Children: hearing, breathing and sleep
Children do not complain about their hearing or their breathing. They do not tell you they can't hear well or that they sleep badly, you notice it yourself: a mouth open during sleep, "what?" every other sentence, yet another ear infection this year. Most of these start from the same place, behind the nose, where the adenoids sit next to both the airway and the tubes that ventilate the ears. That is why they are checked together, and why we do not leave them for later: especially while a child is learning to talk, they need to hear clearly.
What do we treat?
- Hearing and speech delay: when your child is late to start talking, does not respond to their name, or the school says they do not pay attention. Hearing is tested with methods suited to each age, from babies to primary school children, and the child does not need to cooperate the way an adult would.
- Ear infections and ear tubes: when ear infections keep coming back, or fluid stays behind the eardrum even after the cold has passed. The fluid does not hurt, but it reduces hearing for as long as it is there, and this is where we decide whether to wait or to place ear tubes.
- Tonsils and adenoidswhen your child breathes through their mouth, keeps catching sore throats, or surgery has already been suggested to youThe criteria for surgery are specific and worth knowing before you decide.
- Snoring in children: when your child snores every night, sleeps restlessly or briefly stops breathing. In children, disturbed sleep does not show up as sleepiness but as hyperactivity and difficulty concentrating, which is why it is often put down to something else.
How are they connected?
Behind the nose, at the back of the nasal passage, sit the adenoids. Right next to them are the openings of the Eustachian tubes, the small channels that ventilate the middle ear. It is a crossroads that explains almost all ENT problems in children.
When the adenoids grow large, 2 things happen at the same time. They block the opening of the Eustachian tube, the middle ear stops being ventilated, fluid builds up and hearing drops without anything hurting. The adenoids also narrow the airway, so the child breathes through their mouth during the day and snores at night.
That is why a child who comes in for snoring leaves with a hearing test, and a child who comes in for their tenth ear infection also has their breathing checked. These are not extra tests, they are the same diagnosis seen from 2 sides.
How is the examination done?
Children are examined privately, with equipment and time set aside for their age. The examination starts with the history, with questions that you answer: how they sleep, how they breathe, how many ear infections they have had this year, what words they say.
Hearing tests by age
There is no single hearing test for all children. Babies have otoacoustic emissions and auditory brainstem response (ABR) testing, tests that need no participation from the child at all. Young children have play audiometry, where the child learns to respond to a sound with a movement as part of a game. Older children have a standard hearing test. In every case we add tympanometry, which shows within seconds whether there is fluid behind the eardrum.
Looking behind the nose (endoscopy)
The size of the adenoids can be seen directly with a thin, flexible endoscope, in a few seconds and without an X-ray. It is more accurate than the side-view neck X-ray that used to be ordered, and the child is not exposed to radiation.
Frequently asked questions
Not necessarily. Newborn hearing screening shows hearing at the moment it was done. Some types of hearing loss appear later, and there is also the most common case, fluid in the middle ear, which can develop at any age. If your child does not respond the way you expect, the test is repeated, whatever it showed at birth.
Not necessarily. Clinical guidelines explicitly advise against using antibiotics, steroids, antihistamines or decongestants for fluid in the middle ear, because they have not been shown to help. In most children the fluid clears up on its own, and the right approach is to monitor it with hearing tests.
When the fluid stays for more than 3 months and affects hearing, or earlier in children who belong to higher-risk groups. The decision is not made from the appearance of the eardrum alone, it is made from the duration combined with the hearing test.
For recurrent sore throats and tonsillitis, the criteria are numerical: 7 episodes a year, or 5 a year for 2 years in a row, or 3 a year for 3 years in a row, with documented episodes. Below these thresholds, the recommendation is to wait and monitor. A separate reason, with different logic, is obstructed breathing during sleep.
Occasional snoring during a cold, yes. Snoring every night, no, especially when it comes with pauses in breathing, sweating or restless sleep in unusual positions. It is worth having it checked, because the effects show up in behavior and school performance before they show up anywhere else.
When should you not wait?
Immediately
Pauses in breathing during sleep
When you see your child stop breathing for a few seconds and then take a deep breath, it is not something to just keep an eye on.
Soon
Does not react to sounds or is not talking for their age
Speech delay is checked starting with hearing. Every month of waiting at this age counts for more than it would later.
Soon
Fluid in the ear for more than 3 months
At this point waiting stops and a hearing test comes in, because the decision depends on how well the child hears.
Medical review: Dr. Ioannis KotrotsosENT Surgeon and Specialist in Phoniatrics and Pediatric Audiology.
Πηγές: Rosenfeld RM et al., Clinical Practice Guideline: Otitis Media with Effusion (Update), AAO-HNSF, 2016 · Mitchell RB et al., Clinical Practice Guideline: Tonsillectomy in Children (Update), AAO-HNSF, 2019.
The information on this page is for general information only and does not replace a medical examination. For diagnosis and treatment, please consult a doctor.
