The Parent’s Guide to Middle Ear Issues

Middle ear infections don't get a lot of attention but can be a huge factor for children with hearing loss and their families. Read along to hear one parent explain her family’s struggle with middle ear infection and how important it is to ask the right questions about middle ear fluid with your child’s medical professionals to combat one of the barriers that can keep your child from hearing critical sounds!

Meet Marge Edwards, M.S., CCC-SLP, LSLS Cert. AVT. Marge is a great example of a parent who did exactly what it took to reach the best possible outcomes for her two boys who have hearing loss. Her LSL experience even inspired her to achieve certification as a LSLS Certified Auditory-Verbal Therapist.

My son Cameron was diagnosed with moderate to severe hearing loss and fit with hearing aids at 3 months of age. When he was 5 months old, after one long night of fever and pain, his right ear drum ruptured. He had several more ear infections before he was 18 months old, which our pediatrician treated with antibiotics. When he was almost 2, I noticed that he was not responding to the Ling 6 sounds or my voice as consistently as he should. I distinctly remember one day when he did not respond to his favorite musical toy when it was just inches from his hearing aids. He did not have an ear infection, so I was concerned that his hearing loss had progressed. When we went to the audiologist, Cameron had a flat tympanogram in one ear and negative pressure in the other, meaning his eardrums were not moving as they should. The audiologist said it was ‘just fluid and that it would clear in time’. He sent us home and scheduled us for follow-up in 3 months—no hearing test, no referral to the ENT, nothing.
 
Needing more information, my husband and I scheduled an appointment with an ENT in another town who had a pediatric audiologist in his clinic. The audiologist did a sound booth test and Cameron’s responses were at 85-90dB (30dB worse than his original diagnosis). The ENT and audiologist immediately expressed concern for Cameron’s ‘mixed’ hearing loss and said that he was at-risk for significant speech and language delays. When the audiologist showed us a picture audiogram of what Cameron was missing, we were devastated—again. We knew his brain depended on full auditory access to develop speech and language and his hearing aids were not giving him the access he needed. The ENT scheduled Cameron for surgery to place ear tubes (pressure equalization tubes) the next week. We noticed a big difference after the tubes and Cameron could hear noticeably better. He also started talking a lot more in the following months.
 
Since then, Cameron has continued to have issues with middle ear fluid 1-2 times per year. We now have a plan where we coordinate with the audiologist and ENT. When he reports that his hearing aids are ‘not loud enough’, we make an appointment with the audiologist, she consults with the ENT, completes a tympanogram, assesses Cameron’s hearing in the sound booth and then programs a second setting on his hearing aids to meet the ‘fluid-induced’ thresholds. In several cases, the audiologist has temporarily fit him with more powerful loaner hearing aids until the fluid has cleared.
 
In retrospect, our learning curve was too slow in the early months and years of Cameron’s life. I wish we would have understood how middle ear fluid was further complicating his existing sensorineural hearing loss and had known about the specific questions to ask our EI provider, pediatrician and audiologist. We learned during our experience that team coordination was the answer.

Parents must be aware of the potential effects of middle ear fluid on auditory access, know the signs and have the tools to work with their professional team to diagnose, treat and follow-up so their child has the best auditory access all of the time.