Middle ear dysfunction and hearing loss


How does the ear work?

It helps to understand how the ear works before describing what can cause problems for the ear. The ear is made up of 3 main parts: 1) the outer ear, 2) the middle ear, and 3) the inner ear. The outer ear extends from the flap of skin on the outside of your head up to the ear drum. The outer ear acts like a funnel to quickly send sounds to the ear drum.

Middle ear graphics

The ear drum is where the middle ear starts. Behind the ear drum is the middle ear space, which is normally filled with air. The opening of the eustachian tube is in the middle ear space. This tube connects the middle ear space with the upper part of the throat. The tube opens and closes many times during the day; for example, it opens when we swallow or yawn. Sometimes you can hear it open, or "pop". When it opens, it lets fresh air into the middle ear from the air around us. It helps to make the pressure in the middle ear equal to the pressure of the air outside the ear. This is why our ears pop when we change altitude, like when we travel over a mountain or take off and land in an airplane.

Three tiny bones inside the middle ear are named for their shapes: the malleus (hammer), the incus (anvil), and the stapes (stirrup). These bones connect to form a chain. The first bone, the malleus, is connected to the ear drum. The last bone, the stapes, is connected to another tiny membrane called the oval window. The oval window is the beginning of the inner ear, or cochlea. When sound hits the ear drum, the tiny bones jiggle in the air and the last one pushes on the oval window. Inside the cochlea are over 15,000 tiny nerve endings, called hair cells. They are surrounded by fluid. The hair cells change the sound waves into electrical impulses that travel up the auditory (hearing) nerve to the brain.

What is middle ear dysfunction?

A dysfunction is anything that keeps the middle ear from working correctly. If the eustachian tube does not open enough, the pressure in the middle ear changes. This is called eustachian tube dysfunction. It is the most common kind of ear dysfunction in children. If the eustachian tube stays closed for a long time, no air can get to the middle ear. This is middle ear dysfunction. When this happens, fluid sometimes fills the middle ear space. The fluid can become infected if it remains in the middle ear. When this happens, your child may pull at her ears, complain of ear pain, hold her head at a tilt, become irritable, and possibly run a fever. If your child has any of these symptoms, tell her doctor or nurse.

Can a middle ear dysfunction cause hearing loss?

Yes. When the middle ear is not working correctly, sound cannot travel as well to the auditory (hearing) nerve. This causes what is called conductive hearing loss. This type of hearing loss is usually temporary. The hearing usually returns to normal with medical treatment. A hearing evaluation will find how much hearing loss is being caused by the dysfunction. The amount of hearing loss varies from child to child and may even change from day to day. An ear infection is a health problem that requires medical attention. If it is not treated, it may result in permanent hearing loss and communication problems. The doctor will decide what treatment is right for your child based on the results of the hearing test, the ear examination, and any history of ear problems.

Can a middle ear dysfunction affect speech and language development or school performance?

Yes. Children learn speech and language by listening to the people around them. If a child has conductive hearing loss for an extended time, speech and language development may be delayed. It can also cause listening problems in daycare or school, as well as at home. Sometimes hearing problems make it harder for the child to pay attention. Hearing test results should be shared with your child's daycare workers or teachers, so they will understand your child's behavior. Some children have chronic eustachian tube or middle ear dysfunction, but since they never have an active infection, they do not have any of the symptoms listed earlier. If you have concerns about your child’s hearing, speech, language, or school performance, tell her doctor or nurse. One of these staff members can arrange for a hearing evaluation.

What can I do if my child has as middle ear dysfunction or hearing loss?

  • Get medical attention for the problem as soon as possible. Be sure to follow the directions on any medicines the doctor gives you and finish the medicine.
  • Create the best possible listening environment at home, daycare, and school.
    • Minimize background noise (television, radio, etc.)
    • Get your child's attention before speaking.
    • Get close to your child and let her see your face when you are talking.
    • It will help your child in school if she sits near the teacher and away from any sources of noise (hallways, air conditioners, overhead projectors)
  • If you are concerned about your child's speech or language, discuss the problem with her doctor or audiologist. A speech/language evaluation may be needed.
  • Follow her doctor's recommendations for treatment and follow-up. This might include re-testing your child's hearing to make sure that it has returned to normal.


If you have questions about middle ear dysfunction and hearing loss, call Rehabilitation Services at 595-3621. If you are inside the hospital, dial 3621. If you are outside the Memphis area, call toll-free 1-866-2ST-JUDE (1-866-278-5833), extension 3621.


This document is not intended to take the place of the care and attention of your personal physician or other professional medical services. Our aim is to promote active participation in your care and treatment by providing information and education. Questions about individual health concerns or specific treatment options should be discussed with your physician.

St. Jude complies with health care-related federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

ATTENTION: If you speak another language, assistance services, free of charge, are available to you. Call 1-866-278-5833 (TTY: 1-901-595-1040).

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