Unilateral Hearing Loss in Children: Past, Present, and Future

Dr Anne-Marie Tharpe

For decades, audiologists, speech-language pathologists, teachers, early interventionists, and parents have puzzled over the impact of unilateral hearing loss on children.  After all, one might assume that one normal hearing ear ought to be sufficient for hearing speech and sounds in the environment.  Nonetheless, a growing body of evidence confirms that, on average, children with unilateral hearing loss have more academic, speech and language, and social-behavioural difficulties than their normal hearing peers.

This presentation will review what we know and what we do not yet know about children with unilateral hearing loss.  Specifically, several theories for why these children experience difficulties will be explored and current best practices for management will be addressed. Management is considered in terms of interdisciplinary partnerships that include the child’s parents or caregivers. Tools intended to enhance such partnerships will be described and research designed to inform our future management directions with these children will be discussed.


Biography

Dr. Anne Marie Tharpe is Professor and Chair, Department of Hearing and Speech Sciences, Vanderbilt University School of Medicine in Nashville Tennessee. The primary research emphasis in her laboratory has been in furthering our understanding of the developmental impact of hearing loss on young children. This work has been done by examining questions of behavioral indices of attention, environmental exploration, and academic outcomes. More recently, work has focused on the impact of hearing technology interventions and the sleep patterns in those with hearing loss. Dr. Tharpe has published extensively in national and international professional journals, has published numerous books and book chapters, and has presented to over 250 audiences around the world on pediatric audiology issues. She is co-editor with Dr. Richard Seewald of The Comprehensive Handbook of Pediatric Audiology, 2nd edition, which was published in 2016.

What Lies Ahead for Children with Hearing Loss?

Dr Anne-Marie Tharpe

Despite the best efforts of all stakeholders, many children with hearing loss maintain deficits in the areas of speech perception and psychoeducational development relative to their normal hearing peers. A possible contributor to those deficits could be the recent findings that “full-time” hearing technology use for children in the United States is approximately 8 to 10 hours per day.  This time period offers considerably less access to sound than that received by children with normal hearing who can hear 24 hours a day, even during sleep. It is possible that depriving children with hearing loss of sound for most of their day could contribute to their apparent deficits in areas of speech perception and psychoeducational abilities. Furthermore, the clarity of speech received by children with hearing loss is dis-proportionally degraded as compared to speech heard by children with normal hearing.

This presentation will provide emerging evidence of the importance of children having access to sound throughout the night while they are sleeping. Furthermore, expanding the use of remote microphone use from school to home settings will be discussed. Although these data are preliminary, they should provide some thought for future technology changes and uses.


Biography

Dr. Anne Marie Tharpe is Professor and Chair, Department of Hearing and Speech Sciences, Vanderbilt University School of Medicine in Nashville Tennessee. The primary research emphasis in her laboratory has been in furthering our understanding of the developmental impact of hearing loss on young children. This work has been done by examining questions of behavioral indices of attention, environmental exploration, and academic outcomes. More recently, work has focused on the impact of hearing technology interventions and the sleep patterns in those with hearing loss. Dr. Tharpe has published extensively in national and international professional journals, has published numerous books and book chapters, and has presented to over 250 audiences around the world on pediatric audiology issues. She is co-editor with Dr. Richard Seewald of The Comprehensive Handbook of Pediatric Audiology, 2nd edition, which was published in 2016.

Emerging evidence from the Children with Unilateral Hearing Loss (CUHL) study

Authors

Dr Teresa YC Ching1, Ms Laura Button, Ms Patricia Van Buynder, Ms Sanna Hou, Ms Vivienne Marnane, Ms Louise Martin, Ms Jessica Sjahalam-King, Mr Christopher Flynn, Dr Vicky Zhang;  (National Acoustic Laboratories, Sydney, Australia)

Background:
Universal newborn hearing screening programs effectively detect infants with hearing loss soon after birth, including those with unilateral hearing loss. Although there is some information on the impact of unilateral hearing loss on children, it is not known whether early fitting of hearing devices is beneficial for improving outcomes. Despite this, audiologists and families need to make decisions surrounding appropriate management, including the fitting of hearing devices.

