Ear & Hearing Services

Infants and young children have more ear infections than adults because their ears are different. Infants’ eustachian tubes are straight and shorter, so fluid cannot drain out as easily.

Children born with cleft palate experience more ear problems than children without cleft because the muscles of the soft palate are responsible for correct opening of the eustachian tube, which allows outside air into the middle ear in order to equalize the pressure in the middle ear space with the outside air pressure to effectively ventilate the middle ear space. When the middle ear space is not adequately ventilated, fluid can accumulate, which can lead to an ear infection.

Because cleft palate interferes with how the eustachian tube works, children with cleft palate are more likely to accumulate ear fluid and get ear infections (otitis media). Even after palate repair, these muscles still may not function normally.

As a child with cleft grows older, ear problems tend to occur less often and be less severe. There are a number of tests that help prevent, locate and treat your child's ear problem. The audiologist at Adventist Health White Memorial will discuss your child's test with you.

Because your child will be susceptible to ear infections and fluid, close evaluation of the ears is necessary throughout childhood. Children with middle ear fluid often fail early hearing tests. It does not necessarily mean your child is deaf, though there is a higher risk of a nerve type of hearing loss in children with cleft palate. Most children just have a temporary hearing loss from fluid in the ear.

There are two main types of hearing loss:

1. Sensorineural (nerve problems): The nerves that allow a person to hear do not work correctly
2. Conductive (ear canal and middle ear problems): Generally means that wax in the ear canal or fluid in the middle ear is temporarily keeping the child from hearing sounds clearly

Although children with cleft palate are at greater risk for sensorineural hearing loss, most children with cleft palate have conductive hearing loss, which is easily corrected. After audiology testing, your child will be referred to an otolaryngologist at Adventist Health who specializes in ear, nose and throat. Your otolaryngologist will let you know what the right treatment is and if ear tubes are needed.

Common audiology tests

Tympanometry test

This measures pressure in the middle ear and how the eardrum reacts to pressure changes. It can also find holes in the eardrum and show if tubes are working well. This pain-free test may be done in newborns, but it works better with for children who are at least seven months old.

Otoacoustic emissions (OAEs) test

Records how the inner ear responds to sound. Series of tones are played through a small tip that is placed in the ear. The inner ear responds by emitting tones of its own. This painless test takes only a few minutes, and your child must remain still.

Auditory brainstem response (ABR)

Measures the response of the brainstem (the base of the brain) to sound. In an ABR, electrodes are placed on your child's forehead and behind the ears. Electrodes are soft pads that connect to the ABR machine by covered wires. They do not hurt or shock your child. A clicking signal is made through the earphones. A computer records the brainstem's response, which measures the hearing level of each ear. The test takes up to one hour, and your child has to be asleep during the procedure. Most children are given medicine to help them sleep during the procedure.

Behavioral tests

Measures hearing by the way that the child responds to sound. Test can be done with children as young as six to seven months old. A behavioral test requires your child's interest, attention and cooperation. If your child is fussy or distracted, it may take several sessions to complete a test. There are many types of behavioral tests based on your child's age:

• Your child may sit on your lap while sounds are played through speakers
• Your child may play a listening game
• Older children may wear earphones and raise their hands when they hear tones