Sudden Sensorineural Hearing Loss in Children

Sudden sensorineural hearing loss (SSNHL) affects around 20 in 100 000 people every year. While most commonly diagnosed in patients over the age of 50, it can also occur in children and adolescents: research has found that about 6-7% of SSNHL cases affect patients under the age of 18, and the provoking causes for most of them remain unknown despite investigation, as in the adult population.

SSNHL and Viral Infection

Some cases of childhood sudden onset hearing loss might be present with signs of a viral infection, including the following:

• A high temperature

• A cough

• Tonsillitis

Some viruses (CMV, herpes simplex, rubella, etc) can lead to a sudden decrease in hearing sensitivity, and we know children’s immune systems tend to be exposed to viruses and bacteria more than the average adult.

What Is the Most Common Viral Cause of SSNHL in Children?

Cytomegalovirus (CMV) represents the most common virus linked to hearing loss, as 21% of all hearing losses from birth are CMV-related.

Young patients with CMV but normal hearing may need to be monitored in Audiology for years: 1 in 4 children with congenital CMV develops a hearing loss in the first 4 years of life. This change in hearing can occur suddenly or gradually over time, that is why ongoing monitoring of children with risk factors is crucial, especially during the critical period for speech development (0-3 years).

What Investigations Are Carried Out When a Child Is Diagnosed With Sudden Hearing Loss?

When a child is found to have a sudden hearing loss, specific investigations are performed to rule out any medical reason that might be behind it.

An MRI scan should be performed to check for any abnormalities in the child’s ear. An MRI takes detailed pictures of the brain and inner ear which can help doctors find the underlying cause of sudden hearing loss. Sometimes a CT scan may be performed.

Some underlying causes can be inner ear abnormalities, usually visible on MRI or CT scan, autoimmune diseases, head trauma, tumours and ototoxic drugs.

Will a Child Recover Their Hearing Following SSNHL?

Although childhood SSNHL tends to be more severe than adults, the recovery rates have been reported to be much better, with up to 57% of complete recovery after treatment. Early detection and thus intervention are fundamental in these cases.

What Are the Signs of SSNHL in Children?

Children are not always good communicators, so it can be difficult to notice if a child is experiencing a sudden drop in their hearing, let alone correlated symptoms such as tinnitus or dizziness.

As sudden hearing loss affects in most cases one ear only, it might not cause poor speech development, which usually represents a red flag for hearing impairment.

It is therefore important to keep an eye on subtle hints that your child might be giving you if they are experiencing a sudden drop in hearing:

• Turning to one side when someone is speaking with them

• Sudden difficulty in noisy environments (school, parks)

• Keeping the TV higher than normal

• Speaking louder

If you have noticed any of the above-mentioned signs in your child, speak with your GP and get a referral to the nearest Paediatric Audiology clinic.

Early detection and treatment are fundamental in giving your child the best chance of recovering their hearing.

References:

National Institute for Health and Care Excellence (NICE) guidelines, Hearing loss in adults: assessment and management, June 2018

Prognostic factors of profound idiopathic sudden sensorineural hearing loss. Wen YH, Chen PR, Wu HP. Eur Arch Otorhinolaryngol. 2014;271:1423–1429

Li FJ, Wang DY, Wang HY, et al. Clinical study on 136 children with sudden sensorineural hearing loss. Chin Med J 2016; 129:946–952.

Chung JH, Cho SH, Jeong JH, et al. Multivariate analysis of prognostic factors for idiopathic sudden sensorineural hearing loss in children. Laryngoscope 2015; 125:2209–2215

 Ječmenica J, Bajec-Opančina A. Sudden hearing loss in children. Clin Pediatr (Phila) 2014; 53:874–878.