Help For Chronic Ear Infections In Infants

Ear infections, a fairly common occurrence in infants, are caused when there is an inflammation of the middle ear which is the cavity behind the ear drum.  When an ear infection does not heal in time or if the infection continues to reoccur (recurring), it is said to have become chronic. Chronic ear infections are called chronic otitis media.

What causes Chronic Ear Infections

The middle ear produces secretions which usually drain out through the eustachian tube to the throat. The eustachian tube is also critical for maintaining airflow through the ear and equalizing air pressure, which is essential for balance. When the fluids don’t drain properly, the bacteria present in the fluid gives rise to an infection.

Children are more likely to suffer from ear infections because the tubes are smaller and at a similar horizontal level hampering drainage, most often when the tubes are swollen or blocked with mucus from other illnesses like the flu. The ear infections typically occur with regularity in children under the age of 3 years.

Treatment of Chronic Ear Infections In Children

Doctors today usually have a wait-and-watch approach towards ear infections in infants with symptomatic relief since the infection often clears up on its own. When this condition continues, specific treatment for the infection needs to be undertaken.

For treating chronic infections, the doctor may prescribe a course of antibiotics.  When the infection fails to responds to the antibiotics, fluid builds up in the middle ear remains for longer time or hearing loss begins , a minor surgical procedure  (Myringotomy)is advised.

Myringotomy the surgery is especially recommended for infants since having persistent fluid in the ear might impact their hearing and speech development.

Under this surgery, a small ventilation tube or grommet, made of metal, plastic or Teflon, is placed in the eardrum to help drain the fluid. The tube releases pressure and acts as a vent until the eustachian tube returns to normal functioning.

Myringotomy is simple, low risk and takes less than half an hour. The surgeon makes a small incision in the eardrum, drains the liquid and then places tiny tube connecting the middle ear and the outer ear. The surgery is usually done in both ears and is called bilateral myringotomy.

The surgery significantly reduces the pain, the severity of symptoms experienced, and over time reduces the infection and its reoccurrence. Any loss in hearing is often restored. The tubes, which are invisible, stay for six to nine months and usually fall out by themselves.  At times, the infection reappears in which case the procedure would need to be repeated.

If left untreated for long, chronic ear infection may, in addition to causing hearing loss, also affect other areas of the ear such as the small bones in the middle ear or the eardrum itself. Surgical procedures are also needed in these cases to repair them.

Music is Increasing Risk of Hearing Loss in Teenagers

Every time you hear loud music you are increasing the risk of damaging your hearing. Repeated exposure to loud music can permanently damage the inner ear and can cause permanent hearing loss.

Image attributes –https://commons.wikimedia.org/wiki/File:Elo_27041978_04_800.jpg#/media/File:Elo_27041978_04_800.jpg

 According to a February 2015 news release, the World Health Organization has reported that about 1.1 billion teenagers have been found to be at risk of developing hearing problems. The primary reason attributed to this alarming statistic is the frequent use of Ipod, MP3 players and smart phones, and also the high exposure to noise pollution at public entertainment facilities like discos or nightclubs.  Musicians are also at increased risk of hearing loss.

WHO’s report has particularly singled out the 12-35 years age-group from middle-class and affluent families who routinely listen to loud music are developing hearing loss.

By definition, any individual exposed to over 85 db of noise for more than 8 hours at a stretch is a high-risk individual for hearing loss.

The risk of damage to hearing from music depends on:

• Loudness of the music
• Closeness to the source of music/ speakers
• Duration of exposure to loud musi
• Family history of hearing loss
• Individual susceptibility to noise

The adverse effect of noise on the teenager’s ears

 Typically during New Year parties or other similar festivities, sound levels are very high before people realize, they may experience a sudden numbing sensation in the ears followed by a deafening silence! This experience differs from person to person, but teenage party-goers frequently complain about hearing problems after attending a rock concert or a whole-night party. Many of these teenagers who complain about temporary hearing loss from time to time may develop serious problems later in their lives, as indicated in Noise induces hearing loss.

Teenagers from low-income groups working at mines, construction sites, oil drills are at same risk of developing hearing loss because of the nature of their occupational environments.

How to know noise is harmful:

• If you have to shout to be heard
• You have pain in the ears be cod noise
• If there is ringing in the ears
• If ears feel muffed or reduced hearing

What are some practical solutions to reduced music related damage?

