How Headsets Made For Cyclists Are Giving Hearing And Hope To Kids With Glue Ear

How do you change a medical treatment protocol that’s been around for 200 years? It’s not easy to step outside the status quo; but if you do, you might just discover that with the right combination of technology and expertise, you can forge a new path – one that has the potential to improve outcomes for children across the world.

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The problem: conductive hearing loss in children

Otitis media with effusion (OME), AKA glue ear

You might be shocked to learn that 80 percent of all children will have an episode of glue ear,  which can cause temporary hearing loss, by the age of 4. I certainly was.

Glue ear – or, to give it its proper medical name, otitis media with effusion (OME) – is a condition where fluid builds up in the eustachian tubes of the middle ear, the space just behind the eardrum. Most cases follow a middle ear infection (otitis media), but the fluid buildup continues after the initial inflammation has settled down.

As you might imagine, having fluid sitting in your ear does absolutely nothing for your ability to hear. Kids are particularly susceptible, but adults get this problem too – ever felt that your ears were “stuffed up” after having a cold? 

The thing is, if adults temporarily lose our hearing, we have ways of coping. We have very well-developed language skills; we can figure out a lot from context or fill in the blanks if we miss words when someone’s talking to us. Children are still learning these skills, so it’s much more difficult for them to get by when their hearing is suddenly impaired.

This type of hearing loss is called conductive hearing loss. All the machinery inside the ear works normally – it’s just that the sounds can’t make it through all that fluid to be transmitted via the ear bones. This is in contrast to sensorineural hearing loss, where the transmission of signals within the inner ear, cochlea, or cranial nerves is affected. 

When people think of the concept of deafness, most of the time they’re imagining some form of sensorineural hearing loss. However, OME is actually the most common reason for hearing impairment in children. 

How is OME treated?

The foundations for how we treat OME today were laid around two centuries ago – and honestly, it all sounds pretty gnarly.

“Two hundred years ago, a surgeon – without any anaesthetic – used to put a needle through people’s eardrums,” Dr Tamsin Holland Brown, a Community Paediatrician with a special interest in audiology, told IFLScience. 

“Can you imagine someone lancing your eardrum, blindly as well? No one’s doing it under a microscope.”

Nope, nope, nope.

“So this is a surgeon,” Holland Brown continued, “who’s put a needle through people’s eardrums and worked out that, in some cases, their deafness is cured. That’s the people who’ve got fluid stuck behind their eardrum. And then forevermore it becomes a surgical thing.”

Thankfully, these days there is anesthesia involved; but aside from that notable improvement, the actual surgical management of the condition is not all that different.

“We now put children under general anaesthetic, make a cut in their eardrum, and we hold that eardrum cut open because [it] seals quite quickly on its own […], with a little circular tube called a grommet,” Holland Brown explained.

That eardrums heal very quickly was also noticed by our forebears, who quickly decided to start holding the incisions open rather than repeatedly lancing everyone. Unfortunately, they weren’t so hot on infection control.

“They put things in the middle of that cut they’ve made, like rubber or whatever they can find, and there’s no sepsis management at that point,” said Holland Brown. “They’re so ill, it’s all terrible.”

Thankfully, things have moved on substantially. 

Not every child with OME will require surgery – sometimes the issue goes away on its own. But for those with more persistent problems who might benefit from grommets, it can be a long road. Their hearing loss must first be recognized and the cause determined, and there are often long waiting lists for the operation. This can result in some children having uncorrected hearing loss for prolonged periods. 

These children can miss out on vital education during their early school years; their speech and language development can be delayed; and they can struggle socially, as it’s just harder to interact with other kids when you can’t hear them properly. 

As a pediatrician, Holland Brown was seeing the impact of these issues in her clinics. But in the region of the UK where she was based, she was also lucky enough to have the benefit of insight from other professionals who saw another side to conductive hearing loss in children: specialist Teachers of the Deaf (ToDs).

“It’s not just in the education setting,” explained now-retired ToD Sara Brierton to IFLScience. “If you speak to parents of children who have it, then it also affects them clearly in the home, when they’re out playing, all of those things too. […] Clearly our focus is mostly education, but it will affect them in every sphere of their life.”

Teachers with this level of specialist training are not in unlimited supply, however, and funding constraints mean that not every child who could benefit will have access to one. Because of limited resources, Brierton explained, the focus tends to be on children with permanent hearing loss, meaning that children with OME – although their temporary hearing loss may be impacting them significantly – may not meet the criteria for additional support. 

