Hearing Disorders in Children — with Dr. Jeyanthi Kulasegarah (SJMC)

In this episode of the Medifly Podcast, consultant ENT surgeon Dr. Jeyanthi Kulasegarah discusses hearing loss in children, covering the critical importance of universal newborn hearing screening, the impact of untreated conditions such as glue ear and ear infections, and the differences between hearing aids, cochlear implants, and bone-anchored hearing devices. She emphasises that hearing concerns should be taken as seriously as vision problems, and urges parents not to wait and see but to seek specialist assessment early.

Introduction & Dr. Kulasegarah's Background

Host: Hi everyone, welcome back to the Medifly Podcast. This is around the fourth or fifth episode, and today I'm at SGH with Dr. Jeyanthi Kulasegarah, a consultant ear, nose, and throat surgeon with a specialty in ENT. Doctor, would you like to introduce yourself before we continue?

Dr. Kulasegarah: I'm currently working at Subang Jaya Medical Centre. I went to medical school at the Royal College of Surgeons and graduated in 2001. After a year of internship I started surgical training in Ireland, which is quite a long process — two years of basic surgical training with an exam at the end, followed by six years of ENT specialty training with another exam at the end. Within those six years I also completed a PhD, which took about two years. In total, including some medical officer postings of two to three years, my entire training was around twelve years.

Once qualified as an ENT specialist, I completed two fellowships: one in Auckland, New Zealand, in paediatric ENT, and a second in Birmingham, UK, in skull base surgery. After all of that I returned home to Malaysia in 2017, worked at University Malaya until 2025, and then joined Subang Jaya Medical Centre.

Why Research? The PhD Experience

Host: You mentioned your PhD at Trinity College Dublin. A lot of ENT surgeons don't pursue a PhD — what drew you to research, and how has it changed how you work today?

Dr. Kulasegarah: I had a two-year gap and I thought it would be useful to try something very different to widen my perspective. Most of the research we do is clinical — based on patients and patient data. Lab-based research is very different. You are in there on your own, trying to figure things out, learning different experiments. It was a totally eye-opening process and I'm glad I did it. It taught me time management, how to process and present data. That is actually where my presentation skills really took off.

Why Paediatric ENT?

Host: Your profile prominently mentions paediatric ENT. Did that focus begin with your fellowship?

Dr. Kulasegarah: During my ENT training, the specialty is divided into: nose (rhinology), ears (otology), head and neck (laryngology), and paediatric ENT. During my paediatric ENT posting as a trainee I really enjoyed it — as I did otology. That is why I did two fellowships: I wanted to deal with ears and I also wanted to deal with children. The tricky thing about children is that it covers everything in ENT, but in smaller patients — from airway to hearing. It is quite broad, so the fellowship was important to broaden my exposure.

How Common Is Hearing Loss in Children?

Host: Is it really common for children to have hearing loss from an early stage?

Dr. Kulasegarah: There are two types of hearing loss. One is congenital hearing loss — you are born with it — and the other is acquired hearing loss, where hearing deteriorates over time.

For children born with hearing loss, in the past we often did not catch it early. The first four years of life are critical — that is when the whole hearing mechanism is developing and language is being learned. Missing that window has significant consequences. This is where universal newborn hearing screening came about.

In many places hearing screening is compulsory for all newborns. In Malaysia most hospitals have it, but it is still not available in every hospital because it requires equipment and trained staff. In some lower-resource settings, screening is limited to high-risk babies such as premature infants.

We used to follow the 1-3-6 rule: detect within one month of birth, confirm the diagnosis by three months, and have a hearing aid fitted by six months. We are now trying to bring that even closer — to a 1-2-4 framework. This requires a multidisciplinary team: not just ENT, but audiologists, paediatricians, and obstetricians, because counselling begins while the mother is still expecting.

Monitoring Development After a Normal Screening

Host: If a child passes the newborn screen, can hearing loss still appear in the first or second year? What signs should parents look for?

Dr. Kulasegarah: Yes. We always advise parents to monitor the child's development regardless of screening results — look out for babbling, eye contact, and first words. If there is any delay, it is best to see a specialist early so we can kick-start the referral to an audiologist for detailed testing. A normal hearing screen does not mean everything is fine forever. You still have to monitor the baby's development.

Glue Ear: Don't Wait for Children to "Grow Out of It"

Host: Glue ear seems very common. A lot of parents assume children will grow out of it — is that a concern?

