Management of Children With Bilateral Mild or Unilateral Hearing Loss Diane L Sabo Faye P McCollister Yusnita Weirather
Mar 27, 2015
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)
dB
Normal
Mild
Moderate
Severe
Profound
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Frequency (Hz)
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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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Frequency (Hz)
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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