Key points
- Most children referred for hearing concerns have a temporary, treatable cause: ear wax, glue ear, or an ear infection.
- If you have a concern about your child's hearing, a clinical assessment is always the right next step. Waiting is rarely advisable.
- Private appointments are available within 48 hours for children aged 2.5 and over. NHS appointments currently carry waits of up to 6 months in some areas.
- Permanent hearing loss in children is uncommon but does occur. Early identification significantly improves outcomes.
Most parents contact us because they, or someone who interacts regularly with their child, has raised a concern about their hearing. The patterns we see most often: a child who failed the school entry hearing screen, a child whose teacher has noticed them asking for repetition, a child who turns the television up significantly higher than others prefer, or one who does not consistently respond when called by name.
These observations matter. In our experience, the majority of children referred with these concerns are found to have a treatable cause. This article explains what those causes are, what an assessment involves, and what happens next depending on what is found.
What is usually causing the problem
In the large majority of cases, a child presenting with the patterns described above is found to have one of four conditions:
- Ear wax accumulation — blocked ear canals reducing sound transmission. Straightforward to treat, results in immediate improvement.
- Glue ear — fluid in the middle ear space, the most common childhood hearing condition, affecting approximately 8 in 10 children before the age of 10.
- Ear infection (otitis media) — inflammation and fluid in the middle ear, often presenting alongside other symptoms of illness.
- Permanent hearing loss — present from birth or progressive in nature, and the least common of the four. In many cases this was not identified at the newborn hearing screen or developed subsequently.
Clinical note
If you or any person who interacts regularly with your child has a concern about their hearing, book an assessment. The cost of waiting is significantly higher than the cost of being assessed and reassured. Hearing affects language development, literacy, and classroom performance in ways that compound over time if left unaddressed.
First steps
If you have a concern, the appropriate first step is to contact your GP and share what you have observed. Depending on the services available in your area, your child may be seen by a paediatric audiologist at your local NHS department within a few weeks. However, NHS waiting times for children's hearing assessments have lengthened considerably in recent years. Parents are currently reporting waits of four to six months in a number of London boroughs.
For parents who want answers sooner, we are usually able to offer a children's hearing test within 48 hours for children aged 2.5 years and over. If your child also needs ear wax removal, this can be carried out at the same appointment rather than requiring a separate booking.
If the assessment finds glue ear
Glue ear is the accumulation of fluid in the middle ear space. It is extremely common in childhood and typically produces a mild to moderate conductive hearing loss. The condition often resolves without intervention.
The standard management pathway following a glue ear diagnosis includes:
- Otovent exercises — autoinflation of the Eustachian tube using a nasal balloon device, which helps decongest the middle ear. The NHS recommends autoinflation as a first-line management strategy for children old enough to use the device.
- Bone conduction hearing aids — where a hearing loss is present and affecting development, temporary bone conduction hearing aids support the child's hearing while awaiting resolution of the glue ear.
- Review appointment — if glue ear persists at the follow-up assessment, a referral to an Ear, Nose and Throat surgeon is appropriate. The surgical option is the insertion of grommets (ventilation tubes), which drain the fluid and restore normal middle ear pressure.
In the large majority of cases, glue ear resolves without surgery. Where it does not, grommets are a well-established and low-risk procedure with a strong evidence base.
If the assessment finds permanent hearing loss
Permanent hearing loss in children is less common but requires a thorough and systematic response. The process typically involves the following:
Aetiology investigation — a fact-finding process to understand the cause of the hearing loss. Is it genetic in origin? If so, is it a known variant and is it associated with a syndrome? Is there any possibility of medical intervention to improve hearing? This investigation is led by an audiovestibular physician.
Hearing aid fitting — arrangements are made to fit the child with appropriate amplification as early as possible. Early fitting significantly improves speech and language outcomes.
Teacher for the Deaf referral — the local authority's Hearing Support Service is notified. Teachers for the Deaf work within school settings to ensure children with hearing loss have appropriate support, access to assistive listening technology, and are not disadvantaged in a classroom environment.
A clinical view
Where permanent hearing loss is identified in a child, we would generally recommend that management is carried out with significant NHS involvement. The complexity of the pathway, the number of services involved, and the long-term follow-up requirements mean that the NHS specialist pathway typically offers the most comprehensive support structure for these families. Private services are most useful for prompt initial assessment and for accessing hearing technology not available on the NHS.
In summary
If someone who knows your child well has raised a concern about their hearing, the correct response is to arrange an assessment. The most common findings are temporary and entirely treatable. Permanent hearing loss, where it occurs, is best identified as early as possible and managed with specialist support.
If you would like to discuss your child's hearing with one of our paediatric audiologists before booking an assessment, a complimentary telephone consultation is available.