Dr. Kulasegarah: Glue ear occurs because fluid collects in the space behind the eardrum. The reason is that the Eustachian tube is not functioning properly. In children, the Eustachian tube is much shorter and more horizontal, and its opening is at the back of the nose — where large adenoids can block it, causing fluid to accumulate.

Imagine yourself underwater trying to hear: you can hear, but the clarity is not there. That is exactly what a child with glue ear experiences. Do not ignore fluid in the middle ear because it really impacts the child's learning capabilities — they are having to strain and not catching everything. Get it checked early, because there are ways to improve the hearing so the child can function to their best capability.

"Don't ignore fluid in the middle ear because it really impacts the child's learning capabilities. They're having to strain — they're not catching everything, the clarity is not there."

Understanding Hearing Test Results: Mild, Moderate, Severe, Profound

Host: When patients see numbers like "60 decibels" on a hearing test, it can be confusing. Could you explain what those numbers actually mean?

Dr. Kulasegarah: Rather than focusing on the numbers themselves, the key question is whether the person has mild, moderate, severe, or profound hearing loss.

• Normal hearing: 20 dB and under — the lower the number, the better.
• Mild hearing loss: approximately 20–40 dB
• Moderate hearing loss: approximately 40–60 dB
• The bigger the number, the worse the hearing.

So rather than focusing on numbers, ask your audiologist or ENT doctor: "Is this mild, moderate, severe, or profound?" It is the severe-to-profound group that requires the most attention, because this is the group where we move beyond hearing aids toward considering a cochlear implant.

Hearing Aids vs. Cochlear Implants vs. Bone-Anchored Devices

Dr. Kulasegarah: These devices work in fundamentally different ways:

Hearing aids A hearing aid amplifies acoustic sound. It does not restore normal hearing — it amplifies what is already there. In a noisy environment a hearing aid also captures all background sound, so a person's understanding can still be affected despite wearing one. Hearing aids do not require surgery.

Cochlear implants A cochlear implant provides a different type of hearing — a digitised, electric signal. It works in a completely different way from a hearing aid and requires surgery.

"A hearing aid amplifies sound — it does not give normal hearing. A cochlear implant is more a digitalised hearing, an electric hearing. They work in completely different ways."

Bone-anchored hearing devices (e.g., bone bridge) There are two types of hearing loss:

• Conductive hearing loss — the sound cannot reach the inner ear because something is blocking the ear canal, there is a problem with the eardrum, or the three little bones of hearing are affected.
• Sensorineural hearing loss — the problem lies in the cochlea, the hearing nerve, or the part of the brain involved in hearing.

A bone bridge places the hearing device on the bone. Sound transmitted via bone bypasses the outer and middle ear entirely and goes directly to the hearing organ. This is very different from a conventional hearing aid, where sound must travel through the ear canal, eardrum, and the ossicles before reaching the inner ear.

"Rather than focusing on which device is suitable for your child, get the assessment done first. Once we as professionals see what type of hearing loss it is, we will decide which device suits the child and take it from there."

Other Common Ear Conditions Parents Must Not Ignore

Dr. Kulasegarah: Glue ear is one of the most common causes of hearing loss in children — easily missed and easily corrected.

Ear infection is another one: please do not take it lightly. A discharging ear is very often dismissed by parents — "it's just a little discharge, we'll see what happens" — and it is left for weeks. Sometimes that discharge is a sign that something more significant is going on inside the ear. Get it checked, because these are things that can be corrected quite easily before they cause damage that cannot be reversed.

Dr. Kulasegarah's Key Advice to Parents

"Treat your ears like you would treat your eyes. When you have a vision problem, you go and get glasses — no questions asked. But for some reason, for hearing loss, people are very reluctant to do something about it. It is completely ignored. Just treat your ears like you treat your eyes."

Closing Remarks

Host: Thank you very much, Dr. Kulasegarah, for joining Part 1 of this podcast. We will continue with a second part focused on adult hearing. Dr. Kulasegarah is based at Subang Jaya Medical Centre in Kuala Lumpur. If you have further questions, feel free to comment below. She is also active on social media.

Dr. Kulasegarah: Yes — my handle is @JENT — feel free to browse. It covers not only hearing and ears but many other topics. Thank you for this opportunity and I look forward to the next podcast.

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