Protect your ear from the new year’s noise suggests some practical ways to avoid hearing problems.

1. Turn down the volume of personal music systems
2. Take regular breaks from loud music or go to less noisy areas from loudest areas in club or
3. Stand away from the sound source or music speakers
4. Use noise cancelling head phones
5. Wear ear plugs. This solution is recommended for young, professional musicians too.
6. Custom-fit musician earplugs can be used.

The deafening volumes of music played at nightclubs, discos, and parties are simply exposing the young adults to life-threatening sound pollution, which will sooner or later, become an uncontrollable malady of teenage lifestyle all over the world.

 

If any teenager experiences noise-induced irritability, ear block, buzzing, or ringing in the ear, he should immediately consult an ENT Specialist and Hearing test by audiologist is to be done.

 

Home Care for chronic cough

E.N.T. Care and Cure

Though general home remedies do not replace proper diagnosis and medical management but it helps as supportive treatment in faster recovery and reduces sleepless nights. It works in lessening patient’s discomfort.

  

Proper rest

 

Take balanced diet with plenty of vitamin and minerals to boost defense mechanism.

 

Vitamin c and zinc supplements.

 

Keep hydration adequate.

 

Hot soups like tomato soup, chicken soup works wonder in thinning of secretions.

 

Black pepper, basil leaves, cloves and ginger boil with water and drink at night time; it’s soothing and helps in mucus coming out.

 

Honey is age old miraculous natural cure from cough.

 

One pinch of turmeric with 1 cup warm milk helps in easy expulsion of mucus.

 

Researches show ginger, garlic and onion has medicinal properties and helps in cold and cough.

 

Gargles with warm saline (salt in warm water)

 

Saline…

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What causes Throat Pain? How to relieve it by Home remedies?

E.N.T. Care and Cure

I have a scratchy feeling in the throat or Pain in throat, sometimes with difficulty in talking and breathing, I have feverish feeling too. Sounds similar to your throat symptoms this season?

Yes, it is sore throat or throat infection.

Image  Drcamachoent – Own work at wikimedia.org

Sore throat is commonly caused by viral, not bacterial infections where antibiotic is not required.   Further allergy and acid reflux can also contribute to throat pain. Thus, home remedies are increasingly advised to provide relief from mild throat pain such as gargling with warm salt water and over the counter pain killers.

However, if sore throat is not going away in 5-7 days or you are not able to maintain usual food intake than its time to visit your ENT Specialist for treatment.

 Causes of throat pain:

Infection by contagious viruses and bacteria are reasons of majority of throat…

View original post 550 more words

Hyperacusis: Intolerance to sound

Hyperacusis is a condition characterized by over-sensitivity to everyday environmental sounds which may be unpleasant or painful to the ear. Hyperacusis usually results from damage to the our auditory (hearing) system. It can be due to damage to the brain or the neurological system, In these cases, there is processing problem specific to how the brain perceives sound. .

Individuals with hyperacusis have difficulty tolerating normal sounds which are not loud to others such as sound from running water in the kitchen sink, ringing phones, shutting doors, shuffling paper, placing dishes on table, TV sound etc.

40% of patients with tinnitus complain of mild Hyperacusis and around 86% of Hyperacusis sufferers have tinnitus.

Tinnitus is the perception of sound within the human ear such as ringing sensation, when no external sound is present.

Hearing Loss with low tolerance to sound is different term known as recruitment, In Hyperacusis usually hearing is normal.

What causes Hyperacusis?

Hyperacusis may be caused by overexposure to excessively high loudness levels, head injury, stress, and genetic differences or by abnormal responses in the ear muscles, which protects the ear from loud sounds. Other causes may include adverse reactions to medicine or surgeries, chronic ear infections, autoimmune disorders, migraine and some forms of epilepsy.

In cochlear Hyperacusis, the symptoms are ear pain, annoyance and general intolerance to everyday sounds.

In some conditions, wherein the vestibular system is involved is called as Vestibular Hyperacusis. In this condition, the sufferer may experience feelings of dizziness, nausea or a loss of balance when sounds of certain pitches are present at certain level.

Anxiety, Stress and Phonophobia (fear of loud sounds) may be present in Hyperacusis. Sufferer may develop avoidant behavior in order to avoid a stressful sound situation or to avoid embarrassing themselves in a social situation which involves noise. This might lead the sufferer stay away from the society.

