This case was discussed on the Academy of Audiology listserv, posted by a private practitioner.

The patient is age 3, with Down syndrome.  He did not pass a hearing screening in either ear, and consistently has flat tympanograms. His ear canals are stenotic, and visualization of the tympanic membrane is impossible.  The patient had been seen by a Children’s Hospital several hours away. They diagnosed unilateral conductive loss but believed treatment was not indicated, in part because of the very small ear canals.  They recommended twice-annual hearing monitoring.  The parents sought care at the private practice, which is closer to home.

Subsequently, medical management became more aggressive.  He has had a tonsillectomy and adenoidectomy; he is on nasal steroids and allergy medication.  Upper respiratory infections are decreased as a result.

The school audiologist obtained behavior thresholds and found one ear had normal hearing, the other had 35-40 dB conductive loss.  The child’s speech and language are appropriate for his developmental age.

A local ENT recommended surgically enlarging the ear canal and placing a tube in the ear with conductive loss.  The parents went back to the Children’s Hospital for a second opinion and the otologist there recommended against ear canal widening surgery. The parents concurred.

The private practitioner is asking colleague – is amplification warranted, and if so, what can be done given the tiny, stenotic ear?

• What are your thoughts?