Academic, behavioural and quality of life outcomes of children with slight to mild hearing loss: A population-based study

Ms Jing Wang1,2, Dr Jon Quach1,2, Dr Valerie Sung1,2,3, Dr Peter Carew1,4, A/Prof Ben Edwards5, A/Prof Lisa Gold6, Prof Melissa Wake7

1Murdoch Children’s Research Institute, Melbourne, Australia,

2University of Melbourne Department of Paediatrics, Melbourne, Australia,

3Royal Children’s Hospital, Melbourne, Australia,

4University of Melbourne Department of Audiology and Speech Pathology, Melbourne, Australia,

5Australian National University, , Australia,

6School of Health and Social Development, Deakin University, Geelong, Australia,

7Department of Paediatrics & The Liggins Institute, The University of Auckland, Grafton, Auckland, New Zealand


Purpose of presentation

To describe the associations between slight-mild hearing loss and academic, behavioural and quality of life outcomes in 11-12 year-old Australian children at a population level.

Nature and scope of topic

The presentation outlines the prevalence of slight-mild hearing loss in Australian school-aged children, using data from the Longitudinal Study of Australian Children’s ‘Checkpoint’ study. Identification of slight-mild hearing loss in school-aged children may be important. This may have implications on policy regarding screening for hearing loss in school-aged children.

Issue or problem under consideration

Understanding the population-level impact of slight-mild hearing loss in children is a requisite for evidence-based hearing policy. While universal newborn hearing screening (UNHS) programs are now widely implemented with the goal of early treatment of moderate to profound hearing loss (>40 dB HL), which has major negative impacts on child outcomes (e.g. speech and language, academic performance, social interaction and isolation, behaviour and health-related quality of life (HRQL)) very few studies have focused on the population-level outcomes associated with slight-mild hearing loss.

Outcome or conclusion reached

Continuous hearing thresholds and slight-mild hearing loss (16 to 40 decibels hearing loss (dB HL)) showed small associations with outcomes. Of 1483 children (mean age 11.5 years), 9.2% and 13.1% had slight-mild bilateral and unilateral hearing loss, respectively. One standard deviation (SD) increment in the worse-ear threshold (6.8 dB HL) was associated with poorer academic outcomes, parent-reported behaviour, and HRQL (effect sizes 0.07 to 0.15 SDs). Similar associations were evident for better-ear threshold with language, parent-reported internalizing behavior and HRQL scores (effect sizes 0.07 to 0.15 SDs). Compared to normally hearing children, children with bilateral slight-mild losses displayed 0.2-0.3 SD lower scores in sentence repetition, teacher-reported learning and physical HRQL, but not in other outcomes. Similar but attenuated patterns were seen in unilateral slight-mild losses.


Jing is a PhD candidate at the Murdoch Children’s Research Institute. Her thesis

‘Prevalence, risk factors and outcomes of hearing loss in Australian children and adults: the Growing Up in Australia’s Child Health CheckPoint Study’ reframes hearing loss as a lifecourse problem with childhood origins. Jing collected hearing data from ~1500 child-parent dyads at child age 11-12 years. Her PhD describes the current prevalence of hearing loss in children and mid-life adults, the associations of obesity, inflammation and telomere length with hearing loss, and the academic, behavioural and quality of life outcomes of slight-mild hearing loss in Australian children.

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.

Parent perceptions and experiences of managing young children with mild hearing loss: A qualitative study

Dr Jing Jing Lin1, Dr Valerie Sung1,2,4,6, Prof Lynn Gillam2,3,6, Ms Libby Smith1, Dr Peter Carew6, Dr Alison King5, Dr Teresa Ching7

1Centre for Community Child Health, Melbourne, Australia,

2The Royal Children’s Hospital, Melbourne, Australia,

3Children’s Bioethics Centre, Melbourne, Australia,

4Murdoch Children’s Research Institute, Melbourne, Australia,

5Australian Hearing, Melbourne, Australia,

6The University of Melbourne, Melbourne, Australia,

7National Acoustic Laboratory, Sydney, Australia


Purpose of presentation

To outline findings of a qualitative study exploring parental experiences related to the management of mild bilateral hearing loss in children.