The solution: bone conduction

To even qualify for grommet surgery, Holland Brown told us, a child’s situation has to be “really bad”. “Both ears have to be affected, and you have to be quite deaf before you can get one of these operations. But this condition is a fluctuating condition, so sometimes it affects one ear. This is why it’s so difficult to manage [in a classroom setting] and people don’t recognize it.”

What this patient population ideally needs, she realized, is a solution that can tide them over to their surgery or act as a stopgap while their OME corrects itself.

Hearing aids have come a long way in recent times, in terms of function, size, and ease-of-use, but they’re not cheap. However, children with conductive hearing loss don’t need the same type of hearing aids that are used in people with sensorineural deafness. It’s not about replacing some function of the ear, but more about bypassing the part where all the fluid is.

And that means a simpler, comparatively inexpensive solution could be within reach. 

In fact, hearing aids specifically for conductive hearing loss exist; but, said Holland Brown, “they’re very expensive, so we’re not using them for this condition. We use them for children born without an ear instead” – a condition called anotia. At the time that Holland Brown was beginning to explore this issue in more depth, such a hearing aid cost around £3,000 (roughly $4,000).

They work via bone conduction. You might well have come across it – but rather than in a medical setting, it was more likely in a sports supply or electricals store. 

Until you try bone conduction headphones, it’s hard to believe they can possibly work. Instead of being inserted into or sitting directly over the opening to your ears, bone conduction headsets are designed to sit just in front of the ears on the zygomatic arch (promise that’s a real body part), transmitting sounds via vibrations through the bones of the face directly to the inner ear.

The reason they gained popularity with runners and cyclists is that they leave the ear canal totally open, so if your hearing is not impaired you can maintain awareness of your environment. Because they circumvent the middle ear altogether, this also makes them ideal for people with conductive hearing loss.

Traditional bone conduction hearing aids, however, don’t look much like the sleek, lightweight headsets marketed at sports enthusiasts. The ones Holland Brown told me about are worn on an elasticated band that goes all the way round the head – not necessarily the most comfortable or the easiest for a child to get along with. 

“There’s nothing wrong with the performance of them, but they don’t look great. A 4-year-old accepts this. An 8-, 10-year-old, especially a boy, is not keen to wear one of these things for very long. Would I wear it? Frankly, probably not.”

Intrigued to see whether the types of bone conduction headsets favored by cyclists might do the job instead, Holland Brown purchased one to try out. With their Bluetooth connectivity, one big plus is that they can not only be connected to any electronic devices a child might be using, but they can also be linked up to a microphone that a teacher can wear in the classroom.

The idea for a scientific study was born. In the first trial, 19 children aged 3-6 years were involved, all of whom were on the standard OME treatment pathway. Using the headset and a Bluetooth mic led to clear improvements in speech discrimination.

Next came the development of a mobile app, which includes games, audiobooks, and songs to help support children’s auditory learning and monitor their hearing. If the child is working with a speech and language therapist, they can use the app to upload personalized videos. 

Holland Brown and colleagues also did a study involving 20 children with normal hearing, and found that even for them, using a headset helped with speech discrimination. 

I was able to get my hands on one of the very kits that are offered to the children, and I can confirm that even for a mid-30s millennial, it was very simple to pair with my phone – it’s no wonder tech-savvy Gen Alphas take to the devices so well.

I’ve tried bone conduction before, so I was prepared for how well it works. The headset is lightweight and flexible, and wouldn’t look remotely out of place in a world where so many people carry headphones every time they leave the house. 

The kit comes with the mic as well, and the team also came up with an ingenious added extra: a 3D-printed ear made to match the child’s skin tone. The plastic ears – which did give me a bit of jump-scare when I unboxed the kit, I will admit – slip over the mic worn by the child’s teacher, giving them a more visual representation of how they’re able to hear the sounds. 

“One child said she called it her Harry Potter ‘extendable ear’ to her friends,” said Holland Brown. She and that patient even co-wrote an article about it, which was published in Archives of Disease in Childhood. For some kids, this is just added fun; for younger children or those with a learning disability (kids with Down’s syndrome, for example, are at higher risk of OME), it helps them understand how the kit works. 

Looking beyond the UK

Armed with evidence that these devices can make a real difference, and with a deal in place with manufacturers Raspberry Pi that allowed them to keep costs as low as possible (just £50 for a full kit, around $70), the question of trialing this initiative elsewhere in the world was raised by a colleague of Holland Brown’s, Dr Isobel Fitzgerald O’Connor, a surgeon who had spent time in Malawi.

“They gave [headsets] to two girls who had moderate hearing loss and they were struggling to access education. One of the two girls was lost to follow-up, [but] her teacher had written to say that she was performing better, and could she keep it? And the second child we followed up, and she said ‘I was failing everything at school, and now I’m passing everything, and now I want to become a healthcare professional so that I can help other people get this type of thing.’ So she’s now training to be a nurse, having passed her exams,” Holland Brown recounts. 

