Management of Children With Bilateral Mild or Unilateral Hearing Loss

Diane L Sabo

Faye P McCollister

Yusnita Weirather

Research findings Language and

academic issues Audiologic assessment Audiologic

management Issues for states

Management of Children With Bilateral Mild or Unilateral Hearing Loss

Bilateral Mild or Unilateral Hearing Loss May be present at birth May be acquired early in

life May be intermittent May be progressive May be fluctuating Behavioral tests difficult

with the very young Masking may be a

problem Monitoring with

Electrophysiological tests becomes expensive

Prevalence

Estimates of 5% with mostly being unilateral (3%)

3% conductive hearing losses in children in grades 3-6; impact?

Prevalence

Approximately 5% of the hearing losses in school age children Close to 2.5 million children Most prevalent are unilateral losses High frequency losses next and then bilateral Some estimate that hearing loss (all forms and

degrees) is present in 11% of the school-aged population

Prevalence of Unilateral Hearing Loss >25 dB 13/1000 >45 dB 3/1000

4 Million Annual Birthrate=51,000 per year

5-21 years (School Age)=816,000

Definition

Minimal-mild hearing losses Hearing losses from

15 to 40 dB Unilateral or bilateral Sensorineural or

conductive

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Frequency (Hz)

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Normal

Mild

Moderate

Severe

Profound

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Classification of Hearing Loss

Stable Less than 10 dB decrease

Progressive 10 dB or more decrease

Fluctuating 20 dB or more improvement or decrease

Delayed Onset Normal hearing documented, with later

onset of loss

Etiology of Unilateral HL

Unknown Heredity Meningitis Mumps Asphyxia Head trauma Measles Congenital CMV Fistula

Unilateral- at risk for progressive and

bilateral HL (Brookhouser, Worthington, Kelly, l994)

Mild Persistent OM

Continued Surveillance

Vigilant Surveillance RequiredEstimated that about 16-18 % of hearing loss is

delayed in onsetEducate parentsEducate primary care providersProvide information on normal auditory development

Provide information of signs and symptoms of hearing loss

Unilateral Atresia

Why Do We Care? Binaural hearing

discrimination binaural summation head shadow squelch effects localization binaural release form masking

Audiological Problems Reported for Children with Unilateral Hearing Loss Sound localization Speech discrimination in noise Speech discrimination in quiet

Why Do We Care?

Less known are effects of minimal losses difficulty understanding speech

under adverse listening conditions

formal testing not available until 3 years

Hard of Hearing ChildrenSpeech and Language Issues

Vocabulary size

Syntax and pragmatics

Speech production

Issues of Diagnosis

For minimal hearing loss, issue is the accuracy of the physiologic tests and ability to estimate accurately hearing levels

Academic and Speech/Language Greater difficulty in

educational system

Educational Performance of Students with Unilateral HL

24-35% failed at least one grade

15% needed resource services

Bess & Tharpe, 1986

Oyler, Oyler & Matkin 1987

Educational Problems Reported

Management strategies usually not

appropriate Assumed to be normal

Teacher Reported Problems of Students with Unilateral HL Student is:

More dependent More easily frustrated More emotionally

labile More often aggressive Gives up easily More behavior

problems

Other Reported Problems

Withdrawal Embarrassment Regression Inferiority Fear Reactions Annoyance

Other Problems Reported

Somatic Complaints

Confusion

Paranoia

Helplessness

Depression

Additional Concerns

Safety with mobility, can not localize sound Stability of loss Additional disabilities Etiology Amplification for child, sound field FM Developmental progress

Intervention

When? At identification When confirmed with behavioral findings if

physiologic data only available At time of mobility At school age Delays apparent

Intervention For Unilateral Hearing Loss Early Identification

Hospital based newborn hearing screening Routine periodic school screening

Frequent Audiological MonitoringChildren with identified loss

Children with risk indicators for progressive hearing loss

Management

Hearing aids issues with unilateral losses

Other assistive listening technology Classroom management Other supplemental support services (EI or in

school)

Impact of Early Identification

Early research (1960s-1980s) indicated early detection and intervention of educationally significant hearing loss are crucial

recent research (1990s) showed children with hearing loss are likely to achieve normal speech and language skills by age 5 when detection and habilitation are initiated before 6 months of age

Intervention From Audiology

Cross hearing aid FM auditory trainer Hearing aid for impaired ear Counsel regarding acoustic

management of learning environment

Monitor hearing loss for stability

Intervention For Unilateral Hearing Loss Interdisciplinary assessment to identify any

additional conditions Early intervention program Training to empower child/parent to optimize

learning opportunities Parent training regarding federal

legislation/state/local regulations developed to address needs of children with disabilities