Nature and scope of topics

The Mild Matters study aimed to explore and describe parental experiences related to the management of mild bilateral hearing loss in children <3 years old.

Specifically, the study explored the initial counselling and management options offered to families as well as the potential benefits and harms of offering hearing device fitting early.

Issue or problem under consideration

Children who are diagnosed early with mild congenital hearing loss are presenting as a new group emerging as a result of Universal Newborn Hearing Screening. In the limited research available, the benefit of hearing device fitting for these children is conflicting. This has resulted in uncertainty about the appropriate clinical intervention for infants and young children with mild hearing loss. We do not know what the current practices are in providing counselling to families to young children with mild hearing loss, and whether there are any benefits or harms with fitting hearing devices early for these children.

Outcome or conclusion reached

There was wide variation in the management of mild bilateral hearing loss in children <3 years old. Uncertainty from clinicians often led parents to carry the burden of clinical decision making.

Overall, concerns regarding potential harms of not fitting hearing devices often led to hearing devices being adopted for use. Whilst some parents reported positive impacts of hearing devices, others were ambivalent about their impact. There were also significant difficulties with hearing device use and most families were not using hearing devices regularly at time of interview. The study also identified that families were not adequately prepared for these difficulties.


Dr Jing Jing Lin is a doctor completing dual specialty training in General Paediatrics and Community Child Health. She will be completing her General Paediatrics training in 2018. Currently her work in Community Child Health focuses on developmental and behavioural problems. She works from community centres such as schools, kindergartens and maternal child health.

Audiologists perceptions and experiences of managing young children with mild hearing loss and their families: A qualitative study

A/Prof. Nerina Scarinci1, Ms Chermaine Choik1, Ms Patricia Van Buynder2, Dr Kristen Tulloch1, Dr Valerie Sung3, Dr Teresa Ching2

 1School of Health and Rehabilitation Sciences, The University Of Queensland, St Lucia, Australia,

 2National Acoustic Laboratories, Sydney, Australia,

3Murdoch Children’s Research Institute, Melbourne, Australia


Background: Though research in permanent childhood hearing loss has typically centred around more severe hearing losses, children experience a range of degrees of hearing loss, including mild hearing loss. Although variable, children with mild hearing loss may experience more difficulties than typically-developing children in domains such as energy levels, stress, and self-esteem (Bess et al., 1998), all of which may hinder a child’s engagement with the academic environment, impact interpersonal relationships, and result in emotional and behavioural difficulties (Daud et al., 2010; Winiger et al., 2016). Despite these potential negative impacts of mild hearing loss, there is currently limited research describing how children with mild hearing loss are best managed in early intervention.

Aim: The purpose of this presentation is to describe the results of a qualitative study exploring audiologists’ experiences managing clinical decision making for children with mild hearing loss.

Method: In this qualitative descriptive study (Sandelowski, 2000), individual in-depth qualitative interviews were conducted with 23 rehabilitation and diagnostic audiologists.

Results: Through the experiences and amassed clinical expertise of these audiologists, thematic analysis (Braun & Clarke, 2006) revealed three distinct but highly interconnected themes emerging from participants’ accounts of managing mild hearing loss including: (i) assessment and management are tricky, (ii) managing families’ reactions, and (iii) clinicians feel torn between courses of action. These themes reflect the varied impacts of mild hearing loss and lack of evidence regarding best practice for this population, and emphasis the audiologists’ perceptions of the stresses and anxieties expressed by families in response to a diagnosis of mild hearing loss.

Conclusion: The results of this study highlighted audiologists’ uncertainty in managing children with mild hearing loss and provide important insights into management considerations. The importance of considering family outcomes and the need for more definitive recommendations for this population are emphasised.


Nerina is an Associate Professor and Head of Speech Pathology in the School of Health and Rehabilitation Sciences at The University of Queensland. She is a speech pathologist and has a PhD.


The Australasian Newborn Hearing Screening Committee aims to foster the establishment, maintenance and evaluation of high quality screening programs for the early detection of permanent childhood hearing impairment throughout Australia and New Zealand.

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