Effects on Language From Fluctuating Hearing Loss

A fluctuating hearing loss is a hearing loss that seems to frequently change. Successive hearing tests may make the hearing loss seem better or worse. This type of loss can be associated with conductive hearing loss or sensorineural hearing loss and may become worse over time. 

Causes

The most common causes of fluctuating hearing losses are:

• Ear infections (Otitis media)
• Ear wax
• Noise exposure 
• Autoimmune inner ear disease
• Meniere's disease
• Auditory Neuropathy
• Enlarged vestibular aqueduct syndrome

For the purposes of this article, we will focus on fluctuating conductive hearing loss as a result of middle ear infections with fluid as this is the most common cause of fluctuating hearing loss. 

Effect on Speech and Language Understanding

Fluctuating hearing loss can affect a child's academic performance because of the reduced ability to hear. For example, multiple ear infections with middle ear fluid can impact hearing for months. Sounds are muffled and an individual will have to strain to hear the softer level speech. If there is background noise, such as in a classroom, hearing becomes even more difficult. Significant portions of group or class discussions may be inaudible. For a younger child who is still learning speech and language, there may be a noticeable delay in the acquisition or there may be errors in speech production because they are unable to hear the correct pronunciation of words. 

Social-Emotional Effect

When there is inconsistent hearing ability, a person may appear to "hear only what they want to hear" or seem to just not be paying attention. This can actually delay treatment if the problem is seen to be one of behavior and not a true hearing issue. Some behaviors fluctuating hearing loss can be mistaken for include:

• Attention problems
• Insecurity
• Distractibility
• Social immaturity
• Non-participation
• Lack of self-esteem

Management

Regular screenings in school to monitor hearing and language delays are an important part of the early identification of fluctuating hearing loss. Once fluctuating hearing loss is identified, medical management is key. Medical management will vary depending on the cause of the fluctuating hearing loss; for example, managing chronic middle ear fluid will look very different than management of enlarged vestibular aqueduct syndrome. In some cases, amplification through hearing aids or the use of an assistive listening device is necessary. 

Communication is key; educators should know if there is a hearing problem and what signs to look for to make sure information presented in class is understood. Children with fluctuating hearing loss need to be taught how to advocate for themselves — learning how to ask for repetition or to move to a better location to hear instructions is a valuable skill that will empower them. 

In some cases, one on one tutoring or extra assistance may be necessary to "catch up" on skills they may have missed. 

_{Updated by Melissa Karp, Au.D.}