Hearing Impairments Associated With Cerebral Palsy
Cerebral palsy (CP) is a non-progressive disorder that affects motor control. Although genetic and environmental factors may both play a role, cerebral palsy is most often caused by damage to a baby’s brain that occurs during pregnancy, birth, or the neonatal period. The types of brain damage that can cause cerebral palsy can also result in hearing impairment. An estimated 10-20 percent of children with cerebral palsy have some form of hearing impairment, and five percent are deaf (1).
Types and of Hearing Impairment
Children with cerebral palsy may be affected by conductive hearing loss (CHL), sensorineural hearing loss (SNHL), or a combination of the two (mixed hearing loss). Conductive hearing loss affects the conduction of sound through the outer and middle ear (2). It may involve the ear canal, eardrum, and tiny bones called the malleus, incus, and stapes (3). Sensorineural hearing loss can involve damage to the neural receptors of the inner ear (cochlea), nervous pathways to the brain, and the parts of the brain that process sound (2). Generally, sensorineural hearing loss is more serious and harder to treat than conductive hearing loss.
Hearing Impairments and Cerebral Palsy: Causes and Risk Factors
There are many different causes of hearing loss, ranging from highly-treatable infections to skull trauma (3). In children with cerebral palsy, hearing impairment is often associated with hypoxic-ischemic encephalopathy (HIE), a very low birth weight (VLBW), and extremely premature birth (2; 4). In the general population, approximately 50 percent of sensorineural hearing loss cases involve genetic disorders. However, among children with cerebral palsy, non-genetic causes are more likely. These include:
- Hypoxic-ischemic insults (oxygen-depriving events)
- Elevated bilirubin/kernicterus
- Periventricular white matter injury
- Post neonatal infection
- Recurrent otitis media (infection of the middle ear)
- Ototoxic drugs
Research has shown that hearing loss is most common in dyskinetic and hypotonic forms of cerebral palsy, and in children with more severe or extensive motor function impairments. It is also correlated with intellectual disabilities and visual impairments (2).
Diagnosis of Hearing Impairments
Early diagnosis of a hearing impairment can maximize a child’s speech-language abilities, cognitive development, and psychosocial skills. All newborns should be screened for hearing loss; children with cerebral palsy should additionally be given at least one formal audiologic assessment. Professionals say that this should occur by 20 to 30 months, or sooner if there are any early signs of hearing impairment (1). Early hearing assessments can classify hearing loss as conductive, sensorimotor, or mixed type. Audiometry can also be used to rate the severity of hearing loss and determine whether it is stable, progressive, or fluctuating. Usually, hearing tests are behavioral, but children with severe motor and/or cognitive impairments may be unable to communicate with clinicians, and may instead require evaluation via physiological assessment of the auditory system (2).
Management of Hearing Impairments
Interventions for hearing loss vary greatly depending on the nature of the impairment and underlying cause. The following are just a few possible treatments and solutions:
- Antibiotics or antifungal drugs to cure infections
- Corticosteroids to reduce inflammation and cochlea hair swelling
- Surgeries to correct malformations or injuries
- Hearing aids
- Cochlear implant devices
- Avoidance of hypoxic ischemic insults
In addition to medical treatments and forms of assistive technology such as hearing aids and cochlear implants, children with hearing impairments may benefit from speech-language therapy. This can help improve communication and social skills. Children who are deaf or have severe hearing impairments may need sign language instruction and augmentative and alternative communication devices (AACs).
Hearing Impairments and Medical Malpractice
Sometimes, children develop cerebral palsy and associated hearing impairments despite having medical care from competent professionals who did everything in their power to prevent harm. Unfortunately, these conditions can also result from acts of medical malpractice. For example, doctors and nurses may fail to monitor for and/or appropriately respond to signs of fetal distress. These are signs that a baby is being deprived of oxygen and is in need of immediate intervention (such as an emergency C-section). Other problematic behaviors include deviating from standard of care for a high-risk pregnancy, inducing labor when it is not safe to do so, or using risky birth-assisting tools such as forceps and vacuum extractors when they are not indicated.
The attorneys at Reiter & Walsh ABC Law Centers have decades of experience litigating birth injury/infant malpractice cases. To find out if your child’s condition may be the result of medical malpractice, contact our firm for a free case review. We give personal attention to each child and family we help, and no fees are ever paid unless we win.
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- UptoDate: Evaluation and diagnosis of cerebral palsy
- Developmental Medicine & Child Neurology: A population-based study and systematic review of hearing loss in children with cerebral palsy
- Hearing Loss Association of America: Types, causes and treatment
- UptoDate: Clinical features and classification of cerebral palsy