Diagnosing Hyperacusis

Understanding the mechanism of Hyperacusis is often challenging. People who develop Hyperacusis should have a thorough Evaluation by otorhinolaryngologist (Ear, Nose and Throat doctor) and a detail Audiological tests to determine the state of the Auditory- Vestibular system.

Treatment of Hyperacusis

Although a corrective medical or surgical approach for treating Hyperacusis is not available at this time, there are therapies that can help to reduce fears and anxieties towards sensitivity of sounds under guidance of an ENT Specialist and supervision by a Clinical Audiologist.

Antidepressant medicines and treating migraine may help.

Retraining Therapy for Hyperacusis

Retraining therapy consists of counseling and acoustic therapy. The aim is to reduce the patient’s reactions to Hyperacusis. Counseling is designed to help a patient better cope, while acoustic therapy is used to decrease a patient’s sensitivity to sounds and to teach them to view the sound in a positive manner.

Sound Generators

This treatment approach uses the sound of music or broadband noise or music produced via a body-worn system or a small device that looks like a hearing aid, which produces steady and gentle sounds. The theory is that, by listening to a sound at a low level for a certain amount of time each day, the auditory nerves and brain centers will become desensitized and able to tolerate normal environmental sounds again.

Constant use of earplugs/ earmuffs is not recommended because constant or frequent blocking of the ears may further alter the brain’s calibration of loudness which may lead the brain to further restrict its comfort range for sounds.

What to do in hyperacusis ?

1 .Avoid exposure to loud noise

2. Avoid caffeine, chocolate, smoking , alcohol, MSG
3. Avoid ototoxic medicines (medicines that might damage ear) such as aspirin, quinine)
4. Daily exercise
5. Adequate rest
6. ENT & Audiological evaluation

Read more about Hyperacusis  http://www.tinnitus.org.uk/hyperacusis

Is There a Cure for Tinnitus? How hearing aid help in tinnitus treatment?

There’s no medication or proven cure for tinnitus at present, however, a number of treatments have been shown to significantly reduce the symptoms.

Digital Hearing aid may substantially help a person who is suffering from tinnitus along with hearing loss.  Hearing aid may be used alone or in combination with other measures to control tinnitus.  Siemens micon, phonak Audio Q, Starkey Xino Tinnitus, Widex Xen and unitron Moxi kiss are few digital hearing aids which comes along with tinnitus maskers.

Hearing Loss and Tinnitus:

Tinnitus is a ringing, buzzing, clicking or hissing sound when there is no such external sound present. Although some people with normal hearing may also experience ringing in ear but most commonly it is associated with hearing loss.

There is common assumption in many people that because of continues sound in the ear they cannot hear. People also believe that nothing can be done for tinnitus. Consequently a considerable number of people do not seek help for hearing loss also. 

Tinnitus Treatment

Tinnitus is managed by treating the underlying cause   or by altering reactions to it, (Tinnitus retraining Therapy-a holistic approach which tries to make the patient accustomed to a noise in such a way that he /she learns to ignore it).

There are other therapy options like music therapy, yoga and CBT .

Digital Hearing Aids for Tinnitus treatment-

Hearing aids can help people with hearing loss and in many cases it also reduces tinnitus symptoms.

Patients not showing relief with hearing aids alone are fitted with combination of a hearing aid and a tinnitus masker.

Patients who do not have hearing loss can be benefited with Tinnitus maskers. These devices are similar to hearing aids but it does not amplify sound and  provides continuous low level sound to the ear.

Studies prove that hearing aid properly fitted by qualified hearing professional results in better relief from tinnitus

A survey of 230 hearing care professionals suggests that six out of 10 patients (60%) experience minor to major relief of tinnitus when wearing hearing aids, and a total of one in five (22%) receive major relief. Less than 2% of patients experience a worsening of their tinnitus when wearing hearing aids, while 39% receive no benefit.

Kochkin S, Tyler R. Tinnitus treatment and the effectiveness of hearing aids: hearing care professional perceptions. Hearing Review. 2008;15(13):14-18. – read See more here .

How hearing aids may help in tinnitus?

