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Choe G, Lim JW, Lee HJ, Kim SH, Carandang M, Kim BJ, Choi BY. Comparing pronunciation challenges in South Korean preschoolers with unilateral single-sided deafness due to cochlear nerve deficiency to a norm-referenced standard. PLoS One 2024; 19:e0297640. [PMID: 38394067 PMCID: PMC10889857 DOI: 10.1371/journal.pone.0297640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 01/05/2024] [Indexed: 02/25/2024] Open
Abstract
This study aimed to compare the development of pronunciation in South Korean preschoolers with unilateral cochlear nerve deficiency (CND) to that of age-matched preschoolers with normal hearing, a topic that has not been explored previously. In a retrospective analysis, 25 preschoolers with unilateral CND who had undergone a speech evaluation battery, including a pronunciation and vocabulary test, were enrolled. Utilizing the Urimal Test of Articulation and Phonation and customized language ability tests, pronunciation and vocabulary were assessed. The subjects' speech evaluation scores were converted into age-adjusted z-scores using normal controls' data. While vocabulary performance was within normal limits, their average pronunciation z-score was -2.90, significantly lower than both the zero reference point and their vocabulary z-scores. None of the subjects scored above average in pronunciation. Thirteen patients were recommended for articulation therapy, seven were considered as potential candidates for this therapy, and the remaining five were within normal limits. There was no observed correlation between the development of pronunciation and vocabulary. Notably, some subjects' pronunciation scores did not improve, even after serial follow-up during their preschool years. Despite typical vocabulary development, preschoolers with unilateral CND exhibit significant delays in pronunciation. These findings emphasize the necessity for vigilant monitoring of their language development.
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Affiliation(s)
- Goun Choe
- Department of Otolaryngology-Head and Neck Surgery, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Republic of Korea
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jong Woo Lim
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyun Jung Lee
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seung Hyun Kim
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Marge Carandang
- Department of Otorhinolaryngology-Head and Neck Surgery, Tondo Medical Center, Metro Manila, Philippines
| | - Bong Jik Kim
- Department of Otolaryngology-Head and Neck Surgery, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Republic of Korea
| | - Byung Yoon Choi
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, Korea
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Patel R, Hoare DJ, Willis KR, Tabraiz S, Bateman PK, Thornton SK. Characterisation of the treatment provided for children with unilateral hearing loss. Front Pediatr 2023; 11:1197713. [PMID: 37559951 PMCID: PMC10407268 DOI: 10.3389/fped.2023.1197713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/16/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Children with permanent unilateral hearing loss (UHL) are an understudied population, with limited data to inform the guidelines on clinical management. There is a funding gap in healthcare provision for the children with UHL in the United Kingdom, where genetic screening, support services, and devices are not consistently provided or fully funded in all areas. They are a disparate population with regard to aetiology and their degree of hearing loss, and hence their device choice and use. Despite having one "good ear", some children with UHL can have similar outcomes, socially, behaviourally, and academically, to children with bilateral hearing loss, highlighting the importance of understanding this population. In this longitudinal cohort study, we aimed to characterise the management of the children with UHL and the gaps in the support services that are provided for the children in Nottingham, United Kingdom. METHODS A cohort study was conducted collecting longitudinal data over 17 years (2002-2019) for 63 children with permanent congenital confirmed UHL in a large tertiary regional referral centre for hearing loss in Nottingham, United Kingdom. The cases of UHL include permanent congenital, conductive, mixed, or sensorineural hearing loss, and the degree of hearing loss ranges from mild to profound. The data were taken from their diagnostic auditory brainstem responses and their two most recent hearing assessments. Descriptors were recorded of the devices trialled and used and the diagnoses including aetiology of UHL, age of first fit, degree of hearing loss, when and which type of device was used, why a device was not used, the support services provided, concerns raised, and who raised them. RESULTS Most children (45/63; 71%) trialled a device, and the remaining 18 children had no device trial on record. Most children (20/45; 44%) trialled a bone-conduction device, followed by contralateral routing of signal aid (15/45; 33%) and conventional hearing aids (9/45; 20%). Most children (36/45; 80%) who had a device indicated that they wore their device "all day" or every day in school. Few children (8/45; 18%) reported that they wore their device rarely, and the reasons for this included bullying (3/8), feedback from the device (2/8), and discomfort from the device (2/8). Only one child reported that the device was not helping with their hearing. The age that the children were first fitted with their hearing device varied a median of 2.5 years for hearing aids and bone-conduction devices and 7 years for a contralateral routing of signal aid. The length of time that the children had the device also varied widely (median of 26 months, range 3-135 months); the children had their bone-conduction hearing aid for the longest period of time (median of 32.5 months). There was a significant trend where more recent device fittings were happening for children at a younger age. Fifty-one children were referred by the paediatric audiologist to a support service, 72.5% (37/51) were subsequently followed up by the referred service with no issue, whilst the remaining 27.5% (14/51) encountered an issue leading to an unsuccessful provision of support. Overall, most children (65%, 41/63) had no reported concerns, and 28.5% (18/63) of the children went on to have a documented concern at some point during their audiological care: five with hearing aid difficulties, five with speech issues, four with no improvement in hearing, three facing self-image or bullying issues, and one case of a child struggling to interact socially with friends. Three of these children had not trialled a device. We documented every concern reported from the parents, clinicians, teachers of the deaf, and from the children themselves. Where concerns were raised, more than half (58.6%, 10/18) were by schools and teachers, the remaining four concerns were raised by the family, and further four concerns were raised by the children themselves. CONCLUSION To discover what management will most benefit which children with permanent UHL, we first must characterise their treatment, their concerns, and the support services available for them. Despite the children with UHL being a highly disparate population-in terms of their aetiology, their device use, the degree of hearing loss, and the age at which they trial a device-the majority report they use their device mostly in school. In lieu of available data and in consideration of the devices that are available to them, it could be useful to support families and clinicians in understanding the devices which are most used and where they are used. Considering the reasons for cessation of regular device use counselling and support services would be vital to support the children with UHL.
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Affiliation(s)
- Roshni Patel
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, The University of Nottingham, Nottingham, United Kingdom
| | - Derek J. Hoare
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, The University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Karen R. Willis
- Children’s Audiology, Ropewalk House, Nottingham, United Kingdom
| | - Shammas Tabraiz
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, The University of Nottingham, Nottingham, United Kingdom
| | - Paul K. Bateman
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, The University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Sally K. Thornton
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, The University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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Effect of Hearing Device Use on Speech-in-Noise Performance in Children with Severe-to-Profound Unilateral Hearing Loss. Ear Hear 2022; 44:588-602. [PMID: 36575571 DOI: 10.1097/aud.0000000000001310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Limited evidence exists for the use of rerouting devices in children with severe-to-profound unilateral sensorineural hearing loss. Many laboratory studies to date have evaluated hearing-in-noise performance in specific target-masker spatial configurations within a small group of participants and with only a subset of available hearing devices. In the present study, the efficacy of all major types of nonsurgical devices was evaluated within a larger group of pediatric subjects on a challenging speech-in-noise recognition task. DESIGN Children (7-18 years) with unaided severe-to-profound unilateral hearing loss (UHL' n = 36) or bilateral normal hearing (NH, n = 36) participated in the present study. The signal-to-noise ratio (SNR) required for 50% speech understanding (SNR-50) was measured using BKB sentences in the presence of proprietary restaurant noise (R-SPACE BSIN-R) in the R-SPACE Sound System. Subjects listened under 2 target/masker spatial configurations. The target signal was directed toward subjects' NH or hearing-impaired ear (45º azimuth), while the interfering restaurant noise masker was presented from the remaining 7 loudspeakers encircling the subject, spaced every 45º. Head position was fixed during testing. The presentation level of target sentences and masking noise varied over time to estimate the SNR-50 (dB). The following devices were tested in all participants with severe-to-profound UHL: air conduction (AC) contralateral routing of signal (CROS), bone conduction (BC) CROS fitted on a headband with and without the use of remote microphone (RM), and an ear-level RM hearing assistance technology (HAT) system. RESULTS As a group, participants with severe-to-profound UHL performed best when the target signal was directed toward their NH ear. Across listening conditions, there was an average 8.5 dB improvement in SNR-50 by simply orienting the NH ear toward the target signal. When unaided, participants with severe-to-profound UHL performed as well as participants with NH when the target signal was directed toward the NH ear. Performance was negatively affected by AC CROS when the target signal was directed toward the NH ear, whereas no statistically significant change in performance was observed when using BC CROS. When the target signal was directed toward participants' hearing-impaired ear, all tested devices improved SNR-50 compared with the unaided condition, with small improvements (1-2 dB) observed with CROS devices and the largest improvement (9 dB) gained with the personal ear-level RM HAT system. No added benefit nor decrement was observed when RM was added to BC CROS using a 50/50 mixing ratio when the target was directed toward the impaired ear. CONCLUSIONS In a challenging listening environment with diffuse restaurant noise, SNR-50 was most improved in the study sample when using a personal ear-level RM HAT system. Although tested rerouting devices offered measurable improvement in performance (1-2 dB in SNR-50) when the target was directed to the impaired ear, benefit may be offset by a detriment in performance in the opposing condition. Findings continue to support use of RM HAT for children with severe-to-profound UHL in adverse listening environments, when there is one primary talker of interest, to ensure advantageous SNRs.
