Cerebral Palsy and Hearing Problems
This article has been fact checked by a Board Certified Pediatrician. Sources of information for the article are listed at the bottom.
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Cerebral Palsy, or CP, is among the most common of all chronic motor disorders in children. It affects the brain, nerves, and muscles and can have a variety of effects on how a child moves or functions. Most children with CP, as a result of damage that occured in parts of the brain, have spastic muscles that impact their coordination and ability to move normally, but many also experience other complications, including intellectual impairment, speech disorders, and vision problems.
Another one of these potential complications is hearing loss. Exactly what causes hearing loss in an infant or child with CP is not always understood, but there are many potential causes. Impaired hearing can impact a child negatively and cause delays and disabilities in language, speech, social, and cognitive development. Early screening for hearing loss in children with CP is important. It allows doctors and other caregivers to diagnose the impairment and recommend interventions that will mitigate the developmental delays triggered by hearing loss.
Prevalence and Causes of CP and Hearing Loss
Several studies have investigated just how common hearing loss is in people with CP. The results have varied a little bit by study but, generally, they show that the prevalence of this complication is significant. One study found that about seven percent of people with CP experienced moderate to profound hearing loss, while three to four percent experienced profound to severe hearing loss. Another study looked at 685 children in Australia diagnosed with CP and found that 13 percent suffered from hearing loss.
What causes hearing loss depends on the type, but various factors may contribute to this impairment. For any one child, it may be difficult to pinpoint an exact cause. Some of the possibilities include genetic abnormalities, whereas others have nothing to do with genes. Non-genetic risk factors for CP and hearing loss include infections, oxygen restriction to the brain during development, and low birth weight.
Signs of Hearing Loss
Early screening for hearing loss is crucial to getting a child appropriate treatments. For parents of children with CP, it is important to know and look for the signs that a child may have a hearing deficit. This can be tricky in infants and toddlers who cannot easily communicate what they cannot hear.
Some telltale signs in infants include failure to react or wake to loud noises and not calming to the sound of a familiar soothing voice. Babies may also show signs of hearing loss by failing to react when being spoken to or not turning toward familiar sounds.
Toddlers and younger children may begin to show even more signs that hearing is impaired as they grow. These include being unresponsive to their name or simple requests, not talking as much as expected for a given age, and not repeating sounds and words or reacting to music. An older toddler or young child may turn off the volume on devices, be unresponsive to questions, say “what?” or “huh?” often, and exhibit ongoing delays in speech and language development.
Types of Hearing Loss
There are two main types of hearing loss that children with CP may experience: conductive hearing loss and sensorineural hearing loss.
Conductive hearing loss means that sounds are not being transmitted from the outer world to the inner ear. The sound never makes it to the area where the cochlea and nerve cells would have picked it up and sent signals to the brain. This type of hearing loss is often caused by otitis media, inflammation or infection in the middle ear that leads to the buildup of fluid.
Conductive hearing loss is more physical, whereas sensorineural hearing loss is related to the function of nerves in the inner ear. Damage to the nerve receptors in the inner ear blocks transmission of sound to the brain. This can be caused by genetic factors or other factors that occur during fetal development, childbirth, or infancy. Some children with CP experience both types of hearing loss.
Treatment of Conductive Hearing Loss
Treatment for conductive hearing loss is more straightforward and usually more successful than treatment for sensorineural hearing loss. Giving antibiotics to treat the underlying infection and inflammation can reverse conductive hearing loss. For more severe conductive hearing loss, surgery to place ear tubes can often completely and permanently restore hearing. Hearing aids can also help, especially in children for whom surgery is not an option.
Treatment of Sensorineural Hearing Loss
Treating sensorineural hearing loss is trickier because it involves damaged nerves in the inner ear rather than the physical damage to the middle ear seen in conductive loss. This type of damage is permanent and cannot be reversed. Hearing can be improved with hearing aids, though. These devices amplify sounds so that the undamaged nerve receptors can receive more sound signals.
Although the damage is permanent, it can be bypassed to restore hearing with a cochlear implant. This device has two parts: one is inserted inside the ear under the skin, and the other is worn behind the ear. Unlike hearing aids, a cochlear implant does not simply amplify sound; it actually bypasses damaged inner ear nerves and uses mechanical parts to collect and convert sounds into electrical impulses that are then sent to the brain as sounds. Cochlear implants may be used successfully in children with severe or even total hearing loss.
Impact of Hearing Loss on Children with CP
Hearing loss can have a profound impact on a child, especially if it is not diagnosed and treated. Being unable to hear adequately can lead to delays in all aspects of development, but especially in the areas of language, speech, and social interactions. Being able to hear is essential for learning to speak and use language. It is also plays a large role in learning how to relate socially to others. Children with untreated hearing loss will struggle to communicate and are at risk of becoming socially isolated.
Treatments for the underlying causes of hearing loss in children with CP and developmental and educational interventions can help them overcome the effects of the impairment. Recognizing and treating hearing loss early is critical, but if it is not discovered until later, there are still interventions can help a child catch up developmentally and eventually learn to communicate.
Language and speech therapy, specialized language educational interventions, and behavioral and social therapies can help. Hearing loss does not have to be a permanent disability for a child with CP if addressed appropriately and promptly treated.