Hearing impairment in a 5 year old child

A 5 year old boy was referred to the ear, nose, and throat (ENT) outpatients department by his general practitioner after his school had raised concerns about his hearing and attention. His parents had also noted that he tended to have the television on a loud volume, and they thought that he was a “loud child,” often shouting unnecessarily in quiet situations. On further questioning, it was apparent that his speech was delayed and difficult to understand. He had no history of other ENT problems or ear infections, and he had passed his neonatal hearing screening test. He was otherwise fit and well, had reached his milestones appropriately, and had no family history of note.

On examination, he had dull retracted ear drums with loss of the light reflex on both sides, and tympanometry showed flat traces bilaterally, consistent with no movement of the ear drums. The remainder of the examination was normal.

A pure tone audiogram was obtained (figure⇓).