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Gargula S, Simon F, Célérier C, Couloigner V, Leboulanger N, Loundon N, Denoyelle F. French adaptation and validation of the Speech, Spatial and Qualities of Hearing scale for Parents (SSQ-P) and for Children (SSQ-Ch). Int J Audiol 2022:1-9. [PMID: 35671326 DOI: 10.1080/14992027.2022.2084461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Hearing loss can seriously impact children's daily life. This study aims to translate and validate the French versions of the hearing performance questionnaires, SSQ-Parent (for 5-18 years old children), and SSQ-Children (for 11-18 years old children). DESIGN This controlled prospective trial was conducted between April and October 2020. The forward-backward translation method was used, and a test-retest procedure was carried out on a case and a control population. Cases had at least 30 dBHL hearing loss. STUDY SAMPLE 54 cases (mean age 10.4 years old) and 32 controls (mean age 12.5 years old) answered the SSQ-Parent. 35 cases (mean age 13.1 years old) and 35 controls (mean age 14.3 years old) answered the SSQ-Children. RESULTS Spearman's correlation coefficients between global scores of the test and re-test were 0.91 (p < 0.001) for SSQ-Parent, and 0.89 (p < 0.001) for SSQ-Children. Both tests were discriminant (respectively, global score 57.8 vs 92 p < 0.001, 61.2 vs 92.6 p < 0.001), and internally consistent (Cronbach's alpha 0.94 and 0.97). Items-global score correlation was satisfactory. ROC curves showed high area under curve for the SSQ-Children (0.990), and SSQ-Parent (0.988). CONCLUSION The SSQ-Parent and SSQ-Children revealed excellent statistical properties, and can be used for the evaluation of hearing performance of children.
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Affiliation(s)
- Stéphane Gargula
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - François Simon
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Charlotte Célérier
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Vincent Couloigner
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Nicolas Leboulanger
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Natalie Loundon
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Françoise Denoyelle
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
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Rerouting Hearing Aid Systems for Overcoming Simulated Unilateral Hearing in Dynamic Listening Situations. Ear Hear 2021; 41:790-803. [PMID: 31584502 DOI: 10.1097/aud.0000000000000800] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Unilateral hearing loss increases the risk of academic and behavioral challenges for school-aged children. Previous research suggests that remote microphone (RM) systems offer the most consistent benefits for children with unilateral hearing loss in classroom environments relative to other nonsurgical interventions. However, generalizability of previous laboratory work is limited because of the specific listening situations evaluated, which often included speech and noise signals originating from the side. In addition, early studies focused on speech recognition tasks requiring limited cognitive engagement. However, those laboratory conditions do not reflect characteristics of contemporary classrooms, which are cognitively demanding and typically include multiple talkers of interest in relatively diffuse background noise. The purpose of this study was to evaluate the potential effects of rerouting amplification systems, specifically a RM system and a contralateral routing of signal (CROS) system, on speech recognition and comprehension of school-age children in a laboratory environment designed to emulate the dynamic characteristics of contemporary classrooms. It was expected that listeners would benefit from the CROS system when the head shadow limits audibility (e.g., monaural indirect listening). It was also expected that listeners would benefit from the RM system only when the RM was near the talker of interest. DESIGN Twenty-one children (10 to 14 years, M = 11.86) with normal hearing participated in laboratory tests of speech recognition and comprehension. Unilateral hearing loss was simulated by presenting speech-shaped masking noise to one ear via an insert earphone. Speech stimuli were presented from 1 of 4 loudspeakers located at either 0°, +45°, -90°, and -135° or 0°, -45°, +90°, and +135°. Cafeteria noise was presented from separate loudspeakers surrounding the listener. Participants repeated sentences (sentence recognition) and also answered questions after listening to an unfamiliar story (comprehension). They were tested unaided, with a RM system (microphone near the front loudspeaker), and with a CROS system (ear-level microphone on the ear with simulated hearing loss). RESULTS Relative to unaided listening, both rerouting systems reduced sentence recognition performance for most signals originating near the ear with normal hearing (monaural direct loudspeakers). Only the RM system improved speech recognition for midline signals, which were near the RM. Only the CROS system significantly improved speech recognition for signals originating near the ear with simulated hearing loss (monaural indirect loudspeakers). Although the benefits were generally small (approximately 6.5 percentage points), the CROS system also improved comprehension scores, which reflect overall listening across all four loudspeakers. Conversely, the RM system did not improve comprehension scores relative to unaided listening. CONCLUSIONS Benefits of the CROS system in this study were small, specific to situations where speech is directed toward the ear with hearing loss, and relative only to a RM system utilizing one microphone. Although future study is warranted to evaluate the generalizability of the findings, the data demonstrate both CROS and RM systems are nonsurgical interventions that have the potential to improve speech recognition and comprehension for children with limited useable unilateral hearing in dynamic, noisy classroom situations.
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Diego-Lázaro BD, Pittman A, Restrepo MA. Is Oral Bilingualism an Advantage for Word Learning in Children With Hearing Loss? JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:965-978. [PMID: 33647222 DOI: 10.1044/2020_jslhr-20-00487] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The purpose of this study was to examine whether oral bilingualism could be an advantage for children with hearing loss when learning new words. Method Twenty monolingual and 13 bilingual children with hearing loss were compared with each other and with 20 monolingual and 20 bilingual children with normal hearing on receptive vocabulary and on three word-learning tasks containing nonsense words in familiar (English and Spanish) and unfamiliar (Arabic) languages. We measured word learning on the day of the training and retention the next day using an auditory recognition task. Analyses of covariance were used to compare performance on the word learning tasks by language group (monolingual vs. bilingual) and hearing status (normal hearing vs. hearing loss), controlling for age and maternal education. Results No significant differences were observed between monolingual and bilingual children with and without hearing loss in any of the word-learning task. Children with hearing loss performed more poorly than their hearing peers in Spanish word retention and Arabic word learning and retention. Conclusions Children with hearing loss who grew up being exposed to Spanish did not show higher or lower word-learning abilities than monolingual children with hearing loss exposed to English only. Therefore, oral bilingualism was neither an advantage nor a disadvantage for word learning. Hearing loss negatively affected performance in monolingual and bilingual children when learning words in languages other than English (the dominant language). Monolingual and bilingual children with hearing loss are equally at risk for word-learning difficulties and vocabulary size matters for word learning.
