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Pedunclehood is a critical phase of human development that precedes puberty and is characterized by significant biological and psychological changes.

It begins around the age of 8-12 for girls and 9-14 for boys, although the exact ages may vary. Regarding hearing abilities, these remain stable and similar to those of adults. In addition, middle ear infections tend to decrease during this period due to the maturation of the Eustachian tube and the immune system. However, hearing loss may occur or existing hearing loss may worsen.

Data from the US Centers for Disease Control and Prevention show that even mild hearing loss can cause a child to miss 50% of classroom instruction. Hearing loss is also associated with two times more emergency room visits & a tenfold increase in the risk of the child falling behind at least one grade in school. A child can have normal hearing as an infant and lose their hearing later. When children are born with hearing loss, it is considered “congenital,” while the development of hearing loss after birth is called “acquired.”

Hearing loss, depending on the site of damage/dysfunction, is divided into hearing loss:

• Conductivity, when there is a problem transmitting sound through the external auditory canal or the middle ear. Common causes include: auditory canal obstruction, atresia-stenosis of the external auditory canal, middle ear infection, cholesteatoma, middle ear atelectasis, perforation of the tympanic membrane, otosclerosis
• Sensory, which is due to damage to the inner ear (cochlea) or the auditory nerve. Common causes include: exposure to loud noises, genetic factors (syndromes, neurodegenerative disorders), ototoxic drugs (e.g. aminoglycosides, chemotherapeutics), infections (e.g. CMV, HSV, VZV, meningitis), autoimmune diseases, head and skull base injuries
• Mixed type with elements of both conductive and conductive hearing loss sensorineural hearing loss
• Central from damage or dysfunction in the brain
• Functional or psychogenic, which is related to psychological or emotional factors, without organic damage to the auditory system

Hearing loss during preadolescence causes serious consequences for the child’s communication skills, educational progress and social development. Children with hearing problems often face difficulties in attending classes, understanding teaching and participating in school activities. These difficulties can lead to lower academic performance and negatively affect their educational path. Hearing plays a crucial role in the development of social skills, friendship and social integration.

Hearing loss can lead to social isolation, as children may have difficulty communicating with their peers and participating in social activities. Furthermore, difficulty communicating can affect children’s self-esteem and confidence, especially during this sensitive period of their lives.

Signs that indicate hearing loss are:

• Difficulty communicating
• Poor performance in school
• Avoidance of participation in social activities or games
• The child’s own report that he or she does not hear well
• Reduced response to sounds or changes in the child’s speech

The diagnostic process includes:

• A detailed medical and family history of the child
• Clinical examination of the ears for any anatomical abnormalities or infections
• Audiometric tests (tympanogram and audiogram) to evaluate hearing and detect possible problems
• Imaging methods such as magnetic resonance imaging (MRI) or computed tomography (CT) scan to detect anatomical abnormalities
• Genetic testing when a genetic cause is suspected

If hearing loss is detected, treatment options include:

• Hearing aids for children with mild/moderate hearing loss
• Cochal implants for children with severe hearing loss/deafness
• Placement of ventilation tubes to prevent fluid accumulation in the middle ear or remove accumulated fluid & prevent reaccumulation
• Tympanoplasty to repair a perforated eardrum
• Surgical removal of a cholesteatoma to restore ear function and prevent further damage
• Speech therapy to support speech & language development
• Educational intervention by specialized teachers or use of technological aids

Regarding the prevention of hearing disorders, it includes:

• Regular update of the vaccination program
• Avoidance of ototoxic medications-use of non-ototoxic alternatives & careful monitoring of the dosage of necessary ototoxic drugs
• Regular audiological check-ups

Noise protection:

• • Avoiding exposure to loud sounds
  • Using protective equipment (earplugs/earmuffs) in environments with high noise levels, such as concerts, sporting events, etc.
  • Educating children about the dangers of noise
  • Encouraging the adoption of practical measures to protect hearing in everyday life, such as reducing the volume of hearing aids & their use in moderation

A successful hearing screening of a newborn does not protect the individual from lifelong hearing loss. There are factors during fetal/infant life that affect hearing and subsequently lead to the appearance of hearing loss. Progressive hearing loss has significant consequences if not recognized and treated promptly and effectively. A multidisciplinary approach by a pediatric ENT specialist, pediatrician, speech therapist, educators & other health professionals is essential to support children and their families.