Frequently asked questions

Why does my child get glue ear? “Glue ear is a build-up of sticky fluid in the middle ear. For the ears to work properly the middle ear needs to be kept full of air. The eustachian tube usually keeps the middle ear full of air. It runs from the middle ear to the back of the throat. In children, this tube is not as vertical and wide as it will be when they get older. As a result, it doesn’t work as well. In children with Down’s syndrome, this tube can be particularly narrow. If the eustachian tube becomes blocked, air cannot enter the middle ear. When this happens, the cells lining the middle ear begin to produce fluid. With fluid filling the middle ear, it becomes harder for sound to pass through to the inner ear and sounds become more muffled”

(excerpt from “ Down’s syndrome and Childhood Deafness” Information for Families by National Deaf Children’s Society, Down syndrome Medical Interest Group UK/Ireland and Down Syndrome Association UK) read more...

How can glue ear be treated? Each child is different and therefore examination and treatments will differ and may include treatment by antibiotics, antihistamines and decongestant medicines, insertion of grommets, removal of adenoids and sometimes tonsils and some parents may use alternative treatments i.e. change in diet.

Why does my child get too much wax? All ears produce wax and the natural way wax is expelled from the ear canal when we chew and the wax travels along the hair cells in the ear canal and is gradually expelled.   Wax is a very common problem for children and adults with Down syndrome because the narrow ear canals can easily become blocked and this can cause hearing difficulty.  Wax can cause feedback (a whistling noise) for children who use hearing aids.  Ear drops for wax removal can be very helpful but when the ear canal is very narrow, it can easily become even more blocked by the drops and wax together.  Have your ENT doctor check your child’s ears on a regular basis and arrange for wax to be removed when necessary.

What are Middle-Ear infections?
Middle-ear infections are common in children:-

Acute otitis media which causes severe earache and a high temperature. Most infections clear up without any long-term effects once they are treated with antibiotics. However, sometimes repeated infections can cause the eardrum to weaken and could eventually leave a permanent hole (perforation).
A hole in the eardrum exposes the middle ear. It can then easily become infected leading to long-term discharge from the ear. Sometimes longer-term problems can arise. They can lead to a second and more serious form of middle-ear disease known as chronic otitis media.
Chronic middle-ear disease is usually associated with a smelly discharge from the ear and deafness, but rarely pain. It is important that you see your doctor if your child has a discharge from their ear. Most infections clear up with a course of antibiotics, but if infections become frequent or long-term it is important that your child sees an ENT doctor to examine the ears
Hyperacusis: Hyperacusis is sensitivity to noise. Studies have shown that a few children with Down’s syndrome are particularly sensitive to noise. These children may be distressed in some situations especially when there is a lot of background noise. If this seems to be a problem, discuss this with your child’s audiologist.
Cholesteatoma: Cholesteatoma is a cyst or pouch of skin within the ear. It is usually due to repeated infection, which causes skin to grow inwards from the eardrum. The first sign may be a persistent smelly discharge from the ear. If left untreated, it could get bigger and destroy the delicate bones within the middle ear and so cause permanent deafness. So it is necessary to remove the cholestatoma before it can cause damage. If your child has a chronic discharge from the ear over a long period it is very important that your child sees an ENT doctor for assessment and advice.

(excerpt from “ Down’s syndrome and Childhood Deafness” Information for Families by National Deaf Children’s Society, Down syndrome Medical Interest Group UK/Ireland and Down Syndrome Association UK) read more…

Further Reading:
Additional information about hyperacusis on the Tinnitus and Hyperacusis is available on following website:- www.tinnitus.org.

What should I do if I am worried about my child’s hearing? If you are concerned about your child’s hearing ask for an early appointment with your ENT specialist and audiologist.  You may be referred by your GP, Public Health Nurse, Area Medical Officer or Paediatrician.  All children with Down syndrome should have their hearing tested regularly. This may be required every three to six months for young children and every year for older children. See Medical Management Guidelines

How can my child’s hearing be tested?
All children can have their hearing tested from birth. Hearing tests are performed by the Audiologist.
There are two types of hearing tests, (1) behavioural tests and (2) objective tests.

Behavioural Hearing tests:-
Your child will be introduced to the hearing test procedure using a variety of toys. Each child will be expected to respond appropriately to the sounds that are presented to test their hearing ability.

  1. Visual Reinforcement Audiology (VRA) is a behaviour test used with children from approximately 6 months of age
  2. Pure Tone Audiometry (PTA) is a behaviour test used with children from approximately 3 or 4 years of age

Speech discrimination tests is a behaviour test used with children from approximately 3 or 4 years of age read more… page 6-9

Objective Hearing tests:-
These tests involve the use of hearing screening machines which assess the ears ability to function normally.  These tests may be performed from birth

  1. Tympanometry (not a hearing test) assess how well the eardrum and moving parts of the middle ear are functioning.
  2. Otoacoustic emissions (OAE) This tests the function of the inner ear (cochlea)
  3. Auditory Brainstem Response (ABR) This tests whether sound is being sent from the cochlea and through the auditory nerve to the brain. (usually performed when child asleep under anaesthetic)

VRA. PTA, SPEECH DISCRIMINATION, TYMPANOMETRY, OAE, AND ABR
ALL IN BOOK ON ‘Down’s syndrome and Childhood Deafness” Information for Families by National Deaf Children’s Society, Down syndrome Medical Interest Group UK/Ireland and Down Syndrome Association UK) read more… pages 6 – 8

What if my child is recommended a hearing aid? If your child has any level of deafness a hearing aid can be most beneficial.  The type of hearing aid that will be suitable for your child will very much depend on the level and type of hearing impairment that your child has. Hearing aids amplify (make louder) sounds going into the ear and come in a range of different styles. Most children use behind the ear hearing aids

‘Down’s syndrome and Childhood Deafness” Information for Families by National Deaf Children’s Society, Down syndrome Medical Interest Group UK/Ireland and Down Syndrome Association UK) read more… pages 9-10

Tips for getting children to wear hearing aids ‘Down’s syndrome and Childhood Deafness” Information for Families by National Deaf Children’s Society, Down syndrome Medical Interest Group UK/Ireland and Down Syndrome Association UK) read more... page 11

Tips on Communication – no matter which way you and your child communicate there are some tips that will help. ‘Down’s syndrome and Childhood Deafness” Information for Families by National Deaf Children’s Society, Down syndrome Medical Interest Group UK/Ireland and Down Syndrome Association UK) read more... page 14
Helpful hints:

While waiting to see the doctor and audiologist you could bring some toys to keep your child interested and occupied.
If you know that your child will sleep at a particular time of day, particularly after a bottle feed or meal, or be more alert or co-operative, discuss with the Outpatient Department the possibility of arranging an appointment that suits you.

Further Reading
Other Sources of Information on Hearing Problems - Where can I get more help in Ireland’  (page of addresses important)

References
Guidelines for the Medical Management of Irish Children and Adolescents with Down Syndrome, Irish Medical Journal, Feb 2005, Vol 98 No 2; 48-52.  Murphy J, Hoey HMCV, Philip M, Roche EF, Macken S, Mayne P, Duff D, O’Keefe M, McShane D, Fogarty E, O’Regan M.

LINKS
Glue Ear Information sheet
“Down’s syndrome and Childhood Deafness” Information for Families
‘Other Sources of Information on Hearing Problems -Where can I get more help in Ireland’