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Affiliation(s)
| | - Andrea Pittman
- Department of Speech and Hearing Science, Arizona State University, Tempe, AZ
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What Can a Child Do With One Normal-Hearing Ear? Speech Perception and Word Learning in Children With Unilateral and Bilateral Hearing Losses Relative to Peers With Normal Hearing. Ear Hear 2021; 42:1228-1237. [PMID: 33734172 DOI: 10.1097/aud.0000000000001028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine the effects of unilateral hearing loss on children's ability to perceive familiar words and to learn and retain new words. Because children with unilateral hearing loss receive full auditory input in one ear, their performance was expected to be consistent with that of children with normal hearing rather than that of children with moderate bilateral hearing loss. DESIGN Participants were 36 school-age children with normal hearing bilaterally, 11 children with moderate bilateral hearing loss, and 11 children with mild-to-profound unilateral hearing loss (six right and five left). Half of the normally hearing children and two-thirds of the children with unilateral hearing loss were from bilingual Spanish/English-speaking homes. One of the 11 children with bilateral hearing loss was from a bilingual Spanish/English-speaking home. All children completed a word recognition test in English and in Spanish, a word-learning task comprised of nonsense words constructed using the phonotactic rules of English, Spanish, and Arabic, and a next-day word-retention test. RESULTS Word recognition did not differ across groups in English or Spanish. Learning and retention of nonsense words was highest for the children with normal hearing in all three languages. The children with unilateral and bilateral losses learned and recalled the English nonsense words as well as their normally hearing peers, but performance for the Spanish and Arabic nonsense words was significantly and similarly reduced by hearing loss in either ear. CONCLUSIONS Failure to learn and retain new words given a full auditory representation in one ear suggests that children with unilateral and bilateral hearing losses may share a unifying feature of impairment at the level of the central auditory system.
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Griffin AM, Poissant SF, Freyman RL. Speech-in-Noise and Quality-of-Life Measures in School-Aged Children With Normal Hearing and With Unilateral Hearing Loss. Ear Hear 2020; 40:887-904. [PMID: 30418282 PMCID: PMC7104694 DOI: 10.1097/aud.0000000000000667] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES (1) Measure sentence recognition in co-located and spatially separated target and masker configurations in school-aged children with unilateral hearing loss (UHL) and with normal hearing (NH). (2) Compare self-reported hearing-related quality-of-life (QoL) scores in school-aged children with UHL and NH. DESIGN Listeners were school-aged children (6 to 12 yrs) with permanent UHL (n = 41) or NH (n = 35) and adults with NH (n = 23). Sentence reception thresholds (SRTs) were measured using Hearing In Noise Test-Children sentences in quiet and in the presence of 2-talker child babble or a speech-shaped noise masker in target/masker spatial configurations: 0/0, 0/-60, 0/+60, or 0/±60 degrees azimuth. Maskers were presented at a fixed level of 55 dBA, while the level of the target sentences varied adaptively to estimate the SRT. Hearing-related QoL was measured using the Hearing Environments and Reflection on Quality of Life (HEAR-QL-26) questionnaire for child subjects. RESULTS As a group, subjects with unaided UHL had higher (poorer) SRTs than age-matched peers with NH in all listening conditions. Effects of age, masker type, and spatial configuration of target and masker signals were found. Spatial release from masking was significantly reduced in conditions where the masker was directed toward UHL subjects' normal-hearing ear. Hearing-related QoL scores were significantly poorer in subjects with UHL compared to those with NH. Degree of UHL, as measured by four-frequency pure-tone average, was significantly correlated with SRTs only in the two conditions where the masker was directed towards subjects' normal-hearing ear, although the unaided Speech Intelligibility Index at 65 dB SPL was significantly correlated with SRTs in four conditions, some of which directed the masker to the impaired ear or both ears. Neither pure-tone average nor unaided Speech Intelligibility Index was correlated with QoL scores. CONCLUSIONS As a group, school-aged children with UHL showed substantial reductions in masked speech perception and hearing-related QoL, irrespective of sex, laterality of hearing loss, and degree of hearing loss. While some children demonstrated normal or near-normal performance in certain listening conditions, a disproportionate number of thresholds fell in the poorest decile of the NH data. These findings add to the growing literature challenging the past assumption that one ear is "good enough."
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Affiliation(s)
- Amanda M Griffin
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah F Poissant
- Department of Communication Disorders, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Richard L Freyman
- Department of Communication Disorders, University of Massachusetts Amherst, Amherst, Massachusetts, USA
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Lewis DE. Where Do We Go From Here? Some Messages to Take Forward Regarding Children With Mild Bilateral and Unilateral Hearing Loss. Lang Speech Hear Serv Sch 2020; 51:98-102. [DOI: 10.1044/2019_lshss-19-00075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose
This epilogue discusses messages that we can take forward from the articles in the forum. A common theme throughout the forum is the ongoing need for research. The forum begins with evidence of potential progressive hearing loss in infants with mild bilateral hearing loss, who may be missed by current newborn hearing screening protocols, and supports the need for consensus regarding early identification in this population. Consensus regarding management similarly is a continuing need. Three studies add to the growing body of evidence that children with mild bilateral or unilateral hearing loss are at risk for difficulties in speech understanding in adverse environments, as well as delays in language and cognition, and that difficulties may persist beyond early childhood. Ambivalence regarding if and when children with mild bilateral or unilateral hearing loss should be fitted with personal amplification also impacts management decisions. Two articles address current evidence and support the need for further research into factors influencing decisions regarding amplification in these populations. A third article examines new criteria to determine hearing aid candidacy in children with mild hearing loss. The final contribution in this forum discusses listening-related fatigue in children with unilateral hearing loss. The absence of research specific to this population is evidence for the need for further investigation. Ongoing research that addresses difficulties experienced by children with mild bilateral and unilateral hearing loss and potential management options can help guide us toward interventions that are specific for the needs of these children.
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Affiliation(s)
- Dawna E. Lewis
- Center for Hearing Research, Boys Town National Research Hospital, NE
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Griffin AM, Poissant SF, Freyman RL. Auditory Comprehension in School-Aged Children With Normal Hearing and With Unilateral Hearing Loss. Lang Speech Hear Serv Sch 2020; 51:29-41. [PMID: 31913800 DOI: 10.1044/2019_lshss-ochl-19-0020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose The purpose of this study was to measure auditory comprehension performance in school-aged children with unilateral hearing loss (UHL) and with normal hearing (NH) in quiet and in the presence of child-produced two-talker babble (TTB). Method Listeners were school-aged children (7-12 years) with permanent UHL (n = 25) or NH (n = 14). Comprehension of three short stories taken from the Test of Narrative Language (Gillam & Pearson, 2004) was measured in quiet and in the presence of TTB at two signal-to-noise ratios (SNRs): (a) +6 dB and (b) the individualized SNR required to achieve 50% sentence understanding in the presence of the same TTB masker in a prior study (Griffin, Poissant, & Freyman, 2019). Target/masker spatial configuration was 0°/±60° azimuth. Results As a group, subjects with UHL demonstrated auditory comprehension abilities in favorable listening environments (i.e., quiet, +6 dB SNR) that were statistically equivalent to the NH group. However, in the most challenging listening condition (individualized SNR), many subjects with UHL demonstrated poorer comprehension performance than their age-matched peers with NH. Comprehension abilities were not associated with degree of UHL, unaided speech intelligibility index at 65 dB SPL in the impaired ear, side of UHL, or sex. Conclusions As a group, children with UHL demonstrated deficits in auditory comprehension compared to age-matched peers with NH in challenging listening environments. Findings highlight the importance of ensuring good SNRs for children with UHL.