Following factors can explain relief in tinnitus symptoms when a hearing aid is used-

Reduced Stress:

A person with hearing loss is struggling to hear, which makes communication stressful for him and stress in turn increases tinnitus symptom. Digital Hearing aid makes communication easy and subsequent reduced stress level is helpful in better coping with tinnitus.

Sound Therapy:

Tinnitus is more noticeable and disturbing when environment is quiet. Hearing aid amplifies background sound thus increasing information available to brain. Which in turn makes tinnitus sound less audible (Masking tinnitus). Open fit hearing aid or RIC are found better in controlling tinnitus as it does not cause blocking effect in the ear.

Combination of hearing aid with tinnitus masker provides low level masking sound in addition to amplification. Low level sound helps in getting accustomed to tinnitus sound.

Studies suggest sufficient evidence for use of hearing aid fitting as an option for the tinnitus treatment. Once hearing loss is addressed by using hearing aids people become more aware of sound around them and less aware of their tinnitus.

In short use of hearing aid along with proper counseling do help tinnitus sufferer in living better quality of life.

If tinnitus is bothering you meet an ENT specialist and get your hearing test done by audiologist to know cause of your tinnitus and take second step of digital hearing aid trial if test report shows hearing loss.

Audicco Tinnitus & Hyperacusis program Vashi,  Navi Mumbai offers ENT and audiological practices to evaluate, diagnose and treat tinnitus so that it no longer interferes with daily activities.

Ask for appointment at 9322229159 or info@audicco.com

 

What causes Throat Pain? How to relieve it by Home remedies?

I have a scratchy feeling in the throat or Pain in throat, sometimes with difficulty in talking and breathing, I have feverish feeling too. Sounds similar to your throat symptoms this season?

Yes, it is sore throat or throat infection.

Image  Drcamachoent – Own work at wikimedia.org

Sore throat is commonly caused by viral, not bacterial infections where antibiotic is not required.   Further allergy and acid reflux can also contribute to throat pain. Thus, home remedies are increasingly advised to provide relief from mild throat pain such as gargling with warm salt water and over the counter pain killers.

 

However, if sore throat is not going away in 5-7 days or you are not able to maintain usual food intake than its time to visit your ENT Specialist for treatment.

 

 Causes of throat pain:

Infection by contagious viruses and bacteria are reasons of majority of throat infection.

Virus infection: Viral infections such as cold, flu, measles, chicken pox and infectious mononucleosis are often associated with throat infection . There could be runny nose, fever, muscle aches and swollen glands in the neck.

Bacterial infection: Strep throat caused by streptococcus bacteria. It is treated by antibiotic as same bacteria can cause scarlet fever or damage heart valves and kidneys. Sending throat swab for bacterial culture is the only way to confirm diagnosis.

Tonsillitis and sinus  infection can also cause a sore throat.

Epiglottitis: Epiglottitis is a dangerous type of throat infection and an emergency condition. Symptoms like painful swallowing, drooling of saliva, muffled speech and difficulty in breathing are a few of the symptoms indicating that throat pain could be epiglottitis.

Allergy to dust, pollen and mold are common causes of sore throats.

Irritation caused by dry heat/dry air, smoking, pollutants, chemicals can also result in sore throat.

Acid Reflux, or a regurgitation of stomach content into the throat is a common cause of throat pain, patients usually describe symptoms as feeling of some lump in throat or as if hair is stuck along with pain or raw sensation in throat

Tumors of the throat and tongue can also cause sore throat along with other associated symptoms, important being hoarse voice, difficulty in swallowing, difficulty in breathing , blood from mouth and weight loss.

HIV infection or lowered immunity can also cause a recurrent or chronic sore throat.

 

When to take appointment of an ENT Specialist?

• Severe and prolonged sore throat more then 3-5 days or recurrent throat pain
• Finding difficulty to breathe
• Swallowing is Difficult
• Difficulty in mouth opening
• Blood in saliva or phlegm
• Joint pain/rashes/High fever
• Earache

 

Treatment of sore throat:

Home remedies for sore throat

Mild sore throat associated with runny nose/stuffy nose can be relieved with the following home  remedies:

•  Proper rest
•  Balanced diet with plenty of vitamin and minerals to boost immunity
•  Vitamin c and zinc supplements.
• Proper hydration /increase liquid intake
• Warm soups like tomato soup, chicken soup to soothe throat , avoid too hot and too cold food.
• Gargles with warm salt water
• Use of steamer or humidifier

•  Avoid smoking and Alcohol
• Take over-the-counter pain killers

 

 Treatment of Throat pain:

If diagnosed as bacterial infection, ENT doctor will prescribe a suitable antibiotic along with supportive medications.

