Parents are often concerned about their children’s ability to hear well. This concern goes beyond the ‘selective hearing loss’ we all laugh about – those times when your child simply chooses to ignore you. True hearing loss in children is no laughing matter; the consequences can be long lasting and heartbreaking. Even a mild loss can affect your child’s ability to speak and understand language, sometimes with effects that last a lifetime.
Did you know that the ears are connected directly to the nose? This is why one of the most common causes of hearing loss in children actually starts in the nose. Let me explain:
To understand hearing loss, it helps to understand the way the ear works. There are three parts to the ear: the outer ear, the middle ear, and the inner ear. The outer ear is the ear canal. This is the part we can see, the part children love to fill with beans and peas, and the part that captures sound from outside the body. This ear canal carries sound to a thin translucent membrane called the eardrum. Just on the other side of the eardrum is the middle ear, an air filled chamber that contains three tiny bones all connected to each other. When the eardrum vibrates with sound coming in from the canal, it transmits those vibrations to the three tiny bones in the middle ear. For sound to travel well, this middle part of the ear must be ventilated and must keep the air pressure equalized, so it has a narrow tube connecting it to the back of the nose. When your ear pops at a change in altitude, it is this Eustachian tube clearing the middle ear for you. And, if all is clear, the three tiny bones in the middle ear transfer sound vibrations directly to the inner ear. Within the inner ear is the cochlea, where the vibrations are translated into electrical signals that are picked up by nerves and sent to the brain. Quite an elegant design!
So, if the ear canal is blocked, (with peas, beans, wax, or fluid) the sound can not get to the eardrum. If the eardrum is broken, the sound can not make the three little bones vibrate in the middle ear. If the middle ear is full of fluid, and the eustachian tube is blocked, the three bones can not vibrate, and the sound does not reach the inner ear or the cochlea. And if the cochlea is missing or not functioning, the sound can not reach the brain. Every part of the ear must be working well for good hearing to occur.
Many newborns these days are given hearing tests shortly after birth. This kind of test can rule out congenital problems which are usually due to problems with the cochlea or the nerves that connect the cochlea to the brain. Cochlear implants have allowed many congenitally deaf children to hear – one of medicine’s modern miracles.
However, the most common cause of hearing loss in children is due to problems with the conduction of sound, and this is directly linked to the nose. The eustachian tube is smaller and more nearly horizontal in children than it is in adults. Therefore, it can be more easily blocked by conditions such as large adenoids and infections. Until the eustachian tube changes in size and angle as the child grows, children are more susceptible to eustachian tube problems. This is where understanding the function of the eustachian tube becomes so important. Anyone who has had difficulty clearing their ears after flying in an airplane, or anyone who has had the congestion of a cold that ‘clogged’ their ears knows how eustachian tube dysfunction feels. Children with chronic nasal congestion feel this way all the time. These children think the world always sounds muffled and it is no surprise that they can not speak clearly. Clearing congestion and opening the eustachian tubes to allow the middle ear to clear can cause remarkable changes in a child’s world.
So how to clear that little tube and how to keep it clear? The most common causes of eustachian tube dysfunction are allergies and respiratory infections. Traditionally doctors have given antihistamines to dry up secretions and decongestants to clear the passages. However, the side effects of these two medications can be problematic. Antihistamines tend to thicken the secretions so they are less able to flow, and they have sedative effects that have been shown to interfere with a child’s learning. Decongestants can make some children hyperactive, making bedtime a challenge. Sometimes these medications are warranted, but I recommend an effective first line treatment that is much safer and often more effective than medication: Nasal washing with hypertonic buffered salt water.
Children as young as four years old can learn to rinse their nose with a hypertonic salt solution. Hypertonic saline is a natural decongestant. It acts to shrink the mucus membranes, allowing the little eustachian tube to open and drain. Regularly washing the nose with hypertonic saline will help keep the middle ear open and healthy. In addition, washing routinely will decrease the incidence of upper respiratory infections and allergies by keeping your child’s nasal filter clean and clear of particles. The washing does not hurt, and once children learn the technique they start asking if they can wash when they get congested. They know what makes them feel good!
It is very important to use a nasal rinse system that is designed for children’s safety. The Nasopure Nasal Wash system was designed by a pediatrician specifically for children and their nose woes. Dr. Hana spent years treating children with ear and nose problems. When she realized the benefits of nasal “washing” she developed Nasopure for her own patients and their parents. Now families all over the country are using Nasopure instead of medication for their child’s nasal health.
Little Molly was one of these kids. Her mother brought her to the doctor when she was five years old because her kindergarten teacher said Molly was not paying attention in class. Molly was a girl who often breathed out of her mouth and had been treated for several ear infections as a baby, so her mother wanted to make sure Molly could hear the teacher. A quick screen in the office indicated a “conductive hearing loss”. Mom wanted to avoid medications if possible, so she agreed to try nasal rinsing. With a Nasopure bottle, Dr. Hana was able to easily teach both Molly and her mother the proper technique. Soon Molly was “washing” like a pro, and two weeks later the repeat hearing test was normal. Molly is doing well in kindergarten and loves to wash her nose every single day. She says it makes her nose happy!
Hearing is one of the most important windows to a child’s world. Through good hearing a child learns language skills and an appreciation for the world around her. If you are concerned about your child’s ability to hear well, speak to your physician. If the problem is chronic congestion or infections, ask about nasal rinsing. It could change your child’s life.
Stacey M Kerr, MD, 3344 Cypress Way, Santa Rosa, CA, 95405
Stacey Marie Kerr, M.D. graduated from the University of California Davis Medical School in 1989 and is currently a board certified family physician. Dr. Kerr is a member of the California and American Academy of Family Physicians. She holds a B.S. in Education/Special Education from the University of Missouri, Columbia Missouri.