seating.
Tips for patients and families
Living with hearing loss can affect daily life in many ways. If you have concerns about your child’s hearing, talk to your care team. It is important to diagnose and treat hearing problems early.
To support hearing and communication:
- Talk with your care team about your child’s risk factors for hearing loss.
- Get your child’s hearing tested regularly, so if something changes, you can find it early.
- Watch for signs of hearing loss. Talk with a doctor or audiologist if you notice changes in your child’s hearing or speech.
- Use hearing devices or other support when needed.
- Protect hearing from loud noises. Limit exposure to loud sounds such as music, traffic, sporting events, lawnmowers, and construction equipment. Use ear protection when needed.
Questions to ask your care team