Viral infection lowers your immunity thus, making you susceptible to secondary bacterial infection. Thus doctor may recommend antibiotics at some stage of your viral throat pain.

Antibiotic Resistance and throat pain:

My common observation is patients stop using antibiotic as soon as there is slight relief or do not take it regularly in proper dosage. As a result, throat infection may recur. Thus always complete antibiotic course which could be 7-10 days and take in dosage as advised by your ENT doctor.

Once your throat pain is relieved by home remedies or antibiotics,  you can follow these quick tips for prevention of sore throat-Maintain good hygiene. Wash your hands regularly and keep your napkins, towel and soaps separately, do not share these with the person having throat infection.

                                   And Take Flu vaccine.

What causes Ear Pain – How to get relief?

Edited my old blog post  ear pain

Earache (or Ear pain) in adult and children is one of the most common reasons for visiting ENT specialist and common reason my clinic gets calls on the helpline during Sundays, nights and other emergencies.  

The most common cause of ear pain is swelling or infection within the ear itself and diagnosis is simple. However, sometimes the cause is not in the ear, but in remote areas, known as referred earache. Therefore, finding out the cause of referred ear ache is real challenge and requires thorough examination by ENT doctor.

 Causes of Ear Pain-

Common causes of earache are Outer ear infection (otitis externa), Middle ear Infection (acute otitis media), eustachian tube blockage and impacted wax.  

1. Causes of ear pain within the ear–

•  Outer Ear and Ear-canal– Outer ear canal infection (Otitis externa), impacted wax, boil, Herpes Zoster
• Middle ear– Infection (Acute otitis media), Eustachian tube blockage, Glue ear, travel by flight

2. Causes of ear pain outside the ear (Referred Earache)– 

• Carious tooth, impacted wisdom tooth
• TMJ (Jaw joint) disorder
• Oral cavity and tongue-ulcers
• Mumps/ Parotitis
• Base of tongue- ulcer, tumor
• Sore throat (Pharyngitis), tonsillitis, after tonsillectomy surgery
• Elongated styloid process stretching nerve

  Common reasons and treatment of Ear Pain:

External ear infection (Otitis Externa)– Moisture may be trapped inside the canal while bathing or injury may occur in the skin of the ear canal while using ear buds to clean the ear. Consequently outer ear and ear canal infection develops.  Further, it may lead to fungal infection of the skin of outer ear.

Ear pain of otitis externa worsens on touching the ear and there may be swelling of the ear and blocked ear feeling.

Treatment – Outer ear infection is treated with combination antibiotic and steroid ear drops for 7-10 days.

If ear swelling is severe a wick/ear dressing soaked with ear drops or ointment is placed in the canal. Oral antibiotics and analgesics are prescribed.

Furthermore if pus accumulates, incision and drainage may be required.

Impacted wax and foreign bodies–  Ear wax is not a disease rather it makes a protective layer in the ear canal. It may be a reason of ear pain; also attempts to clean the wax at home may hurt the skin, as a result ear infection develops.

Removal of Impacted ear wax causing obstruction and ear foreign bodies is done by an ENT Specialist by instruments or syringing.

If wax is hard then wax-softening ear drops may be prescribed for 5-7 days and ear cleaning is done after wax becomes soft.

Eustachian-tube block and glue ear– Eustachian tube connects the middle ear with the nasopharynx. It helps with ventilation of the middle ear and drainage of fluid from the middle ear.

Cold, allergy, sinusitis, adenoids or sore throat may cause blockage of the tube therefore resulting in ear pain.

Tube blockage creates negative pressure in the middle ear, which in turn leads to fluid accumulation in the middle ear (Glue ear). Subsequently, increasing pressure in the middle ear may cause pain in the ear.

Treatment of Eustachian tube blockage is oral decongestants and nasal drops. Antibiotics may be given for glue ear.

If the fluid persists for more than 3 months, then a tiny tube (Grommet) may be placed into ear drum.

Otitis media– Otitis media is infection of middle ear which often spreads from cold, flu, sore throat or allergy.  