Learning Environment Assessment Signal/Noise Ratio

Lighting

Traffic Patterns

External Distracters

Needs

Parents perspective

Impact of degree of hearing loss on developing child

Study of 112 Children in Alabama with Unilateral Hearing Gender

Female 40 Male 72 Caucasian 75 Black 25 Other 3

Type Loss for 112 Children with Unilateral Hearing Loss

Permanent or chronic conductive 18 (18.6%) Sensorineural 66

(68.0%) Mixed 11

(11.3%) Not Available 2 (2.1%)

Discovery of Unilateral Hearing Loss Hearing screening in school 43 (45.2%) Child complaints 14 (14.7%) Parental observation 15 (15.8%) Newborn screening 5 (5.3%)

Age Parent Recognized Hearing Loss

0-36 months 26 (29.3%)

37-108 months 59 (66.3%)

Not known 4 (4.5%)

Degree of Loss for 112 Children with Unilateral Hearing Loss Mild (21-45 dB) 32 (33.0%) Moderate (46-70 dB) 31 (31.9%) Severe (71-90 dB) 14 (13.8%) Profound (>90 dB) 15 (16.0%) No measurable hearing 5 (5.3%)

Stability of Loss for 112 Children with Unilateral Hearing Loss Stable 53

(55.8%)

Better 5 (5.3%)

Variable 18 (18.9%)

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In Which Ear Is Hearing Loss for 112 Children with Unilateral Hearing Loss Right 52 (55.6%)

Left 45 (46.4%)

Perception of Hearing Difficulty By Student (Sometimes, Often, Always) Face to face 25 (28.1%) Further than 3 feet 46 (51.7%) In a group 55 (62.5%) On side of loss 72 (80.9%) In noise 59 (66.3%) Video, TV, movies 38 (42.7%)

Risk Factors Reported By Parent for Child’s Unilateral Hearing Loss Low birth weight (<3000 grams) 15 (15.8%)

Placed in an incubator 12 (12.6%) Breathing problems 8 (8.4%) Low APGAR scores 2 (2.1%) Elevated bilirubin 21 (22.1%) Oxygen required 8 (8.4%) Other 14 (4.7%)

Additional Conditions Reported By Parent Attention Deficit /Hyperactivity 19 (20.0%) Behavior Disorder 12 (12.6%) Cerebral Palsy 2 (2.1%) Cleft Palate 1 (1.1%) Learning Disability 4 (4.2%) Mental Retardation 3 (3.2%) Seizures 3 (3.2%) Speech Language Problems 17 (17.9%)

Additional Conditions Reported By Parent (2)

Vision 23 (24.2%)

Other 8 (8.4%)

Unknown problem 14 (14.7%)

Grades Retained

Kindergarten 4 (4.2%) Grades 1-3 21 (22.1%) Grades 4-6 5 (5.3%) Grades 7-9 4 (4.2%) Grades 10-12 1 (1.1%) Total 35 (36.8%)

Resource Services Received

LD 19 (27.9%)

EC 3 (4.4%)

Gifted 4 (5.9%)

HI 19 (27.9%)

AD/HD 3 (4.4%)

Other 13 (19.1%)

Resource Services Currently Received Speech/Language 18 (19.6%)

Preferential seating 66 (71.1%)

Tutoring/Resource help 29 (32.2%)

Management of HI needs 33 (36.3%)

Parental Involvement

Meet with teacher about HL 54 (60.0%)

Meet with teacher about school 66 (73.3%) Send medical reports to school 21 (23.3%) Send audiology reports to school 34

(37.8%) None of the above 6 (6.7%) Other activities of involvement 9 (10.0%

Parents Interested In Receiving Additional Information About UHL >70% about their role >60% about teaching methods and the

teacher and school role for helping their child

>60% expected educational performance

>60% protection of hearing in their child’s good ear

>50% their child’s social development, development of self confidence,

and safety issues related to UHL

Parent Training Very Beneficial

Educational Concerns for Children with Unilateral Hearing Loss

May need resource service from speech/language/hearing, education, and/or psychology

Will need attention to acoustics and lighting in learning environment

Will need technological assistance to improve signal to noise ratio

Will need frequent monitoring of hearing as well as educational performance

Medical Considerations for Children With Unilateral Hearing Loss Avoid noise exposure Avoid ototoxic medications unless essential Obtain prompt medical attention for otitis

media Radiologic evaluation and laboratory test

results obtained to evaluate etiology Torch test results Genetic consult report Vestibular findings

Considerations for Parent/ PCP/ Others Involved in Child’s Care Provide printed material on hearing, speech, language,

development Provide information regarding risk factors identified, give

additional resources for further reading, web sites, etc Give handout on signs and behaviors associated with

changes in hearing Give return date for reassessment and advise parent to

notify you for reassessment if changes in hearing suspected

Document in your report that you did all this