GPAtlas🧭 When to suspect
Suspect hearing loss whenever parents, carers, or nursery and school staff report that a child is not responding to their name, seems inattentive, mishears when not looking at the speaker, asks for things to be repeated, or turns the television volume up. Equally important are delayed or unclear speech and language, unexplained behavioural change, and poor progress at school.
The single most common cause in primary care is conductive hearing loss, usually from otitis media with effusion (OME) – ‘glue ear’ – a collection of fluid in the middle ear without acute infection. Most permanent sensorineural deafness present at birth is picked up by the NHS Newborn Hearing Screening Programme (NHSP), but screening is not infallible and detects only hearing loss present at birth; it does not catch later-onset, progressive, or acquired loss. Persistent parental concern, even after a ‘pass’, is a sensitive indicator and always warrants assessment.
The key clinical skill is to take concern seriously and arrange age-appropriate hearing testing, while staying alert to the smaller number of children with a permanent or urgent cause.
| Type of loss | Typical causes in children | Key features |
|---|---|---|
| Conductive | OME (glue ear) – commonest; impacted wax; acute otitis media (AOM); perforation; cholesteatoma | Usually mild–moderate and fluctuating; often reversible |
| Sensorineural (SNHL) | Congenital (genetic in ~50%; congenital cytomegalovirus, CMV); acquired (post-meningitis, ototoxic drugs); progressive syndromes | Usually permanent; the loss that newborn screening targets |
| Mixed | A conductive problem superimposed on an SNHL (e.g. glue ear in a child with a permanent loss) | Consider when speech delay is out of proportion to otoscopy |
Source: NICE NG233 · NHS Newborn Hearing Screening Programme
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