Clinical Case · Foundation

Fluctuating hearing in a 2-year-old

Vignette

A 2-year-old with frequent colds and unclear speech is brought by parents worried about hearing. Visual reinforcement audiometry is performed in sound field and then with inserts.

Audiogram

-10020406080100120500 Hz1k Hz2k Hz4k HzHearing level (dB HL)
O Right earX Left ear
Estimated thresholds by ear. O = right, X = left.

Test findings

VRA shows mild, fairly flat elevated minimum response levels bilaterally. Tympanometry (226 Hz, appropriate at this age) is flat (type B) with normal canal volume in both ears, and otoscopy suggests effusion.

Diagnostic question

What is the most likely explanation and initial management?