If the problem of OME is notable in the UK, it’s a major public health issue in lower income countries. Holland Brown describes it as “glue ear max” – if children experience repeated ear infections, particularly where they don’t necessarily have access to antibiotics, the eardrum can start to break down and discharge seeps out of the ear. In these cases, traditional hearing aids would not be effective, and in any case, wearing something that sits inside the ear canal would be out of the question.

A bone conduction headset, on the other hand, could be life-changing. The batteries are rechargeable, which can be achieved using solar-powered chargers where there is no access to mains electricity. Once the child is comfortable in using the device, they can basically be left to get on with things – ideally, there would be further medical follow-up, but where this is not accessible, they could potentially continue using the device for years, throughout their school career. 

“It’s not miraculous, I don’t want to suggest that,” said Brierton. “But you do get that instant, kind of ‘oh my god, I can hear like I used to’ type of thing. Wherever [the child’s] language was at, they can hit it straight back at that level.”

After the success of the pilot in Malawi, Brierton’s friend and fellow ToD Isobel Blakeley flagged the possibility of a similar project in Rwanda. Having undertaken work in the country with the nonprofit Voluntary Service Overseas, Blakeley had built contacts and could see the potential of bone conduction devices. 

One key individual the UK team have linked up with is Dr Kaitesi Batamuliza Mukara, senior Ear, Nose, and Throat surgeon and founder of Humanhood Clinics in Kigali, Rwanda’s capital. 

Dr Kaitesi told me that one of the main challenges she sees is awareness. “Generally, people seek treatment late. You may have a child who is 5 or 6 and they’re coming to seek treatment at the age of 6 because they have delays in speech and language development, yet the parents don’t even suspect that they have hearing loss in the first place.”  

Even where hearing loss is recognized, or while a child is waiting for surgery, there aren’t always resources there to help them – hearing aids may not be available or affordable, and there’s also the ongoing expense of batteries to consider. “It’s a web of many small and big factors that come into play,” Dr Kaitesi said. 

Rechargeable bone conduction headsets for children with chronic conductive hearing loss could fill a big clinical need. Dr Kaitesi explained the impact that such a device can have on quality of life for a patient awaiting surgery and also pointed out the sustainability of the model: “it’s possible to continue reusing it and reusing it for the next, and next, and next patient until maybe it outlives its lifespan.”

It's for these reasons that a potential partnership with the UK team, with the aim of replicating their work in Malawi on a larger scale, is causing excitement. 

At time of writing, the initial work had already begun and a small number of headsets were already on their way to Rwanda. Dr Kaitesi has been liaising with local and national government and secured support for a school hearing screening project, which is getting underway as schools reopen this fall. Training will be provided to teachers as well as to the nurses who will be conducting the screening. 

Once children with chronic conductive hearing loss have been identified, the hope is that the bone conduction initiative can slot right in, offering the affordable, easy-to-use devices the UK team has already trialed so successfully.

“Obviously we’ll be starting with a small pilot, but I’m hoping that given the results you’re having from other countries, then it’s likely it’s something that will be embraced with ease,” said Dr Kaitesi.

Eventually, the hope would be to have “comprehensive hearing care along the life course,” with projects supporting children, teens, and adults – “but we have to start somewhere, and that’s what is exciting about it,” Dr Kaitesi told me. 

“Literally no rocket science to it”

“I was just a paediatrician, just trying to find something [with] literally no rocket science to it,” said Holland Brown. “The children can’t hear very well and when you don’t give them any hearing support for a long time, it affects their development. […] But nothing happens without people like Isobel and Sarah.”

We’re many of us guilty of neglecting our hearing. As Holland Brown told me, “Everyone’s 10 years late getting any hearing [support] as adults.” Hearing aids are certainly not as normalized as glasses have become. That unwillingness to engage with potential hearing problems “trickles down to children,” she added.

“Once I saw the anxiety that it caused children to have glue ear – and it doesn’t matter what country you’re in – when you can’t hear what’s going on and you’re constantly behind, and you think you’re going to be told off all day […] what happens is the child starts to think they’re not clever, or they are a bit naughty, and they internalize that.”

The solution already existed. But it’s hard to change an establish medical protocol. It took the combined efforts of professionals across different disciplines – pediatrics, audiology, ToDs, surgery, and even the engineers who create the bone conduction headsets in the first place – to start to tread a new path. 

And it’s only with the expertise, drive, and passion of people like Dr Kaitesi that these projects can grow to newer and greater heights, potentially offering hope to children who’ve previously had very few options.