My baby has always passed his left year and failed right ear (was tested about 3 times shortly after birth). However, at around 9 weeks he passed in both ears. We were instructed to retest at 6-9 months.
His left ear did well in the test that captures how eardrum responds to movement/air/pressure, but right still did not “pass”.
However in the sound booth, he did turn to each corner when they played sounds. But only through the speakers, she couldn’t test each ear truly because the headphones made him fussy.
We’ve been referred to an doctor but she also made it seem like we should get him tested again with an audiologist and she still would like to see him in three months…
Whats going on?! I’m just confused… why would one pass the ABR but not pass the movement/pressure test? What could that mean? To continually respond to sounds but not to pressure movement?
He doesn’t really babble, but does yell. Does not really imitate us either… but our pediatrician acts unconcerned.
They are testing two different things. Normally sound travels down the ear canal and hits the eardrum, the ear drum vibrates and this vibration is passed through the tiny bones of the middle ear and into the cochlea (inner ear) where it is transduced to neural signals that are interpretted by the brain.
Given that your child passed the , their hearing at the level of the inner ear, their “true” hearing, is normal. If there are no particular risk factors (i.e. the birth history was uncomplicated and there are no genetic, syndromic, or disease concerns) then it is VERY unlikely that your child will develop hearing loss (in childhood, who knows what their hearing will be when they are 80). There are genetic mutations that result in children having normal hearing at birth and progressive loss later on, but they are very rare and not really worth worrying about unless particular concerns arise.
The pressure test is testing the movement of the ear drum. The middle ear space connects through the eustachian tube to the nose and throat. The eustachian tube’s normal job is to open and close to maintain appropriate pressure in the middle ear space. When we’re born, it is very flat and small and it is tremendously common for it to get plugged up, and when it gets plugged up you can get a fluid build up in the middle ear space that stops the eardrum from moving. This may be referred to as abnormal middle ear function or middle ear dysfunction, because the eardrum and bones of the middle ear aren’t moving the way they should be (because of the fluid). This can cause a temporary hearing loss–the inner ear hears normally but the sound is not transmitting through the middle ear properly. Note that it doesn’t always cause clinical hearing loss–sometimes the eardrum isn’t moving well, but there are negligible impacts on hearing.
Most children just grow out of this, the fluid clears on its own, the eardrum starts moving normally and hearing returns to normal. Where we are concerned is when it does NOT clear on its own and the temporary, mechanical hearing loss impacts language development because there is a critical window for language development between the age of 0 and 4. As a result, kids with chronic middle ear dysfunction are sent along to the to determine whether they should get PE tubes placed in their eardrums to clear the fluid. In many cases, one set of tubes is all it takes and the child doesn’t have trouble again. Some children get multiple sets of tubes. Some children might also need their adenoids/tonsils assessed.
It sounds like your child has middle ear dysfunction, but only in one ear, and it’s not clear that it is really impacting your child’s hearing much at this time. As a result, your child is not currently at risk for language delays BUT the audiologist wants to keep monitoring to make sure that the middle ear dysfunction clears up on its own and doesn’t become a chronic concern.
Extra note: Many children are fine at birth, or have temporary middle ear dysfcuntion that clears up on its own, but start having problems again between the ages or 2-5, often when they are entering daycare or preschool and picking up viruses all the time. This is another point where you want keep an eye on how they are hearing in case they might need reassessment or rereferral. Children with multiple ear infections in a year will also typically be referred on to the ENT. All of this is super common and kids who get PE tubes generally grow up to be adults with completely normal ears.
Thank you so much for this great explanation of infants ear issues.
My daughter started having issues around 7-8 months. Lots of infections and fever. It was nerve racking as a parent! Finally tubes were put in and she started talking sentences within a month and fever gone. She hasn’t had any hearing issues since, she is 45 now.
Yeah, the watchful waiting can be frustrating. On the one hand, PE tubes are a surgery even though they are a very minor surgery, and one wants to avoid surgery (and anaesthesia) whenever possible. On the other hand, language is important and there’s some suggestion that chronic middle ear dysfunction in childhood can lead to difficulty developing audiotry skills which may later lead to central auditory processing issues.
If I could throw a bone conduction hearing aid on every kid with middle ear dysfunction so that they could hear while waiting for their ears to clear, I would. But it is currently dramatically cost prohibitive.
I am a little late to this post. My son just now partially failed his . His left ear resulted in mild hearing, and his right ear was perfect. But both ears failed the pressure test completely. He is 4 months old, and we have been concerned about his hearing since he was born because he has had zero startle reflex, nothing wakes him up, and he does not look when people are talking or making noises. He just has no cares in the world unless you get directly into his line of sight. The audiologist told us that more than likely it was temporary, and that there was just fluid behind his ear drums, besides that left ear which could be further down. We are also more alert because his father has hearing loss and hearing aids since he was a kid. We went to the , and there is no blockage of any kind behind his ear drums and we are waiting now until he is 6 months old to go retake the ABR test. They told us if he fails again, then it was a permanent thing and intervention of some sort will be needed to correct it or help him. I was told there is a slight chance that he could outgrow the immobile ear drums and be perfectly fine, because by 6 months, he would have outgrown it by then. I have done research and I cannot find anything that could cause his ear drums to be immobile that makes me think it is what is happening to him. Can ear drums just not work?? There is not any blockage or fluid, he has never had any infections of any kind, I have never been told is was retracted, there is nothing on the ear drum, his ears are normal shaped and all those things, he has an ears canal. There has never been any drainage or any signs of pain. He is the happiest baby. I am just trying to prepare myself for what is to come, because my gut is telling me that this is just his ear drum and it will be like this forever. Any help??
On the one hand, PE tubes are a surgery even though they are a very minor surgery, and one wants to avoid surgery (and anaesthesia) whenever possible.
