Ears and hearing The majority of individuals with Down syndrome will have had otitis media with effusion (glue ear) in childhoodwhich may have required treatment with ventilation tubes (grommets). In many the glue ear issues resolves in their adolescent years however in a small proportion of individuals resultant perforations of the ear drums may persist. The ears of individuals with Down syndrome should be examined at the yearly health check for the evidence of perforations. As a result of narrow external auditory canals which are associated with Down syndrome, wax accumulation can obstruct the ear canal. Regular dewaxing in the GP practice can keep the canal open. Increased sensitivity to sounds Hyperacusis is an increased sensitivity to sounds. It means that individuals may feel pain or discomfort when they hear sounds that most people are able to tolerate. Hyperacusis is more prevalent in individuals with Down syndrome. It may affect individuals in different ways, for example refusal to go to large indoor areas e.g. shopping centres, or hyperacusis to certain sounds, for instance rattle of cutlery. If suspected, a referral to a specialist in audiological medicine or local audiology department is recommended. Early onset hearing loss Early onset age-related hearing loss (early onset presbycusis) is common in individuals with Down syndrome and easily overlooked. The hearing loss may start in early adulthood. A yearly hearing assessment will detect the onset of the hearing loss. Consideration should be given to provision of hearing aids when the hearing thresholds are significant enough to disrupt daily activity, for example repeated requests to turn up the volume on the TV, radio or personal audio devices or difficulty to hear in the presence of background noise.