Aim:
To determine whether early intervention improves outcomes of children detected with unilateral hearing loss soon after birth, and the factors influencing outcomes. We also aim to examine perspectives of parents and audiologists on early detection and intervention for unilateral hearing loss.

Method:
A prospective, population-based study, including 180 children detected with unilateral hearing loss via universal newborn hearing screening in New South Wales, Victoria and Queensland. About half of the children were fitted with hearing devices soon after diagnosis. Their hearing status, demographic information, functional performance, and usage of hearing device (for the fitted children) are examined at several intervals between 6 and 36 months of age. Information about language input is collected by using the LENA device at 12 and 36 months of age. Children’s speech and language abilities are assessed at 1 and 3 years of age using standardised measures. In addition, we conducted semi-structured interviews with 20 parents and 20 audiologists. The transcripts of the interviews are analysed using thematic analyses.

Results:
Interim findings on evolution of hearing loss, aetiology, language input environment and vocalisations will be reported. Hearing device usage for children who were fitted with hearing devices will be described.  In addition, preliminary findings on perspectives of audiologists and parents regarding early detection and intervention for unilateral hearing loss will be discussed.

Conclusion:
This study will generate evidence on the effectiveness of early fitting of hearing devices for improving early language outcomes that will form the basis of best practice management guidelines on management of unilateral hearing loss in young children.

Effect of age at intervention on language outcomes at age 5 years for children with mild hearing loss in the LOCHI study

Dr Teresa YC Ching1, Dr Harvey Dillon, Mr Mark Seeto, Ms Patricia Van Buynder, Ms Laura Button, Ms Vivienne Marnane (National Acoustic Laboratories, Sydney, Australia)

Background: Universal newborn hearing screening has been implemented to detect permanent childhood hearing loss early, with the ultimate goal of improving outcomes through early treatment. Despite previous literature showing an association between early treatment and superior language outcomes, there is disagreement between studies on the size of this benefit, and in some cases whether it is significantly different from zero. No study of sufficient size had determined reliably whether the effect varies with degree of hearing loss.

Aim: In a population-based prospective study, the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study, we aimed to explore how intervention timing influences 5-year language in children with hearing loss. This paper describes the effect of age at intervention on outcomes of children with mild hearing loss.

Method: We collected demographic information and measured language outcomes of the LOCHI cohort at several intervals after detection. The outcomes measured at 5 years were analysed using multiple regression analyses. The effect of age at intervention was quantified, after allowing for the effects of nonverbal IQ, severity of hearing loss, sex, birthweight, maternal education, socio-economic status, and communication mode.

Results: The benefit of early intervention for language development increased as hearing loss increased. Factors influencing outcomes will be discussed.

Conclusion: The evidence arising from the LOCHI study can be used to guide management of children with different degrees of hearing loss.


Biography

Dr Teresa Y.C. Ching, PhD is Head of Communication Sciences Department and Pediatric Hearing Impairment research at the National Acoustic Laboratories in Australia. Her current research focuses on investigating the efficacy of early hearing aid fitting or cochlear implantation for populations of children with hearing loss and determining factors influencing outcomes; evaluation of sound detection and discrimination in infants with hearing loss or auditory neuropathy spectrum disorder using cortical measurements and parental reports; and prescription of hearing aids and electric-acoustic stimulation (bimodal fitting) for children and adults. Teresa is leading longitudinal, population-based studies that examine the outcomes of children with bilateral or unilateral hearing loss. She has published more than 120 peer-reviewed manuscripts. She is regularly invited to deliver keynote presentations at international conferences. She serves on the editorial boards of international journals.

