Down's syndrome and childhood deafness

Many children with Down’s syndrome have some degree of hearing loss. Often this is caused by glue ear (a build-up of fluid in the middle ear) but there can be other causes. This page aims to answer questions you may have about your child's hearing.

A child with Down's syndrome and their siblings at home.

 

It’s important to find out if your child has a hearing loss as early as possible because deafness that isn’t managed or diagnosed can have a negative impact on a child’s social and language development, especially if the child also has a learning disability.

I’m worried about my child’s hearing, what should I do?

All children with Down’s syndrome should have their hearing tested regularly. If you’re worried about your child’s hearing you should make an appointment with your family doctor (GP) who will refer your child to your local audiology service for hearing tests.

If your child has already been diagnosed with a hearing loss then depending on the type or degree of deafness they might have their hearing tested every three to six months when they’re young. Older children might have their hearing tested every year. If you feel your child’s hearing may have changed between appointments ask for an earlier appointment.

The Down’s Syndrome Medical Interest Group publishes guidelines for professionals on how often children with Down's syndrome should have their hearing tested.

Visit our section on hearing tests to find information and resources that explain the different types of tests used to find out your child’s level of hearing. 

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My child has glue ear, what treatments are available?

It is common for children with Down’s syndrome to have a conductive hearing loss (when sound cannot pass properly to the inner ear) caused by glue ear.

Most children who have glue ear grow out of it by about the age of eight. However, children with Down’s syndrome often get glue ear before the age of one and because their Eustachian tubes ( the tube that connects the throat and middle ear) stay small throughout their life, it may last to the age of 10 or even longer.

For this reason it is recommended that you seek treatment for your child's glue ear. Depending on the child and the degree of deafness caused by the glue ear, several options are available.

Hearing aids

Hearing aids may be recommended alongside or instead of other treatments for glue ear. Our guide Hearing Aids has more information about the types available and how they could help your child.

Antibiotics, antihistamines and decongestant medicines

If glue ear is caused by an ear infection, or repeated infections of the breathing passages, your doctor may prescribe a six-week course of low-dose antibiotics. This may be combined with a decongestant medicine to help dry up the fluid. Some children may need a further course of antibiotics the next time they get an infection.
Using decongestant nose drops isn’t recommended as long-term use can lead to too much mucus being produced.

Evidence suggests that antihistamines aren’t effective in managing glue ear in children with Down’s syndrome.

Grommet surgery

Grommets are tiny plastic tubes, inserted into the ear drum, which help air to circulate in the middle ear to prevent fluid from building up. If glue ear doesn’t respond to antibiotics or clear up by itself, an operation to clear the fluid from the middle ear and insert a grommet can be recommended.

Grommet operations can be very difficult in young children with Down’s syndrome because the ear canal can be too narrow for the surgeon to operate. In this situation hearing aids may be helpful until the child is older and the operation to insert grommets can be performed.

For about one in five children without Down’s syndrome who have had grommets, glue ear comes back again. This is much more likely in children with Down’s syndrome but, because the glue is more sticky, the grommet itself often becomes blocked and the improvement in hearing may be short-lived. This may mean that further grommets need to be fitted.

It’s possible to put grommets in about three times. However, repeated grommet operations aren’t recommended as every time one is put in the eardrum is punctured and when it falls out a scar is left. Because of this, some ENT doctors recommend hearing aids as the preferred treatment for glue ear in children with Down’s syndrome.

Boy with Down's syndrome outside playing.

Sometimes removing the adenoids (fleshy pads at the back of the nose and throat area) is also recommended. If the adenoids enlarge they may block the eustachian tubes. Removing them means glue ear is less likely to return when the grommets have fallen out.

If your child is having grommet surgery you may find our tips on preparing your child for surgery helpful.

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Other hearing issues in children with Down’s syndrome

Glue ear is the most common cause of hearing loss in children with Down’s syndrome but it can be caused by other things. Some children with Down’s syndrome have what is called a sensori-neural deafness. Our section on childhood deafness  explains the different types and levels of deafness, and looks at some of the causes as well as the treatments available.

It's important to look out for any issues that can affect your child's hearing such as:

Earwax

Wax is a common problem for children and adults with Down’s syndrome because it easily blocks the narrow ear canals and can cause hearing difficulty. For children who use hearing aids, wax can cause feedback (a whistling noise). You can buy ear drops for wax removal but when the ear canal is very narrow, it can easily become even more blocked by the drops and wax combining. It’s a good idea to ask your audiologist to check your child’s ears every four to six months and arrange for wax to be removed by your ENT doctor if necessary.

Hyperacusis

Hyperacusis is sensitivity to noise. Studies have shown that a few children with Down’s syndrome are particularly sensitive to noise. These children may be distressed in some situations especially when there is a lot of background noise. If this seems to be a problem, discuss this with your child’s audiologist. There is also more information about hyperacusis on the British Tinnitus Association website.

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How can I make communication easier?

Developing good communication skills that fit with your child’s and family’s needs is very important.

When your child is a baby, you will be communicating by using facial expressions, body language, gestures and tone of voice to show love and let your child know that you are there. Because speech development may be delayed in children with Down’s syndrome it can be very helpful for families to learn some sign-based language to help the child communicate. Learning and using sign-based languages early on will not prevent speech from developing as long as normal spoken language and signs are used together.

Depending on their age, ability and level of deafness, children with Down’s syndrome may use spoken language, makaton (a language programme using signs and symbols, often used by people with communication and learning difficulties), sign language or a combination of these.

It’s important to remember that you don’t have to make a choice for life. The communication method you use may change as you learn more about what your child needs.

We’ve created some useful resources on communication, such as:

Child with Down's syndrome playing in garden.

“In playschool they’ve noticed a huge difference since we’ve started signing...his concentration is much better.”

– Lisa, mum to Caleb (4) who has Down's syndrome and a hearing loss has found using sign language a huge help. Read their story, first featured in Families magazine.

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Where can I get more support?

  • Our Freephone Helpline is open Monday to Friday to answer further question about your child’s hearing.
  • The Down’s Syndrome Association website has lots of information and resources for parents of children with Down’s syndrome.
  • Down Syndrome Education International works to improve education for children with Down’s syndrome and has many resources for parents and professionals
  • Our Family Programme events offer you the chance to meet other parents whose children have a hearing loss, share your experiences and get advice from professionals.
  • Parent Place is our online forum where you can chat to and make connections with other parents whose children have a hearing loss.

References

The information on this page has been produced with the help of The Down's Syndrome Medical Interest Group (UK) and The Down's Syndrome Association. We are grateful to Mr Patrick Sheehan, Consultant Paediatric Otolarynologist, and the Audiology Department at Royal Manchester Children's Hospital. 

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