I also want to say that I really appreciated your diagnosis and explanation here. I wish I’d been born just 15 years later, cuz as a child, I was also prone to chronic ear infections, that PAINFUL fluid build-up, and then in my teens had both ears infected and from that point on got 24x7 tinnitus and genetic hearing loss that has marched ever DOWNWARD over the decades.
When I was a teenager babysitting a kid, his folks told me about the PE tube. I guess my own folks didn’t know about it, but I bet I would’ve been a good candidate for that procedure. I’d have been 14 at the time?
Ah well. I still daydream about having those tubes put in, cuz I have a sense of my eustachian tubes not being able to clear. Drives me nuts. At my age of almost 70, believe me the “pina colada” sensation of anesthesia would be WELCOME.
I am responding mobile so apologies for any typos or limitations.
Normally sound travels along the ear canal, vibrates the eardrum and those vibrations are sent through the little middle ear bones and into the inner ear. The middle ear space around the middle ear bones connects down to the back of the throat and sinuses via the eustachian tube. When we are born the eustachian tube is very flat and very small and it’s very easy for it to not work well doing its job at equalizing the pressure between the outside environment and the middle ear space. If the eustachian tube isn’t working well you can get a buildup of fluid in the middle ear that stops that your drum from vibrating. Middle ear dysfunction, middle ear fluid, middle ear effusion. This is very common for infants, and typically it is temporary. When the eardrum isn’t moving well you can see a fluctuating hearing loss, or sometimes no hearing loss at all.
It is very, very difficult to fake pass an , so if your child was tested by a real audiologist in North America then we know for sure that the right ear was hearing normally at that time. Typically an ABR can also confirm whether any hearing loss present is permanent and in the inner ear, or conductive due to a problem in the middle ear (unless baby wakes up and results are incomplete). It is indeed likely that the mild hearing loss seen in the left ear was temporary due to the abnormal eardrum function. By the time your child got to see the ear nose and throat specialist, it looks like that middle ear dysfunction had cleared up, which means your child was probably hearing normally at that time.
If your baby has middle ear dysfunction again at 6 months with an associated hearing loss, he may end up needing PE tubes. This is a fairly easy solution and very unlikely to leave any permanent hearing loss. If he is a kid who has chronic middle ear dysfunction, his hearing might fluctuate from day to day. However, most children grow out of this and as long as language is developing typically it’s not a big concern.
Hearing aside, some babies are just super chill and don’t really startle to loud noises. Hopefully in the next few months you’ll see him responding to sound a little bit better. But it sounds like he’s being well taken care of. Even if this isn’t resolved until he’s between one and two years of age, he’ll still be fine.
Addendum: middle ear fluid can get infected but also may not. If the eardrum doesn’t rupture you won’t see drainage. If it’s just sitting there and not really building up, the eardrum won’t be distended or retracted. If it’s not infected, it’s really hard to SEE visually with an otoscope even in many adults, let alone an infant. The audiologist will find it with , or the will with the pneumatic otoscope, most GPs and nurses have no idea unless it’s pretty brutally obvious.
@1bluejay, they may not have had PE tubes when you were young, or not like they have now. My dad’s just a bit older than you and he had some horrid eustachian tube reaming procedure when he was a child.
@1bluejay, they may not have had PE tubes when you were young, or not like they have now. My dad’s just a bit older than you and he had some horrid eustachian tube reaming procedure when he was a child.
Yes, that is what I thought - PE tubes were simply not around. Your dad’s experience also gives me the willies - even the idea of a would be too scary to contemplate for me. I feel incredibly lucky to be doing SO WELL with the Lumity Life 312s.
They are a fashion statement AND kick some a$$ with speech comprehension.
Yes, his right ear was hearing at the time. But the audiologist explained to me that he was still little, so he would have to get used to hearing the distortion from his ear drum not moving. So, even if he is hearing in that ear, it would be distorted. It only took a week to get into the after his audiologist appointment, and during that appointment, the ENT did use the tool needed to see deep in there to determine if there was any blockage or fluid build-up in the middle ear or behind/around the ear drum. There was not, and my son was not responding to him of any kind, just doing random testing- nothing formal. i.e. snapping, talking, clapping, those kinds of things. He wasn’t responding to any of those, on either side. I even showed him how I can talk loudly to my other children while holding him and he wont even look in my direction. With all of that knowledge, he believes its either an underdeveloped ear canal that is preventing the ear drum movement, or it will end up being a bigger cause of immobile ear drums that we would have to look further into if he fails his next . With the ABR last time, on his left ear- he might still need assistance with that ear because his loss extended further than just the ear drum. I was just curious if there was something that could cause the hearing issue that even may be genetic, that would have nothing to do with tubes, fluid, blockage or any thing of that sorts. Because that has already been ruled out and he is still experiencing hearing loss. I am just trying to prepare and learn and figure out that right questions to ask just in case! This is an area that I am new in, and although my husband is hard of hearing, I still am not sure.
Honestly, it sounds like you’re getting a bit ahead of yourself. If his right ear was normal on the and his left ear is a bit of a question mark, he’s still hearing everything he needs right now for appropriate language development. At six months, either it will be clear and he’ll be discharged, or there will be middle ear fluid and he might need tubes, or there will still be a mild loss in his left ear and he might need a hearing aid on that side (but still might not if it’s very mild). If it’s actually permanent hearing loss it could be genetic or a structural under-developed thing, or it could be cCMV which is the most common cause of non-genetic permanent childhood hearing loss, but depending where you are he may have been screened for cCMV on his birth bloodspot testing.
I know “wait and see” sucks. But your son has everything he needs right now and if it does come to getting a hearing aid you’ll have support from your professionals and a good resource in your husband.
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