Her research interest and experience encompass many aspects of hearing rehabilitation for children and adults with hearing loss: bimodal hearing, electric-acoustic stimulation, cochlear implantation candidacy and outcomes, amplification requirements, speech intelligibility, psychoacoustic abilities, and evaluation methods for children. Her current research focuses on evaluating the efficacy of early intervention for improving outcomes of children with bilateral or unilateral hearing loss.

Why do so many children get their first hearing aids during the early school years?

Harvey Dillon, David Nilsson

 

Despite the effectiveness of new-born screening in Australia, considerably more children receive their first hearing aid(s) during the first four years of school than receive them during the first year of life. While most of these late-fitted children have mild hearing loss in at least one ear, a substantial proportion have more loss than this.  This presentation will use a recent questionnaire sent to these families, and information in the Australian Hearing database, to examine why these children received their hearing aids when they did and what effect the hearing aids have had on them.

 


Biography

 

Harvey Dillon joined the National Acoustic Laboratories (NAL) in 1979 and until 1986 he performed research into speech discrimination testing, audiological testing in sound fields, speech processing for hearing aids, hearing aid fitting methods, and the acoustics of hearing aid coupling systems. From 1986 to 1990 he held various positions (including Chief Engineer and Development Manager) in the operational area of NAL (now called Australian Hearing). From 1990 he headed the Hearing Aid Research Section of NAL and in 2000 became the Director of NAL.

After completing an undergraduate degree in Electrical Engineering, Dr Dillon was awarded a PhD for research into psychoacoustics. His current personal research interests are centred on the assessment and remediation of auditory processing disorders and electrophysiological assessment methods, hearing assessment and methods for evaluating the success of hearing rehabilitation.

Dr Dillon has lectured extensively in the areas of acoustics, psychoacoustics, and hearing aids in the audiology program at Macquarie University, at which institution he is an adjunct professor. He is the author or co-author of over 200 scientific articles, twelve book chapters, and the author of a comprehensive text book on hearing aids, now in its second edition, that is used throughout the world. He has been closely associated with the various NAL prescription rules for hearing aids, COSI outcomes evaluation, the trainable hearing aid, the LiSN-S test of spatial processing disorder, and clinical cortical response testing of infants.
He frequently presents invited and keynote addresses in the area of hearing at international conferences.

Moving forward – what have we learnt and what next…..

This final presentation will take on the challenge of summarising the intensive two days and the thinking, listening and talking which has taken place. What are the real issues left about newborn hearing screening – are there any? Have we achieved the goals the fighters for newborn screening dreamt of? Is all now well?

Set in health, education and social care, newborn hearing screening faces further challenges in increasingly difficult economic times. What can we do to ensure that the best practice is achievable and that others, including public policy makers, understand its value?

 


Biography

Dr Sue Archbold was the teacher of the deaf of the first child in the UK to have a cochlear implant. She then helped establish The Ear Foundation to fund the first paediatric cochlear implants in the UK, and went on to co-ordinate the Nottingham Paediatric Cochlear Implant Programme from its inception in 1989 until 2004. The programme rapidly became one of the biggest in the world, and there she developed methods of assessing and monitoring young children for implantation and a database to manage a cochlear implant programme. She helped establish quality standards for ci programmes and to influence the National Institute of Clinical Excellence (NICE). She has published widely on the education of deaf children and on outcomes from implantation, and received her doctorate from the University of Nijmegen, cum laude, on the subject of Deaf Education: changed by cochlear implantation?

She was Chief Executive of The Ear Foundation from 2008 to 2016, leading its programme of support, information, education and research to ensure the maximum benefit from the latest hearing technologies at home, school and work, and now retains an advisory role there.

Sue is committed to working to raise awareness of the impact of hearing loss in both children and in adults and for access to today’s hearing technologies and support services for all who need them.