Treatment -Visit to an ENT clinic is required for proper diagnosis and suitable antibiotics prescription by an ENT doctor. Additionally pain killer, oral or nasal decongestants and antibiotic ear drops may be advised.

  Home remedies for ear pain-

•  You can apply a cold pack or warm compresses to the ear to reduce pain.
• Some safe over the counter pain-relievers can be used to ease the ear pain.
• Do not use ear buds/q tips to clean the ear.
•  Avoid putting oil, water or any other thing in the ear

Earache may be because of a myriad of reasons. Most common causes are impacted, wax, minor injury while ear cleaning, Eustachian tube blockage and ear infection due to cold.

If Ear pain is severe, continuous or associated with hearing problem, dizziness, headache, fever or is simply unexplainable you should visit your ENT specialist for timely treatment.

What to do if you have piercing /shooting ear Pain?  —Contact ENT clinic, Vashi, Navi Mumbai

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Hearing Loss Linked to other Health Conditions

Studies Show that Hearing Loss is Connected to Other Health Conditions.

Once upon a time, before people knew any better, they thought that hearing loss was simply a part of growing older—something not worth doing much about.

They were wrong.

Turns out, hearing loss isn’t fussy about age. More than half of us with hearing loss are still in the workforce. And hearing loss is a much bigger deal than we ever imagined. We need to take it seriously.

Hearing loss affects baby boomers, Gen Xers and every other age group. And, when left unaddressed, hearing loss affects just about every aspect of a person’s life.

The big surprise is that hearing loss has been linked to other health conditions.

Hearing loss can have unwelcome companions—like heart disease; diabetes; chronic kidney disease; depression; cognitive decline, dementia or Alzheimer’s disease; increased risk of falling; increased hospitalizations.

The very best thing to do for hearing loss is to find out if you have it as soon as possible. Then take it seriously. If deemed appropriate by a qualified hearing health care professional, treat it.  Hearing aids can benefit the vast majority of people with hearing loss.

Most doctors don’t include hearing health as a routine part of annual exams. So ask to have your hearing tested. Once you reach middle-age, it makes sense to include hearing tests as part of your routine annual care.

It seems that the “hearing bone” may be connected to more than we originally thought.

For more information visit http://www.betterhearing.org/news/hearing-bones-connected-what

Poor performance in school! Could it be hearing loss?

Your child performing poor in school! You may have to visit an ENT specialist and Audiologist for his Hearing Test.   Even a slight hearing loss in a child is often a reason behind poor performance in class.

Hearing loss doesn’t essentially mean complete inability to hear. It may be slight hearing disorder, only one sided hearing loss, conductive loss caused by recurrent ear infections or problem with sensory auditory processing skills (where even hearing tests may show normal hearing)

 Most parents and teacher may not be aware of Spectrum of pediatric hearing loss and many years can pass before a student is diagnosed and treated. Sometimes it will be taken as attention deficit disorder or normal childhood behaviour or ignorance.

Even mild hearing  loss can compromise communication skills and school performance.

Specific effects of Hearing Loss on children-

• Children with untreated hearing loss may have lower self esteem, they have tendency to isolate themselves and there is lack of class participation.
• Have difficulty in understanding complex sentences.
•  There could also be slow vocabulary development and Problem with sentence structure as compare to children with normal hearing.
• Children may have unclear speech and their speech may be difficult to understand.

 Treatment Of Hearing Loss-

ENT Specialist can treat some types of hearing loss, (conductive hearing disorder which involves outer or middle ear). Such as most ear fluid and Ear infections are managed with medication or simple surgery  to drain the fluid out from middle ear by putting tiny tubes/grommets.

For other types of hearing loss (Sensorineural hearing loss) Hearing aid or cochlear implant, Bone Anchored hearing aids are provided which does not cure hearing loss but may help a child

Children who received early intervention at 6 month of age have been shown years later to have language skills similar to those of children of the same age who have normal hearing.

 Knowing early regarding childhood hearing loss and initiating early treatment- medical, surgical or use of hearing  aids /cochlear implants are critical for the development  of speech, language, and communication skills in children with hearing loss and shown to increase school performance.

 Even mild hearing loss can compromise academic performance. And You should visit an ENT specialist to find out condition of external and middle ear and an audiologist for hearing test and to manage hearing problems.