Health & Medical Ear & Nose,Throat

Fluctuating Hearing Loss and Education Impact

Updated December 01, 2014.

Written or reviewed by a board-certified physician. See's Medical Review Board.

A common misconception is that hearing loss in children is a low-incidence disability. This misconception is based on the historical tendency to equate the term “hearing impairment” only with severe to profound bilateral hearing loss. A more accurate estimate of the prevalence of hearing loss takes into account a continuum of educationally significant impairments; In that case, severe to profound losses represent a relatively small portion.

Educationally significant hearing losses, include severe or profound bilateral SNHL (about 1 in 1000), mild to moderate bilateral SNHL (about 6 in 1000), unilateral SNHL (about 2 in 1000), and previous losses associated with conductive or recurrent otitis media resulting in speech and language delay (at least 3 in 1000). Applying this definition increases the incidence of educationally significant hearing loss to at least 12 in 1000.  At any given time, one in three young school age children will have a conductive hearing loss, which will impact their learning.  The most prevalent period for Otitis Media to occur is 6-24 months – just when language is being acquired. The impact of fluctuating hearing loss is primarily on speech production, acquisition of early reading skills and attention in class.

A fluctuating conductive hearing loss, commonly due to otitis media, can appear, disappear and reappear - sometimes without anybody knowing. The degree of hearing loss can vary within an hour, day or week from a mild, moderate or severe loss.

The sounds children hear may vary.

Listening with a hearing loss that is about 20dB can be approximated by putting your fingers in your ears and attempting to listen; this loss (or worse!) is typical of what children with fluid behind the eardrum experience. Children will be able to hear, but will miss fragments of what is said. The degree of difficulty experienced in school will depend upon the classroom noise level, the distance from the teacher, and the current degree of hearing loss. At 30dB of hearing loss, a child will miss 24-40% of the speech signal.

In some cases when fluid has been in the middle ear for an extended period of time, a condition called “glue ear” develops; this may result in missing up to 50% of classroom discussions, especially when voices are quiet or the speaker is farther away. Children with this amount of hearing loss will frequently miss unstressed words, consonants, and word endings. Imagine trying to learn something new when you are missing so much information!

The following are some characteristics to look for when fluctuating hearing loss is suspected; please refer to an audiologist if you notice the following:
  • Student appears to be “hearing when he/she wants to” or “not paying attention”.
  • Student stops participating in class and seems distracted.
  • Student appears to be “tuning out” during lecture but does better on written tasks.
  • Student may answer questions inappropriately.
  • Misunderstanding directions.
  • Listlessness.
  • Unexplained irritability.

Most schools will have access to an educational audiologist. Children with fluctuating hearing loss require ongoing monitoring for hearing loss in school and good communication between the audiologist, parents, and teachers to understand particular listening difficulties. Parents will need to coordinate medical management of fluctuating hearing loss with the pediatrician or ENT specialist. The school speech language pathologist should screen for language delays.

In some cases, students may need extra attention to assist development of speech, reading, self-esteem, and listening skills.


Matkin, Noel and Wilcox, Amy. Considerations in the Education of Children with Hearing Loss. Pediatric Clinics of North America. Volume 46, Issue 1 , Pages 143-152, 1 February 1999


Anderson, Karen and Matkin, Noel. Relationship of Degree of Long-term Hearing Loss to Psychosocial Impact and Educational Needs. 1991. 

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