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All you need to know about young ears
Between early years and retirement, most of us will not give our ears much thought. Our sophisticated biological hearing system keeps us connected to the world, warning of danger, allowing interaction, even helping us balance. But how do we treat it? We deafen ourselves with loud sounds and invade it – on hygiene grounds – with all manner of artificial implements, despite it being a delicately balanced self-cleaning device. Worst of all, we never bother to teach our offspring any better habits. Yet experts suggest that a few simple practices can help protect hearing when young. It’s even possible to use aural therapies to improve speech and brain development.
So how does the ear work? Made up of three sections – outer, middle, and inner – its parts work together to hear and process sounds in the brain. To a young teenager, the outer fleshy part is most useful as a place to hang parent-irritating jewellery, but doctors know that the pinna or auricle is designed to capture sounds. It includes the ear canal where wax is produced and sometimes gathers. You can tell your children not to be revolted: it actually contains anti-bacterial chemicals which fight off infection while dirt is also trapped. Noise (called sound waves) passes down the canal, across the eardrum, a piece of skin which acts as a gateway to the middle ear, causes vibrations. These movements cause three tiny bones or ossicles – called the malleus (hammer in Latin), the incus (or anvil) and stapes(or stirrup) – to move, helping transmit the sound towards the brain.
As the vibrations enter the cochlea, a small, curled tube in the inner ear, the liquid inside it is set into a wave-like motion. This shakes the tiny hairs which line the cochlea causing signals to pass to the brain, which then completes the process by interpreting these neurotransmissions as sound.
What can go wrong? For some unlucky children, their hearing will have been compromised at birth, perhaps due to a genetic predisposition towards deafness or a malformation. According to the National Society for Deaf Children (NSDC), 1,600 babies are born deaf every year. Many more will be diagnosed as toddlers with the common condition glue ear, the build-up of a sticky glue-like fluid in the middle ear as a result of chronic inflammation, which causes temporary deafness.
Glue ear mostly clears up spontaneously, but for about five per cent it persists. Doctors call inflammation of the middle ear ‘otitis media’ and if it results in glue ear, they call this ‘otitis media with effusion’. If left untreated, this can cause permanent hearing loss.
Ear, nose and throat (ENT) consultant Richard Irving of the Birmingham Ear Clinic, BMI Priory Hospital, Birmingham explains that school age children who see his team are likely to have rarer conditions. ‘Skin cysts in the middle ear can cause infection, discharge and ultimately hearing loss but these are not common. ‘Parents should be more worried about simple infections such as swimmer’s ear, picked up on holiday for which antibiotic drops are effective.’
A blow to the head on the rugby field could lead to a more serious consideration – a perforation or hole in the middle ear. ‘Traumas such as a knock to the side of the head send a pressure wave down inside the ear canal which can perforate the ear drum and allow infection. Crystal Rolfe, an advisor for Action on Hearing Loss (formerly RNID), says one of the biggest problems young (and older) people face is due to their own bad habits. ‘The old saying, never put anything bigger in your ear than your elbow, still holds true. Cotton buds are not designed to clean ears yet people persist in using them for that purpose. All you are doing is pushing wax further into the ear and impacting it. Then it will be harder to get rid of. And if someone nudges you while you have a cotton bud in your outer ear, the pressure could also cause a perforation.’ She adds: ‘It is OK to tell a teenager to gently wipe around the edge of the outer ear, but explain, ear wax is a healthy thing.’
Her biggest concern is noise: many children will be revelling in new MP3 players after Christmas. But warns Crystal, ‘Noise-induced hearing loss is the most common kind. Our ears can cope with quite loud sounds, but if children turn up the volume persistently it can damage the inside of the cochlear, and will cause tinnitus in the short term, hearing loss in the long term.
‘To protect hearing, tell your children to turn down their music just a notch or two. Our hearing is so sensitive that every notch you turn up the volume halves the time you can listen safely. By turning it down just a little, we extend the safety period without having to stop altogether.’
She adds: ‘It is worth using sound-isolating headphones too which block out extraneous sounds so you or your child can enjoy their music without having to turn it up to high levels to drown out other noises such as roads or trains. And if your child is getting old enough to go to a festival, treat them to ear plugs. These won’t stop all sound, they’ll just keep the level lower and safer. And warn them not to stand in front of the big speakers for hours as well.’
When hearing is damaged, it’s worth remembering that modern hearing aids are much less noticeable than they were. Explains Mr Irving: ‘Miniaturisation of electronics has made a significant difference. They work better and mostly sit behind the ear out of sight. Cochlear implants are available too which are excellent at restoring hearing.’
