It’s a grey area: The factors influencing audiologists’ management of children with mild bilateral hearing loss

Dr Teresa Ching1, Ms Michelle  Saetre-Turner1, Ms Patricia Van Buynder1, Dr Nerina  Scarinci2, Ms Vivienne Marnane1, Dr Valerie  Sung3

1National Acoustic Laboratories, Sydney, Australia,

2School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia,

3Murdoch Children’s Research Institute, Melbourne, Australia


Background: Universal newborn hearing screening programs have resulted in early detection of hearing loss, including those with mild bilateral hearing loss (MBHL). There is a lack of evidence on the effectiveness of early amplification for improving outcomes of children with MBHL (McKay, Gravel, & Tharpe, 2008). Despite this, audiologists need to make decisions surrounding appropriate management, including the fitting of hearing devices (Fitzpatrick et al., 2015).

Aim: To describe the factors influencing audiologists’ management of children diagnosed with MBHL through universal newborn hearing screening.

Method: We conducted semi-structured interviews with 23 diagnostic and rehabilitative audiologists who have experiences in managing MBHL in young children. The recorded interviews were transcribed verbatim by a professional transcription service. Descriptive thematic analysis was performed (Braun and Clarke, 2006). Initial codes were refined and collated into potential categories and themes through an iterative process. After achieving saturation, final themes with clear definitions were established.

Results: Five themes emerged regarding factors influencing audiologists’ management: (1) need to be fluid; (2) evidence or the lack of it; (3) perspectives of parents; (4) child and family factors; and (5) other professional opinions. Some factors influencing management were uniquely associated with the nature of MBHL, and treatment options change as more information becomes available with increasing age. The lack of evidence on effectiveness of hearing aid fitting for MBHL in young children has resulted in clinical practice being influenced mostly by the attitudes and beliefs of a child’s family and the opinions expressed by other professionals that influenced families, instead of being based on evidence.

Conclusion: The results reinforced the need for research into the impact of MBHL on young children and the relative effectiveness of early fitting of hearing aids to better inform clinical practice and empower audiologists to make evidence-based, family-centred management decisions.


Trish is a senior research audiologist with the National Acoustic Laboratories. She started with NAL in 2004 working on the Long Term Outcomes of Children with Hearing Impairment (LOCHI) study. She currently works on a number of additional projects including the CUHL (Children with Unilateral Hearing Loss) and Mild Matters studies.

Trish’s main research interests include amplification and outcomes in children with hearing loss and the impact of mild and unilateral hearing loss in children.