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Preadolescence is a critical stage of human development that precedes adolescence and is characterised by significant biological and psychological changes.

It begins at approximately 8–12 years of age in girls and 9–14 in boys, although the exact ages may vary. Hearing abilities remain stable and similar to those of adults. Middle ear inflammation also tends to decrease during this period as the Eustachian tube and immune system mature. However, hearing loss may develop or existing hearing impairment may worsen.

Data from the US Centers for Disease Control and Prevention show that even mild hearing loss can cause a child to miss 50% of classroom teaching. Hearing loss is also associated with twice as many emergency department visits & a tenfold increase in the risk of a child falling at least one grade behind at school. A child may have normal hearing as an infant and lose their hearing later. Hearing loss present at birth is considered “congenital”, while hearing loss that develops after birth is called “acquired”.

Depending on the site of the damage or dysfunction, hearing loss is classified as:

• Conductive, when there is a problem transmitting sound through the external ear canal or middle ear. Common causes include: ear canal obstruction, atresia or narrowing of the external ear canal, middle ear infection, cholesteatoma, middle ear atelectasis, eardrum perforation and otosclerosis.
• Sensorineural, caused by damage to the inner ear (cochlea) or auditory nerve. Common causes include: exposure to loud noise, genetic factors (syndromes and neurodegenerative disorders), ototoxic medicines (such as aminoglycosides and chemotherapy drugs), infections (such as CMV, HSV, VZV and meningitis), autoimmune diseases, and injuries to the head and skull base.
• Mixed, with elements of both conductive and sensorineural hearing loss.
• Central, caused by damage or dysfunction in the brain.
• Functional or psychogenic, associated with psychological or emotional factors without organic damage to the auditory system.

Hearing loss during preadolescence has serious consequences for a child’s communication skills, educational progress and social development. Children with hearing problems often have difficulty following lessons, understanding teaching and participating in school activities. These difficulties can lead to lower academic achievement and adversely affect their education. Hearing plays a critical role in the development of social skills, friendships and social inclusion.

Hearing loss can lead to social isolation, as children may find it difficult to communicate with their peers and take part in social activities. Communication difficulties may also affect children’s self-esteem and confidence, particularly during this sensitive stage of life.

Signs of hearing loss include:

• Difficulty communicating.
• Poor performance at school.
• Avoiding participation in social activities or games.
• The child reporting that they cannot hear well.
• Reduced responses to sounds or changes in the child’s speech.

The diagnostic process includes:

• A detailed medical and family history.
• A clinical examination of the ears for anatomical abnormalities or infections.
• Audiological tests (tympanometry and an audiogram) to assess hearing and detect possible problems.
• Imaging, such as magnetic resonance imaging (MRI) or computed tomography (CT), to detect anatomical abnormalities.
• Genetic testing when a genetic cause is suspected.

If hearing loss is identified, treatment options include:

• Hearing aids for children with mild or moderate hearing loss.
• Cochlear implants for children with severe hearing loss or deafness.
• Ventilation tubes to prevent fluid from accumulating in the middle ear, or to drain accumulated fluid & prevent it from building up again.
• Tympanoplasty to repair an eardrum perforation.
• Surgical removal of a cholesteatoma to restore ear function and prevent further damage.
• Speech therapy to support speech & language development.
• Educational support from specialist teachers or the use of assistive technology.

Preventing the development of hearing disorders involves:

• Keeping vaccinations up to date.
• Avoiding ototoxic medicines, using non-ototoxic alternatives & carefully monitoring the dosage of necessary ototoxic medicines.
• Regular hearing assessments.

Protection from noise:

• • Avoiding exposure to loud sounds.
  • Using hearing protection (earplugs or earmuffs) in environments with high noise levels, such as concerts and sporting events.
  • Educating children about the dangers of noise.
  • Encouraging practical measures to protect hearing in everyday life, such as reducing the volume of audio devices & using them in moderation.

Passing a newborn hearing screening does not protect a person from hearing loss throughout life. Factors during fetal development or infancy can affect hearing and lead to hearing loss later. Progressive hearing loss has significant consequences if it is not recognised and managed promptly and effectively. A multidisciplinary approach involving a paediatric ENT specialist, paediatrician, speech therapist, teachers & other healthcare professionals is essential to support children and their families.