Sue has published widely on issues associated with language acquisition, and education for deaf and hard of hearing children. Her work has considered parental perspectives, child perspectives and the long-term developmental and educational outcomes of cochlear implantation. She has a particular interest in counselling related to audiological issues and has most recently been involved in advocacy around hearing screening.  Together with Brian Lamb she was the author of the recent (2016) UK report on hearing screening titled ‘Adult Screening: Can we afford to wait any longer’.

Early Intervention or Early Interference?

This conference and its wealth of presentations demonstrates the huge development in the practice of newborn hearing screening and what we have learnt over the years. However, some things remain the same.  Newborn hearing screening means that the diagnosis of deafness often now takes place in the first few weeks of a child’s life and with over 95% of deaf children born to hearing parents, is usually unexpected. Suddenly parents are plunged into a world previously unknown to them, with many professionals taking a role in their lives at a time when they may be confused and vulnerable.  We know that these early days are crucial to the development of early communication skills, the pre-cursors of language, and the parents’ role is crucial. Parents need to be relaxed communicators with their infants to ensure this development, but for hearing parents of deaf children this can be challenging. Parents have a great deal to manage, including the intrusion of professionals and sophisticated technology into their lives, while providing a rich language environment. This presentation will consider these issues, and what we can learn from parents about how professionals can best support families at this time.

 


Biography

Dr Sue Archbold was the teacher of the deaf of the first child in the UK to have a cochlear implant. She then helped establish The Ear Foundation to fund the first paediatric cochlear implants in the UK, and went on to co-ordinate the Nottingham Paediatric Cochlear Implant Programme from its inception in 1989 until 2004. The programme rapidly became one of the biggest in the world, and there she developed methods of assessing and monitoring young children for implantation and a database to manage a cochlear implant programme. She helped establish quality standards for ci programmes and to influence the National Institute of Clinical Excellence (NICE). She has published widely on the education of deaf children and on outcomes from implantation, and received her doctorate from the University of Nijmegen, cum laude, on the subject of Deaf Education: changed by cochlear implantation?

She was Chief Executive of The Ear Foundation from 2008 to 2016, leading its programme of support, information, education and research to ensure the maximum benefit from the latest hearing technologies at home, school and work, and now retains an advisory role there.

Sue is committed to working to raise awareness of the impact of hearing loss in both children and in adults and for access to today’s hearing technologies and support services for all who need them.

Sue has published widely on issues associated with language acquisition, and education for deaf and hard of hearing children. Her work has considered parental perspectives, child perspectives and the long-term developmental and educational outcomes of cochlear implantation. She has a particular interest in counselling related to audiological issues and has most recently been involved in advocacy around hearing screening.  Together with Brian Lamb she was the author of the recent (2016) UK report on hearing screening titled ‘Adult Screening: Can we afford to wait any longer’.

Evaluation of a new directionality system in bone anchored sound processor

Laura Dixon

Oticon Medical, Auckland, New Zealand 

The significance of early intervention on language development in children with hearing loss is undeniable. We are now at a point within the industry where simply providing amplification is insufficient for optimum learning and therefore we aim to gain a greater insight into the fundamental aspects which may enhance or hinder language acquisition.

We will investigate the errors made by those with hearing loss which impact on schooling and language abilities in later life. Research has shown the first and best thing that can be done for those with hearing loss is to provide a well amplified speech signal where loud sounds are perceived as loud, but not overly loud, and quiet sounds as quiet. Greater output has been shown to reduce listening effort, freeing up the brain’s resources for other tasks. Increasing the bandwidth provided to a child can have significant benefits in provision of spectral cues and on the speed at which they learn. We will investigate this further by analysing research which compares children with or without hearing loss who are presented with novel words through a full versus a limited bandwidth. Knowing how important it is to provide the clearest speech signal we will look at the solutions available to children with conductive and mixed hearing losses. A comparison of performance with bone anchored hearing solutions used on a soft band over traditional bone conduction aids will be reviewed.