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Affiliation(s)
- Amanda M Griffin
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, MA.,Department of Otology and Laryngology, Harvard Medical School, Boston, MA
| | - Sarah F Poissant
- Department of Communication Disorders, University of Massachusetts Amherst
| | - Richard L Freyman
- Department of Communication Disorders, University of Massachusetts Amherst
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Huttunen K, Erixon E, Löfkvist U, Mäki-Torkko E. The impact of permanent early-onset unilateral hearing impairment in children - A systematic review. Int J Pediatr Otorhinolaryngol 2019; 120:173-183. [PMID: 30836274 DOI: 10.1016/j.ijporl.2019.02.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 02/13/2019] [Accepted: 02/14/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Decision-making on treatment and (re)habilitation needs to be based on clinical expertise and scientific evidence. Research evidence for the impact of permanent unilateral hearing impairment (UHI) on children's development has been mixed and, in some of the reports, based on fairly small, heterogeneous samples. Additionally, treatment provided has been highly variable, ranging from no action taken or watchful waiting up to single-sided cochlear implantation. Published information about the effects of treatment has also been heterogeneous. Moreover, earlier reviews and meta-analyses published on the impact of UHI on children's development have generally focused on select areas of development. OBJECTIVES This systematic review aimed to summarize the impact of children's congenital or early onset unilateral hearing impairment on listening and auditory skills, communication, speech and language development, cognitive development, educational achievements, psycho-social development, and quality of life. METHODS Literature searches were performed to identify reports published from inception to February 16th, 2018 with the main electronic bibliographic databases in medicine, psychology, education, and speech and hearing sciences as the data sources. PubMed, CINALH, ERIC, LLBA, PsychINFO, and ISI Web of Science were searched for unilateral hearing impairment with its synonyms and consequences of congenital or early onset unilateral hearing impairment. Eligible were articles written in English, German, or Swedish on permanent unilateral hearing impairments that are congenital or with onset before three years of age. Hearing impairment had to be of at least a moderate degree with PTA ≥40 dB averaged over frequencies 0.5 to 2 or 0.5-4 kHz, hearing in the contralateral ear had to have PTA0.5-2 kHz or PTA0.5-4 kHz ≤ 20 dB, and consequences of unilateral hearing impairment needed to be reported in an unanimously defined population in at least one of the areas the review focused on. Four researchers independently screened 1618 abstracts and 566 full-text articles for evaluation of study eligibility. Eligible full-text articles were then reviewed to summarize the results and assess the quality of evidence. Additionally, data from 13 eligible case and multi-case studies, each having less than 10 participants, were extracted to summarize their results. Quality assessment of evidence was made adapting the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) process, and reporting of the results adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. RESULTS Three articles with the quality of evidence graded as very-low to low, fulfilled the eligibility criteria set. Due to the heterogeneity of the articles, only a descriptive summary could be generated from the results. Unilateral hearing impairment was reported to have a negative impact on preverbal vocalization of infants and on sound localization and speech perception both in quiet and in noise. CONCLUSIONS No high-quality studies of consequences of early-onset UHI in children were found. Inconsistency in assessing and reporting outcomes, the relatively small number of participants, low directness of evidence, and the potential risk of confounding factors in the reviewed studies prevented any definite conclusions. Further well-designed prospective research using larger samples is warranted on this topic.
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Affiliation(s)
- Kerttu Huttunen
- Faculty of Humanities, Logopedics, and Child Language Research Center, University of Oulu, Finland; PEDEGO Research Unit, University of Oulu, Finland; MRC Oulu, Oulu, Finland; Oulu University Hospital, Department of Otorhinolaryngology, Head and Neck Surgery, Oulu, Finland.
| | - Elsa Erixon
- Uppsala University, Department of Surgical Sciences, Section of Otorhinolaryngology and Head and Neck Surgery, Uppsala, Sweden.
| | - Ulrika Löfkvist
- University of Oslo, Department of Special Needs Education, Oslo, Norway; Karolinska Institute, Department of Clinical Science, Intervention and Technology, Stockholm, Sweden.
| | - Elina Mäki-Torkko
- Örebro University, School of Medical Sciences, Örebro, Sweden; Örebro University Hospital, Audiological Research Center, Örebro, Sweden.
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van Wieringen A, Boudewyns A, Sangen A, Wouters J, Desloovere C. Unilateral congenital hearing loss in children: Challenges and potentials. Hear Res 2019; 372:29-41. [PMID: 29395617 DOI: 10.1016/j.heares.2018.01.010] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/17/2017] [Accepted: 01/21/2018] [Indexed: 11/16/2022]
Abstract
The estimated incidence of sensorineural hearing impairment (>40 dB HL) at birth is 1.86 per 1000 newborns in developed countries and 30-40% of these are unilateral. Profound sensorineural unilateral hearing impairment or single sided deafness (SSD) can be treated with a cochlear implant. However, this treatment is costly and invasive and unnecessary in the eyes of many. Very young children with SSD often do not exhibit language and cognitive delays and it is hard to imagine that neurocognitive skills will present difficulties with one good ear. In the current paper we review the most recent evidence on the consequences of unilateral hearing impairment for auditory and neurocognitive factors. While data of both adults and children are discussed, we focus on developmental factors, congenital deafness and a window of opportunity for intervention. We discuss which etiologies qualify for a cochlear implant and present our multi-center prospective study on cochlear implants in infants with one deaf ear. The large, state-of-the art body of research allows for evidence-based decisions regarding management of unilateral hearing loss in children.
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Affiliation(s)
- Astrid van Wieringen
- KU Leuven - University of Leuven, Department of Neurosciences, Experimental ORL, Herestraat 49, 3000 Leuven, Belgium.
| | - An Boudewyns
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Anouk Sangen
- KU Leuven - University of Leuven, Department of Neurosciences, Experimental ORL, Herestraat 49, 3000 Leuven, Belgium
| | - Jan Wouters
- KU Leuven - University of Leuven, Department of Neurosciences, Experimental ORL, Herestraat 49, 3000 Leuven, Belgium
| | - Christian Desloovere
- KU Leuven - University of Leuven, Department of Neurosciences, Experimental ORL, Herestraat 49, 3000 Leuven, Belgium; University Hospital Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium
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Anne S, Lieu JEC, Cohen MS. Speech and Language Consequences of Unilateral Hearing Loss: A Systematic Review. Otolaryngol Head Neck Surg 2017; 157:572-579. [DOI: 10.1177/0194599817726326] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Unilateral hearing loss has been shown to have negative consequences for speech and language development in children. The objective of this study was to systematically review the current literature to quantify the impact of unilateral hearing loss on children, with the use of objective measures of speech and language. Data Sources PubMed, EMBASE, Medline, CINAHL, and Cochrane Library were searched from inception to March 2015. Manual searches of references were also completed. Review Methods All studies that described speech and language outcomes for children with unilateral hearing loss were included. Outcome measures included results from any test of speech and language that evaluated or had age-standardized norms. Due to heterogeneity of the data, quantitative analysis could not be completed. Qualitative analysis was performed on the included studies. Two independent evaluators reviewed each abstract and article. Results A total of 429 studies were identified; 13 met inclusion criteria and were reviewed. Overall, 7 studies showed poorer scores on various speech and language tests, with effects more pronounced for children with severe to profound hearing loss. Four studies did not demonstrate any difference in testing results between patients with unilateral hearing loss and those with normal hearing. Two studies that evaluated effects on speech and language longitudinally showed initial speech problems, with improvement in scores over time. Conclusions There are inconsistent data regarding effects of unilateral hearing loss on speech and language outcomes for children. The majority of recent studies suggest poorer speech and language testing results, especially for patients with severe to profound unilateral hearing loss.