A less well-known problem is APD – auditory processing disorder, or central auditory processing disorder, which is better known in the US. Children who have APD can’t process the information they hear in the same way as others because their ears and brain don’t fully co-ordinate. Something adversely affects the way the brain recognizes and interprets sounds, most notably the sounds composing speech.
So affected children often do not recognize subtle differences between sounds in words, even when the sounds are loud and clear enough to be heard. However, normal hearing tests won’t detect APD as these children can usually detect pure tones that are delivered one by one in a very quiet environment (such as a sound-treated room). Symptoms of APD can range from mild to severe and can take many different forms. If you think your child might have a problem processing sounds, consider these questions: Is your child easily distracted or unusually bothered by loud or sudden noises? Are noisy environments upsetting to your child? Does your child’s behaviour and performance improve in quieter settings? Are conversations hard for your child to follow?
APD is an often misunderstood problem as its symptoms appear in other conditions such as learning disabilities, attention deficit hyperactivity disorder (ADHD), and even depression. Although APD is often confused with ADHD, it is possible to have both or other developmental conditions.
Perhaps not surprisingly, the ear is also therefore promising as a channel for a new form of therapy for learning or development delays, administered aurally. The SAS (Sensory Activation Solutions) method uses music, speech and tones, administered through headphones, as a tool to reach and activate the two brain hemispheres. As sounds from the right ear go mainly to the left and sounds from the left ear mainly to the right side of the brain, theoretically the brain will be activated in a co-ordinated manner, training it to process faster and enhance learning, plus building confidence and self-worth.
Children find it easy: the SAS work-out involves listening each day to specially processed sounds through headphones, causing the brain to receive a healthy ‘processing work-out’. Its designers believe that ‘many learning difficulties such as attention and concentration, reading, writing and speech, and behavioural issues are all related to how well we use our two brain-halves and their specialised processing centres… it can help children and adults with a wide range of difficulties to improve performance in daily life.’
If our eyes are the windows to our souls, then perhaps the ears are the gateway to our intelligence? In which case, the least we can do is ban the bud, open our minds and turn down the volume.
According to Jonathan Staiano, consultant cosmetic surgeon at BMI Priory Hospital, Birmingham, if babies are born with prominent ears, a simple non-surgical splint treatment can be very effective (and safe) in helping ears lie flatter against the head. But while this is common in the US, he admits it hasn’t really caught on here yet, and must be done in the first months of life.
If you are concerned about your older child’s appearance, then surgery is the only real answer. ‘We don’t usually do this before six as it is crucial that the child wants it done,’ says Mr Staiano. ‘For practical reasons, really, as post-op the ears need to be held flat in a head bandage for some time. A younger or unhappy child will simply take it off too much and disrupt the healing process and end result.’
Most children he sees are aged between 6 and 16, and will be operated on under general anaesthetic in a procedure that takes about one and a half hours. Recovery takes on average about three months. ‘It is complicated,’ says Mr Staiano, ‘and you can get scarring on the front of the ears. Although results are usually good, I don’t suggest parents take this on lightly, and never without the child’s full co-operation.’
Action on Hearing Loss: www.actiononhearingloss.org.uk
National Society for Deaf Children: www.ndcs.org.uk
BMI Priory Hospital: www.bmihealthcare.co.uk
British Association of Plastic, Reconstructive and Aesthetic Surgeons: www.bapras.org.uk
The SAS Method: www.sascentre.com
Swimmer’s ear: Herbal Aloe Gold Ear Drops (£11.85; 30ml; www.highernature.co.uk) are made from 100 per cent organically-grown whole leaf aloe, and are suitable for adults and children, especially frequent swimmers.
Scalp eczema: Partly due to the constant exposure to shampoos containing perfumes and chemicals, eczema around the ears is very common in children. Dry Scalp shampoo (£5.95; 250ml; tel: 0871 871 9975 www.skinshop.co.uk) which contains Sri Lankan herb cardiospermum along with honey extract, a natural moisturiser for the hair and scalp tissues, can be used on the very sensitive scalps of children both as a regular shampoo and also as a treatment for dry scalp. Dry Scalp Shampoo is Sodium Lauryl Sulphate (SLS) and chemical free and contains a gentle natural foaming agent made from sugar beet.
Volume control: Sennheiser stereo headphones (£49.99; www.actiononhearingloss.org.uk) enclose your ears so the sound is excellent and immersive when listening to the TV, or stereo. They help you hear at the volume you require, without disturbing others.
Quiet please: Moldex Spark Ear Plugs in Pocket Pack (£1.45; 2 Pairs; www.ultimatefestivalkit.com), ready for use and PVC-free.
Noise protection: Peltor Kid Neon Green ear defenders (£12.54; www.actiononhearingloss.org.uk) are ideal to offer protection for children against loud noises.