From the Guidelines
Ear examinations in pediatric patients should begin at birth as part of routine newborn screening and continue at every well-child visit throughout childhood. The initial hearing screening is typically performed within the first 24-48 hours of life using automated auditory brainstem response (ABR) or otoacoustic emissions (OAE) testing 1. Following this, pediatricians should examine the external ear canal and tympanic membrane using an otoscope at every well-child visit, which typically occur at 1,2,4,6,9,12,15,18, and 24 months, and then annually thereafter. More frequent examinations are warranted when children present with symptoms such as ear pain, fever, hearing concerns, or balance issues.
Key Considerations
- Early and regular ear examinations are crucial because children are particularly susceptible to ear infections (otitis media) due to their shorter, more horizontal Eustachian tubes, and untreated ear problems can lead to speech delays, learning difficulties, and permanent hearing loss 1.
- The identification of structural abnormalities or foreign bodies in the ear canal requires prompt attention to prevent complications.
- Children with risk factors, such as Down syndrome or cleft palate, require closer monitoring for otitis media with effusion (OME) and attendant hearing loss, with hearing assessments recommended every 6 months, starting at birth until the age of 3 or 4 years, then annually through childhood 1.
- Any parental concern about hearing loss should be taken seriously and requires objective hearing screening of the patient 1.
Recommendations for At-Risk Children
- At-risk children, such as those with Down syndrome or cleft palate, should have more frequent audiological assessments and otolaryngologic evaluations if middle ear disease, hearing loss, or both are identified or if normal middle ear function cannot be confirmed 1.
- Children with stenotic ear canals are best assessed with an otologic microscope every 3 to 6 months to remove cerumen and assess tympanic membrane appearance and middle ear aeration 1.
From the Research
Checking Ears in Pediatric Patients
- The American Academy of Pediatrics recommends a head-to-toe examination, including a review of growth, during well-child visits 2.
- There is no specific age mentioned in the provided studies for when to start checking ears in pediatric patients.
- However, it is recommended to perform a complete history and physical examination, including a review of growth, during well-child visits, which can help identify any potential issues with the ears 2.
- Tympanostomy tubes are recommended in children with recurrent acute otitis media (RAOM) and an abnormal ear examination at the time of the clinic evaluation 3.
- The efficacy of tympanostomy tubes in preventing recurrences of acute otitis media has been studied, with results showing that tympanostomy tube insertion can be effective in reducing the rate of new episodes of acute otitis media or otorrhea 4, 5.
- Children with otitis media with effusion (OME) at the time of their initial visit had significantly less middle ear disease when treated with tympanostomy tubes 4.