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Affiliation(s)
- Samantha Anne
- Department of Otolaryngology–Head and Neck Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Judith E. C. Lieu
- Department of Otolaryngology–Head and Neck Surgery, Washington University, St Louis, Missouri, USA
| | - Michael S. Cohen
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
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Uwiera TC, Dealarcon A, Meinzen-Derr J, Cohen AP, Rasmussen B, Shott G, Greinwald J. Hearing Loss Progression and Contralateral Involvement in Children with Unilateral Sensorineural Hearing Loss. Ann Otol Rhinol Laryngol 2017. [DOI: 10.1177/000348940911801106] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives We undertook this study to determine the rate of hearing loss progression in the affected ear of children with unilateral sensorineural hearing loss and without an enlarged vestibular aqueduct, and the rate of new-onset hearing loss in the contralateral ear. Methods We searched the database at our pediatric tertiary care center to identify patients who met the inclusion criteria, examining demographic variables, audiometric data, and presumptive causes. Results We identified 198 patients. At presentation, they showed slight left-sided and male predominances. Of 142 patients who had sufficient audiometric follow-up for us to evaluate progression, 21% showed ipsilateral progression and 10.6% developed new-onset hearing loss in the contralateral ear. Isolated high-frequency loss was identified in 11 patients (5.6%), 8 of whom had sufficient follow-up for us to identify progression. Two showed progression; 4 others with progression in the ipsilateral ear developed new-onset high-frequency loss in the contralateral ear. Temporal bone anomalies were identified in 26 children (13%), and these children were more likely to have profound hearing loss than were those without temporal bone anomalies (46% versus 23%). Conclusions The findings suggest that unilateral sensorineural hearing loss may not always be a unilateral process, but that it may be the initial manifestation of bilateral auditory dysfunction.
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Affiliation(s)
- Trina C. Uwiera
- Department of Surgery, Division of Pediatric Otolaryngology–Head and Neck Surgery, University of Alberta, College of Medicine and Dentistry, Edmonton, Canada
| | - Alessandro Dealarcon
- Ear and Hearing Center, Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati, Ohio
| | - Jareen Meinzen-Derr
- Ear and Hearing Center, Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati, Ohio
- Division of Biostatistics and Epidemiology, Cincinnati, Ohio
| | - Aliza P. Cohen
- Ear and Hearing Center, Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati, Ohio
| | - Brian Rasmussen
- Ear and Hearing Center, Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati, Ohio
| | - Gordon Shott
- Ear and Hearing Center, Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati, Ohio
| | - John Greinwald
- Ear and Hearing Center, Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati, Ohio
- Cincinnati Children's Hospital Medical Center, and the Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Rohlfs AK, Friedhoff J, Bohnert A, Breitfuss A, Hess M, Müller F, Strauch A, Röhrs M, Wiesner T. Unilateral hearing loss in children: a retrospective study and a review of the current literature. Eur J Pediatr 2017; 176:475-486. [PMID: 28132094 DOI: 10.1007/s00431-016-2827-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 12/04/2016] [Accepted: 12/12/2016] [Indexed: 12/21/2022]
Abstract
UNLABELLED Despite the introduction of universal newborn hearing screening (UNHS), unilateral hearing loss (UHL) is sometimes recognized late. This diagnostic delay has adverse repercussions, given the importance of binaural hearing for the development of normal auditory processing. It is incorrect to maintain that unilateral hearing is the minimum requirement for adequate speech development and that hearing aid provision is consequently unnecessary. In our retrospective study, hearing aid provision resulted in improved directional and selective hearing (quiet and noisy environments) and, compared with their chronically ill counterparts, the children in our study displayed superior health-related quality of life (HRQoL) scores in all areas. On the basis of the results, the authors conclude that even mild hearing losses (from an auditory threshold of 30 to 40 dB) should have the opportunity for hearing aid provision. A selective literature review was conducted in PubMed and textbooks and with reference to national and international guidelines. Early diagnosis and treatment of UHL have a positive effect on verbal-cognitive, linguistic, communicative, and socio-emotional development, as demonstrated by neurophysiological studies. Among the treatment modalities with differing effects on the quality of binaural hearing, cochlear implants are now used increasingly in children with hearing loss bordering on deafness. CONCLUSION Published evidence and clinical experience support early diagnosis and treatment. Wherever feasible, hearing aid provision before or at the end of the first year of life is recommended for children with UHL. What is Known: • Almost 30 years ago, poor academic performance was reported in children with unilateral hearing loss (UHL). • Despite improvements in treatment options, it is traditionally held that unilateral hearing is the minimum requirement for adequate speech development and hearing aid provision is unnecessary. What is New: • Academic and behavioral deficits in children with UHL may be mediated by deficiencies in the default mode network. • Published evidence supports the recommendation for hearing aid provision before or at the end of the first year of life in children with UHL.
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Affiliation(s)
- Anna-Katharina Rohlfs
- Department of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Martinistrasse, 52 20246, Hamburg, Germany.
| | - Johannes Friedhoff
- Department of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Martinistrasse, 52 20246, Hamburg, Germany
| | - Andrea Bohnert
- Department for ENT and Communication Disorders, University Medical Center of the Johannes Gutenberg University, Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Achim Breitfuss
- Department of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Martinistrasse, 52 20246, Hamburg, Germany
| | - Markus Hess
- Department of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Martinistrasse, 52 20246, Hamburg, Germany
| | - Frank Müller
- Department of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Martinistrasse, 52 20246, Hamburg, Germany
| | - Anke Strauch
- KIND Hörgeräte, Erdkampsweg, 55 22335, Hamburg, Germany
| | - Marianne Röhrs
- Community Practice for Otorhinolaryngology, Phoniatrics and Pediatric Audiology, Pestalozzistraße, 24 22305, Hamburg, Germany
| | - Thomas Wiesner
- Department of Phoniatrics and Pediatric Audiology, Werner Otto Institut, Bodelschwinghstrasse, 23 22337, Hamburg, Germany
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Sangen A, Royackers L, Desloovere C, Wouters J, van Wieringen A. Single-sided deafness affects language and auditory development - a case-control study. Clin Otolaryngol 2017; 42:979-987. [DOI: 10.1111/coa.12826] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2017] [Indexed: 11/28/2022]
Affiliation(s)
- A. Sangen
- Department of Neurosciences; Research Group Experimental Oto-rhino-laryngology (ExpORL), KU Leuven; University of Leuven; Leuven Belgium
| | - L. Royackers
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; University Hospitals Leuven; Leuven Belgium
| | - C. Desloovere
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; University Hospitals Leuven; Leuven Belgium
| | - J. Wouters
- Department of Neurosciences; Research Group Experimental Oto-rhino-laryngology (ExpORL), KU Leuven; University of Leuven; Leuven Belgium
| | - A. van Wieringen
- Department of Neurosciences; Research Group Experimental Oto-rhino-laryngology (ExpORL), KU Leuven; University of Leuven; Leuven Belgium
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Krishnan LA, Van Hyfte S. Management of unilateral hearing loss. Int J Pediatr Otorhinolaryngol 2016; 88:63-73. [PMID: 27497389 DOI: 10.1016/j.ijporl.2016.06.048] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/27/2016] [Accepted: 06/28/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE A representative sample of literature regarding unilateral hearing loss (UHL) was reviewed to provide evidence of the effects of UHL and the intervention options available for children with UHL. Considerations during the assessment and management of children with UHL are illustrated using case illustrations. METHOD Research articles published from 2013 to 2015 were searched in the PubMed database using the keywords "unilateral hearing loss". Articles from 1950 to 2013 were included from a previous literature review on minimal hearing loss [1]. A retrospective review of charts of 14 children with UHL was also conducted. RESULTS The evidence indicates that children with UHL are more likely to have structural anomalies of the inner ear; may face challenges in six different domains, and have six intervention options available. Evidence also indicates that although some children appear to exhibit no delays or difficulties, others have significant challenges, some of which continue into adulthood. CONCLUSIONS Children with UHL have to be treated on a case-by-case basis. Parent education regarding UHL, its effects, and all available management options is critical so they can make informed decisions. Close monitoring and good communication between professionals in different domains is crucial in order to minimize the potential negative effects of UHL.
