Intended for healthcare professionals

Practice 10-Minute Consultation

Paediatric hearing loss

BMJ 2017; 356 doi: (Published 09 March 2017) Cite this as: BMJ 2017;356:j803
  1. Hannah Nieto, ear, nose, and throat ST5 and, research fellow1,
  2. James Dearden, paediatric ST42,
  3. Stacey Dale, general practitioner,3,
  4. Jayesh Doshi, consultant ear, nose, and throat surgeon4
  1. 1Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, UK
  2. 2North Devon District Hospital, Barnstaple, Devon, UK
  3. 3The Cedars Surgery, Swanley, Kent, UK
  4. 4Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, UK
  1. Correspondence to H Nieto dixonh{at}
  • Accepted 4 January 2017

What you need to know

  • Take paediatric hearing loss seriously, especially if neonatal screening has been missed

  • Conductive hearing loss is most commonly caused by glue ear, usually a transient disease

  • All children who have had bacterial meningitis should have a follow-up hearing test

A 3 year old child attends with his mother, who is worried about his hearing. Staff at the child’s nursery say he doesn’t always respond immediately, and his mother is concerned that he is not talking as much as other children.

Paediatric hearing loss is a common problem; diagnosis and appropriate intervention are central to the child’s development. It is estimated that one in five children of around 2 years will have been affected by glue ear and eight in 10 will have been affected once or more by the age of 10.1

What you should cover


The observations of parents or professionals are key; explore inattentiveness at home, nursery, or school, and increased television volume, delayed language skills, and speech impediment. Symptoms will vary with severity and the age of the child.

Ask about

  • • ear infections, earache, or any observations of the child tugging their ear

  • • ear discharge

  • • mouth breathing, snoring, nasal discharge

  • • duration of symptoms

  • • age appropriate vocabulary and pronunciation

  • • known or suspected difficulties learning or playing, which might indicate neurodevelopmental delay

  • • previous health problems, particularly prenatal, perinatal, or postnatal infections such as meningitis

  • • neonatal hearing screening test results2 (box 1)

  • • a family history of hearing difficulties

Box 1: Neonatal hearing screening programme

A well baby (where there is no need for special care, or <48 hours special care) undergoes an automated otoacoustic emissions test. If this is not “passed” after two attempts, then the baby has an automated auditory brainstem response test.

Babies in neonatal intensive care or at risk have …

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