The new Ponto3 Super Power device offers the most powerful abutment-level sound processor on the global market along with the industry’s widest frequency range. With the above in mind, we predict this device can only facilitate language learning for children with a hearing loss. These benefits additionally come with a new soft band for increased comfort and aesthetics to encourage each child in their individual rehabilitation journey.


Biography

Laura trainied as an Audiologist in the UK completing both the Masters and Doctoral programmes. She went on to work in the busy NHS environment and very quickly developed a passion for implantable hearing solutions. Those ‘wow’moments when a patient receives a device that changes their life proved too strong and for the last 13 years Laura has worked only with Cochlear Implants and Bone Anchored Hearing Solutions. In 2010 Laura began working commercially and has been heavily involved in clinical support, audiological and surgical training as well as sales management.

Influences on the development of early intervention practices for children who are deaf or hard of hearing: A systematised literature review

Dr Nic Mahler1, Melissa McCarthy2

1Griffith University, Southport, Queensland, Australia

2RIDBC Renwick Centre, North Rocks, NSW, Australia

The last 15 years have seen a steep trajectory of change in knowledge, skills and resources across the hearing loss sector, leading to rapid developments in choices and expectations of long-term outcomes for children who are deaf or hard of hearing. Advances in technology, services, policy and research have resulted in a highly modernised playing field, where organisations, practitioners and families need to be proactive to keep abreast of developments. The current project aimed to investigate how organisations, practitioners and families are managing the rapid advancements in the sector. How have professional practices developed in this dynamic environment and what has influenced these developments? What are some of the barriers encountered in enabling current practice and what is critical in supporting organisations and practitioners to optimise their early intervention services? How have family-centred principles been translated into practice, and are developments in line with families’ needs? A systematised literature review was used to investigate current issues around professional practice. The identified literature was synthesised and gaps in evidence identified. The results motivated a method for informing answers to critical questions in professional practice today by means of a national survey. Based on the documented importance of informing practices through consultation with providers and recipients of services (Jeglinksy et al, 2012), two parallel surveys—a parent version and a practitioner version—are proposed.

 


Biography

Nic Mahler (PhD) holds an appointment as Lecturer in the Master of Speech Pathology Program at Griffith University. She has extensive experience working with children with communication difficulties in a range of research and clinical positions, with the last 10 years predominantly spent working with children who are deaf or hard of hearing (D/HH) and their families. Her current research interests include optimising early intervention outcomes of children who are D/HH, family-centred practice, and early intervention service development for children who are D/HH.

Bilingual Programs for Young Deaf Children and their Families

Vicki Main1, Linda Mottershead1, Naomi Lee1

1Aurora School, Blackburn South, Victoria, Australia
The inclusion of deaf and hearing children at a very young age in a structured play environment promotes the social, emotional and language development of young deaf children. We propose that there are extra benefits when the learning environment is both bilingual and bicultural.

This poster describes our early intervention group programs for young deaf children and their families at Aurora School. The development of our model has evolved over 10 years. Our bilingual bicultural philosophy is reflected in our current practice where children are exposed to sign language and spoken language regardless of their hearing loss. By exposing a deaf child to both languages early in their development we believe we are providing the safety net for the acquisition of at least one strong language for future learning. Our programs provide further opportunities for this to occur. Children are engaged in developmentally appropriate play experiences and interact with a range of positive language models.
Parents have opportunities to talk with other parents of deaf children as well as learning from the staff ways of promoting their child’s development through play and natural interactions. The parents learn much from contact with deaf parents and deaf staff.
Current research states that bilingual education and exposure strengthens executive function of the brain.

 


Biography

Vicki Main, Linda Mottershead and Naomi Lee are currently employed at Aurora School and lead the Early Intervention Team. Together they hold extensive qualifications and experience spanning more than 40 years in Deaf Education, Early Childhood Education and Special Education.
Aurora School is an innovative educational organisation that provides optimal bilingual learning environments for deaf and deafblind children and their families across the state of Victoria.
Communication, language and literacy form the foundation of programs that support each child’s whole development.

About ANHSC

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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