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Affiliation(s)
- Lata A Krishnan
- Purdue University, West Lafayette, Department of Speech, Language, and Hearing Sciences, Purdue University, 715 Clinic Drive, West Lafayette, IN 47907, USA.
| | - Shannon Van Hyfte
- Purdue University, West Lafayette, Department of Speech, Language, and Hearing Sciences, Purdue University, 715 Clinic Drive, West Lafayette, IN 47907, USA
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Winiger AM, Alexander JM, Diefendorf AO. Minimal Hearing Loss: From a Failure-Based Approach to Evidence-Based Practice. Am J Audiol 2016; 25:232-45. [PMID: 27367972 DOI: 10.1044/2016_aja-15-0060] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/17/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE A representative sample of the literature on minimal hearing loss (MHL) was reviewed to provide evidence of challenges faced by children with MHL and to establish the need for evidence-based options for early intervention. METHOD Research articles published from 1950 to 2013 were searched in the Medline database using the keywords minimal hearing loss, unilateral hearing loss, and mild hearing loss. References cited in retrieved articles were also reviewed. RESULTS In total, 69 articles contained relevant information about pediatric outcomes and/or intervention for unilateral hearing loss, 50 for mild hearing loss, and 6 for high-frequency hearing loss. Six challenges associated with MHL emerged, and 6 interventions were indicated. Evidence indicates that although some individuals may appear to have no observable speech-language or academic difficulties, others experience considerable difficulties. It also indicates that even though children with MHL may appear to catch up in some areas, difficulties in select domains continue into adulthood. CONCLUSIONS Evidence indicates significant risks associated with untreated MHL. Evidence also demonstrates the need for early intervention and identifies several appropriate intervention strategies; however, no single protocol is appropriate for all children. Therefore, families should be educated about the impact of MHL and about available interventions so that informed decisions can be made.
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Kishon-Rabin L, Kuint J, Hildesheimer M, Ari-Even Roth D. Delay in auditory behaviour and preverbal vocalization in infants with unilateral hearing loss. Dev Med Child Neurol 2015; 57:1129-36. [PMID: 26058353 DOI: 10.1111/dmcn.12812] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2015] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the impact of unilateral hearing loss (UHL) on early aural/oral communication skills of infants by comparing performance to infants with bilateral normal hearing (BNH). METHOD Thirty-four infants with UHL (median age 9.4mo, 25th-75th centile 7.34-12.15) and 331 control infants with BNH (median age 9mo, 6.0-13.38) were divided into two subgroups based on risk factors known to cause developmental delay: low risk and high risk. Early auditory skills and preverbal vocalizations were assessed using two parent questionnaires: the Infant-Toddler Meaningful Auditory Integration Scale and the Production of Infants Scale Evaluation. RESULTS Of the infants with UHL, 21% showed delays in auditory behaviour and 41% delays in preverbal vocalizations, compared to their peers with BNH (p<0.01). After adjusting for risk level, delayed auditory behaviour and preverbal vocalizations were approximately four and nine times more common in infants with UHL compared to BNH respectively (p<0.01). INTERPRETATION This is the first study to show that infants with UHL are at higher risk of delay in early aural/oral communication abilities compared to infants with BNH even in the absence of other known risk factors for developmental delay. This has important implications for early intervention and habilitation of infants with UHL, in order to reduce some of the negative long-term consequences of what was once considered 'minor' hearing loss.
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Affiliation(s)
- Liat Kishon-Rabin
- Department of Communication Disorders, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Kuint
- Department of Neonatology, Edmond and Lily Safra Children's Hospital, Sackler Faculty of Medicine, Tel Aviv University, The Chaim Sheba Medical Center, Tel Aviv, Israel
| | - Minka Hildesheimer
- Department of Communication Disorders, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Speech and Hearing Center, The Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Daphne Ari-Even Roth
- Department of Communication Disorders, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Speech and Hearing Center, The Chaim Sheba Medical Center, Tel-Hashomer, Israel
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21
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Vila PM, Lieu JEC. Language Outcomes in Children With Unilateral Hearing Loss: A Review. ACTA ACUST UNITED AC 2015. [DOI: 10.1044/hhdc25.2.60] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Unilateral hearing loss (UHL) in children is only recently beginning to be widely appreciated as having a negative impact. We now understand that simply having one normal-hearing ear may not be sufficient for typical child development, and leads to impairments in speech and language outcomes. Unfortunately, UHL is not a rare problem among children in the United States, and is present among more than 1 out of every 10 of adolescents in this country. How UHL specifically affects development of speech and language, however, is currently not well understood. While we know that children with UHL are more likely than their normal-hearing siblings to have speech therapy and individualized education plans at school, we do not yet understand the mechanism through which UHL causes speech and language problems. The objective of this review is to describe what is currently known about the impact of UHL on speech and language development in children. Furthermore, we discuss some of the potential pathways through which the impact of unilateral hearing loss on speech and language might be mediated.
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Affiliation(s)
- Peter M. Vila
- Department of Otolaryngology - Head & Neck Surgery, Washington University School of Medicine in St. Louis
St. Louis, MO
| | - Judith E. C. Lieu
- Department of Otolaryngology - Head & Neck Surgery, Washington University School of Medicine in St. Louis
St. Louis, MO
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Lewis DE, Valente DL, Spalding JL. Effect of minimal/mild hearing loss on children's speech understanding in a simulated classroom. Ear Hear 2015; 36:136-44. [PMID: 25170780 PMCID: PMC4272681 DOI: 10.1097/aud.0000000000000092] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES While classroom acoustics can affect educational performance for all students, the impact for children with minimal/mild hearing loss (MMHL) may be greater than for children with normal hearing (NH). The purpose of this study was to examine the effect of MMHL on children's speech recognition comprehension and looking behavior in a simulated classroom environment. It was hypothesized that children with MMHL would perform similarly to their peers with NH on the speech recognition task but would perform more poorly on the comprehension task. Children with MMHL also were expected to look toward talkers more often than children with NH. DESIGN Eighteen children with MMHL and 18 age-matched children with NH participated. In a simulated classroom environment, children listened to lines from an elementary-age-appropriate play read by a teacher and four students reproduced over LCD monitors and loudspeakers located around the listener. A gyroscopic headtracking device was used to monitor looking behavior during the task. At the end of the play, comprehension was assessed by asking a series of 18 factual questions. Children also were asked to repeat 50 meaningful sentences with three key words each presented audio-only by a single talker either from the loudspeaker at 0 degree azimuth or randomly from the five loudspeakers. RESULTS Both children with NH and those with MMHL performed at or near ceiling on the sentence recognition task. For the comprehension task, children with MMHL performed more poorly than those with NH. Assessment of looking behavior indicated that both groups of children looked at talkers while they were speaking less than 50% of the time. In addition, the pattern of overall looking behaviors suggested that, compared with older children with NH, a larger portion of older children with MMHL may demonstrate looking behaviors similar to younger children with or without MMHL. CONCLUSIONS The results of this study demonstrate that, under realistic acoustic conditions, it is difficult to differentiate performance among children with MMHL and children with NH using a sentence recognition task. The more cognitively demanding comprehension task identified performance differences between these two groups. The comprehension task represented a condition in which the persons talking change rapidly and are not readily visible to the listener. Examination of looking behavior suggested that, in this complex task, attempting to visualize the talker may inefficiently utilize cognitive resources that would otherwise be allocated for comprehension.
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Doković S, Gligorović M, Ostojić S, Dimić N, Radić-Šestić M, Slavnić S. Can mild bilateral sensorineural hearing loss affect developmental abilities in younger school-age children? JOURNAL OF DEAF STUDIES AND DEAF EDUCATION 2014; 19:484-95. [PMID: 25063005 DOI: 10.1093/deafed/enu018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The research study was conducted for the purpose of examining the influence of mild bilateral sensorineural hearing loss (MBSNHL) on developmental abilities of younger school-age children. The sample encompassed 144 children with MBSNHL, aged 7.5-11 (M = 8.85). MBSNHL (20-40 dB HL) was identified by pure tone audiometry. The control group encompassed 160 children with normal hearing. The Acadia test of developmental abilities was used for assessment of developmental abilities. Although statistically significant differences between participants with MBSNHL and those with normal hearing were established in the majority of estimated developmental abilities domains, those differences do not indicate any significant delay in development of assessed abilities, except in the domain of auditory discrimination. The obtained results call for a systematic approach to children with MBSNHL in elementary schools.
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Lewis DE. Children with Minimal/Mild Hearing Loss: Do We Have a Consensus and is that Important? ACTA ACUST UNITED AC 2014. [DOI: 10.1044/hhdc24.2.54] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Children with minimal/mild hearing loss make up approximately 5% of the school-age population. While there is considerable research indicating that these children experience difficulties in a number of areas, there also is research indicating that they perform similarly to their peers with normal hearing. Understanding the potential difficulties that these children may experience and how their communication access needs may differ from those of their peers with normal hearing is important for habilitation. A lack of clear consensus could negatively impact provision of habilitation services. Awareness of factors that may affect that consensus can be useful in interpreting findings. This paper will address a number of those potential factors.
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Affiliation(s)
- Dawna E. Lewis
- Listening and Learning Laboratory, Boys Town National Research HospitalOmaha, NE
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Abstract
OBJECTIVE To determine whether audiologic characteristics of unilateral hearing loss in children were associated with language, cognitive, or achievement scores. STUDY DESIGN Case-control study SETTING Pediatric otolaryngology ambulatory practice PATIENTS Cases (n = 109) were children aged 6 to 12 years with permanent unilateral hearing loss; controls (n = 95) were siblings with normal bilateral hearing. INTERVENTIONS Audiologic characteristics measured included side and severity of hearing loss and word recognition scores in quiet and in noise. MAIN OUTCOME MEASURES Cognitive abilities were measured using the Wechsler Abbreviated Scale of Intelligence; reading, math, and writing achievement was measured with the Wechsler Individual Achievement Test - Second Edition - Abbreviated; and oral language skills were measured with the Oral Written and Language Scales. RESULTS Children with unilateral hearing loss had worse verbal cognitive and oral language scores than children with normal hearing, but there were no differences in achievement scores. Children with profound unilateral hearing loss tended to have worse cognitive scores and had significantly lower oral language scores. Higher word recognition scores of the normal hearing ear in quiet were associated with higher cognitive, oral language, and reading achievement scores. Higher word recognition scores in noise were slightly correlated with higher oral language scores. CONCLUSION As expected, children with unilateral hearing loss had worse language scores than their siblings with normal hearing, with trends toward worse cognitive scores. Children with profound unilateral hearing loss tended to have worse outcomes than children with normal hearing or less severe unilateral loss. However, there were no differences in outcomes between children with right or left unilateral hearing loss.
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Yoshinaga-Itano C. Principles and guidelines for early intervention after confirmation that a child is deaf or hard of hearing. JOURNAL OF DEAF STUDIES AND DEAF EDUCATION 2014; 19:143-175. [PMID: 24131505 DOI: 10.1093/deafed/ent043] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This document is a supplement to the year 2007 position statement of the Joint Committee on Infant Hearing and provides comprehensive guidelines for establishing strong early intervention (EI) systems with appropriate expertise to meet the needs of children who are deaf or hard of hearing (D/HH). Optimal outcomes can only be achieved when there is high quality to the universal newborn hearing screening programs, the audiologic diagnostic process of confirmation that a child is D/HH and fitting of amplification, and the provision of appropriate, individualized, targeted, and high-quality EI services. There are 12 best practice guidelines for EI programs that include the provision of timely referral to EI services with providers who have knowledge and skills in early childhood deafness and hearing loss, infusion within the system of partnerships with parents as well as professionals who are D/HH, longitudinal developmental assessments for monitoring the child's development, data management systems that include developmental outcomes, a process to monitor the fidelity of the intervention, and appropriate services for children with additional disabilities, those from non-English speaking families, and those from special populations, including unilateral hearing loss and auditory neuropathy/dyssynchrony.
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Affiliation(s)
- Christine Yoshinaga-Itano
- Speech, Language & Hearing Sciences, University of Colorado, Campus Box 409, Boulder, CO 80309-0409.
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Muse C, Harrison J, Yoshinaga-Itano C, Grimes A, Brookhouser PE, Epstein S, Buchman C, Mehl A, Vohr B, Moeller MP, Martin P, Benedict BS, Scoggins B, Crace J, King M, Sette A, Martin B. Supplement to the JCIH 2007 position statement: principles and guidelines for early intervention after confirmation that a child is deaf or hard of hearing. Pediatrics 2013; 131:e1324-49. [PMID: 23530178 DOI: 10.1542/peds.2013-0008] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Briggs L, Davidson L, Lieu JEC. Outcomes of conventional amplification for pediatric unilateral hearing loss. Ann Otol Rhinol Laryngol 2011; 120:448-54. [PMID: 21859053 DOI: 10.1177/000348941112000705] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Although children with unilateral hearing loss (UHL) are at risk for educational difficulties and behavioral problems, the research on treatment outcomes is limited. Previous studies suggested that children with UHL would benefit from frequency-modulated assistive devices only. The objective of this study was to examine whether children with UHL would benefit from using a conventional hearing aid in the poorer-hearing ear. METHODS Eight children, 7 to 12 years of age, with mild to moderately severe UHL and their parents and teachers participated in this study. The participants were fitted with digital hearing aids by use of pediatric prescriptive targets. The primary outcome measures were speech perception tests in quiet and noise and subjective assessments from participants, parents, and teachers, administered before hearing aid fitting and after 3 months of hearing aid use. RESULTS The group average speech perception scores showed no significant aided benefit or detriment in any of the conditions tested. However, subjective assessments showed large significant aided benefits at home and school according to the children and their parents, and in quality of life as reported by the children with UHL. CONCLUSIONS Overall, the results suggest that a hearing aid trial should be considered for children with mild to moderately severe UHL, with individual monitoring for benefit.
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Affiliation(s)
- Lauren Briggs
- Program of Audiology and Communication Sciences and the Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri 63110, USA
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Expressive vocabulary of children with hearing loss in the first 2 years of life: impact of early intervention. J Perinatol 2011; 31:274-80. [PMID: 20706190 DOI: 10.1038/jp.2010.110] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The aim of this study was to determine the expressive vocabulary of children with hearing loss (HL) enrolled in early intervention (EI) ≤ 3 vs >3 months in the first 24 months and to compare with hearing controls. It was hypothesized that the number of words produced would be higher for children with HL enrolled in EI ≤ 3 vs >3 months. STUDY DESIGN This is a prospective longitudinal matched cohort study. RESULT The children with HL produced fewer words than the children with hearing. In addition, children with HL enrolled in EI ≤ 3 months had a larger expressive vocabulary percentile score compared with children with HL enrolled >3 months. Children with mild HL enrolled in EI ≤ 3 months had the greatest growth in vocabulary between 12 to 16 and 18 to 24 months. CONCLUSION Although multiple factors are associated with expressive vocabulary growth of children with HL, enrollment in EI ≤ 3 months has sustained beneficial effects on expressive vocabulary at 18 to 24 months.
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Lieu JEC, Tye-Murray N, Karzon RK, Piccirillo JF. Unilateral hearing loss is associated with worse speech-language scores in children. Pediatrics 2010; 125:e1348-55. [PMID: 20457680 PMCID: PMC3469199 DOI: 10.1542/peds.2009-2448] [Citation(s) in RCA: 214] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine whether children with unilateral hearing loss (UHL) demonstrate worse language skills than their siblings with normal hearing, and whether children with UHL are more likely to receive extra assistance at school. PATIENTS AND METHODS We conducted a case-control study of 6- to 12-year-old children with UHL compared with sibling controls (74 pairs, n = 148). Scores on the oral portion of the Oral and Written Language Scales (OWLS) were the primary outcome measure. Multivariable analysis was used to determine whether UHL independently predicted OWLS scores after we controlled for potential confounding variables. RESULTS Children with UHL had worse scores than their siblings on language comprehension (91 vs 98; P = .003), oral expression (94 vs 101; P = .007), and oral composite (90 vs 99; P < .001). UHL independently predicted these OWLS scores when multivariable regression was used with moderate effect sizes of 0.3 to 0.7. Family income and maternal education were also independent predictors of oral expression and oral composite scores. No differences were found between children with right- or left-ear UHL or with varying severity of hearing loss. Children with UHL were more likely to have an individualized education plan (odds ratio: 4.4 [95% confidence interval: 2.0-9.5]) and to have received speech-language therapy (odds ratio: 2.6 [95% confidence interval: 1.3-5.4]). CONCLUSIONS School-aged children with UHL demonstrated worse oral language scores than did their siblings with normal hearing. These findings suggest that the common practice of withholding hearing-related accommodations from children with UHL should be reconsidered and studied, and that parents and educators should be informed about the deleterious effects of UHL on oral language skills.
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Affiliation(s)
- Judith E. C. Lieu
- Department of Otolaryngology-Head and Neck Surgery Washington University School of Medicine St. Louis, Missouri, USA
| | - Nancy Tye-Murray
- Department of Otolaryngology-Head and Neck Surgery Washington University School of Medicine St. Louis, Missouri, USA
| | - Roanne K. Karzon
- Department of Otolaryngology-Head and Neck Surgery Washington University School of Medicine St. Louis, Missouri, USA
,St. Louis Children’s Hospital St. Louis, Missouri, USA
| | - Jay F. Piccirillo
- Department of Otolaryngology-Head and Neck Surgery Washington University School of Medicine St. Louis, Missouri, USA
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Abstract
Abstract
Although outcomes for children with cochlear implants have been the focus of investigation in the past 20 years, children with hearing loss in the mild-to severe range have received much less attention from researchers. This brief article discusses the current state of knowledge regarding children with all degrees of hearing loss.
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Affiliation(s)
- Melody Harrison
- Department of Master's Studies, University of North Carolina-Chapel Hill Chapel Hill, NC
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McKay S, Gravel JS, Tharpe AM. Amplification considerations for children with minimal or mild bilateral hearing loss and unilateral hearing loss. Trends Amplif 2008; 12:43-54. [PMID: 18270178 DOI: 10.1177/1084713807313570] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Children with minimal or mild bilateral hearing loss and unilateral hearing loss are at higher risk for academic, speech-language, and social-emotional difficulties than their normal hearing peers. The choice to fit infants with moderate or greater degrees of bilateral hearing loss has been standard practice for most clinicians, but for those with minimal or mild bilateral hearing loss or unilateral hearing loss, the fitting of hearing technology must be based on limited data. Evidence does not yet exist to support all the management decisions that an audiologist must make upon identifying an infant with minimal or mild bilateral hearing loss or unilateral hearing loss. It is not yet known which children are at the greatest risk for educational problems nor is it known if the provision of early amplification in this population will help a child avoid later difficulties. Some of these considerations and current hearing technology options for children with minimal or mild bilateral hearing loss or unilateral hearing loss are reviewed in this article.
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Affiliation(s)
- Sarah McKay
- Center for Childhood Communication, The Children's Hospital of Philadelphia, Pennsylvania 19104, USA.
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Abstract
Since the early 1980s, audiologists have become increasingly aware of the potential effect of even mild degrees of hearing loss on the psychoeducational and psychosocial outcomes of children. This review describes some of the key research findings during the past several decades that have led us to our current thinking about unilateral and mild bilateral hearing loss in children. The first section addresses unilateral hearing loss. This is followed by a review of the literature on mild bilateral hearing loss. Specifically, the issues addressed include the significance of permanent mild degrees of hearing loss on children's psychoeducational and psychosocial development and the speech, language, and auditory characteristics of children with mild degrees of hearing loss. Finally, some recommendations regarding the direction of future research are offered. This review is followed by 2 articles summarizing the proceedings of a 2005 workshop convened by the Centers for Disease Control and Prevention (CDC), Early Hearing Detection and Intervention (EHDI) program, and the Marion Downs Hearing Center to address concerns about the underidentification of-- and professionals' apparent lack of awareness of-- permanent unilateral and minimal to mild hearing loss in children.
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Affiliation(s)
- Anne Marie Tharpe
- Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, Tennessee 37232-8242, USA.
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Herrero-Morín JD, Concha Torre JA, Fernández González N, Crespo Hernández M. [Hypoacusis after the neonatal period. Situations requiring hearing assessment]. An Pediatr (Barc) 2005; 63:502-8. [PMID: 16324615 DOI: 10.1016/s1695-4033(05)70249-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Because hearing plays a major role in language development, pediatric hypoacusis is especially damaging. The high frequency of hearing impairment in newborns and the need for an early diagnosis have led to the establishment of neonatal screening. Nevertheless, there are other situations which may compromise hearing quality in later stages and it is essential to identify them in order to be able to provide early and effective treatment. OBJECTIVES To describe the most frequent reasons for referring patients for hearing evaluation to a third level hospital and to identify common situations that require hearing assessment among the pediatric population. PATIENTS AND METHODS The clinical histories of 197 non-neonates evaluated for hypoacusis were reviewed. Clinical parameters and diagnosis were compared in patients with impaired and normal hearing. RESULTS One hundred sixty-one patients had no previous known hypoacusis. The main reason for evaluation was suspicion by the family or child minder (53.4 %), followed by language underdevelopment. In the first examinations 78 children had hypoacusis (48.4 %), which was more frequently bilateral than unilateral. In 29.5 % of hypoacusic patients, the disease was related to recurrent otitis or adenoiditis and in 25.6 % it was genetic. The most frequent antecedent was deaf relatives in hypoacusic patients and abnormal phenotypes in children with normal hearing. Three patients with previous bacterial meningitis were studied and two of these had hypoacusis. CONCLUSIONS Hypoacusic evaluation outside the context of newborn screening is mainly motivated by clinical suspicion of hypoacusis or language underdevelopment. Other situations such as recurrent otitis with effusion, syndromic phenotypic characteristics or bacterial meningitis are related to hearing problems and therefore require detailed evaluation.
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Affiliation(s)
- J D Herrero-Morín
- Departamento de Pediatría, Centro Materno-Infantil. Hospital Universitario Central de Asturias, Oviedo, Spain.
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