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Management of Children With Bilateral Mild or Unilateral Hearing Loss

Management of Children With Bilateral Mild or Unilateral Hearing Loss. Diane L Sabo Faye P McCollister Yusnita Weirather. Management of Children With Bilateral Mild or Unilateral Hearing Loss. Research findings Language and academic issues Audiologic assessment Audiologic management

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Management of Children With Bilateral Mild or Unilateral Hearing Loss

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  1. Management of Children With Bilateral Mild or Unilateral Hearing Loss Diane L Sabo Faye P McCollister Yusnita Weirather

  2. Management of Children With Bilateral Mild or Unilateral Hearing Loss • Research findings • Language and academic issues • Audiologic assessment • Audiologic management • Issues for states

  3. Bilateral Mild or Unilateral Hearing Loss • May be present at birth • May be acquired early in life • May be intermittent • May be progressive • May be fluctuating • Behavioral tests difficult with the very young • Masking may be a problem • Monitoring with Electrophysiological tests becomes expensive

  4. Prevalence • Estimates of 5% with mostly being unilateral (3%) • 3% conductive hearing losses in children in grades 3-6; impact?

  5. Prevalence • Approximately 5% of the hearing losses in school age children • Close to 2.5 million children • Most prevalent are unilateral losses • High frequency losses next and then bilateral • Some estimate that hearing loss (all forms and degrees) is present in 11% of the school-aged population

  6. Prevalence of Unilateral Hearing Loss • >25 dB 13/1000 • >45 dB 3/1000 4 Million Annual Birthrate=51,000 per year 5-21 years (School Age)=816,000

  7. Definition • Minimal-mild hearing losses • Hearing losses from 15 to 40 dB • Unilateral or bilateral • Sensorineural or conductive

  8. Normal Mild Moderate Severe Profound

  9. X O O X X O X X O O

  10. Classification of Hearing Loss Stable Less than 10 dB decrease Progressive 10 dB or more decrease Fluctuating 20 dB or more improvement or decrease Delayed Onset Normal hearing documented, with later onset of loss

  11. Etiology of Unilateral HL • Unknown • Heredity • Meningitis • Mumps • Asphyxia • Head trauma • Measles • Congenital CMV • Fistula

  12. Continued Surveillance • Unilateral- at risk for progressive and bilateral HL (Brookhouser, Worthington, Kelly, l994) • Mild • Persistent OM

  13. Vigilant Surveillance Required • Estimated that about 16-18 % of hearing loss is delayed in onset • Educate parents • Educate primary care providers • Provide information on normal auditory development • Provide information of signs and symptoms of hearing loss

  14. Unilateral Atresia

  15. Why Do We Care? • Binaural hearing • discrimination • binaural summation • head shadow • squelch effects • localization • binaural release form masking

  16. Audiological Problems Reported for Children with Unilateral Hearing Loss • Sound localization • Speech discrimination in noise • Speech discrimination in quiet

  17. Why Do We Care? • Less known are effects of minimal losses • difficulty understanding speech under adverse listening conditions • formal testing not available until 3 years

  18. Hard of Hearing ChildrenSpeech and Language Issues • Vocabulary size • Syntax and pragmatics • Speech production

  19. Issues of Diagnosis • For minimal hearing loss, issue is the accuracy of the physiologic tests and ability to estimate accurately hearing levels

  20. Academic and Speech/Language • Greater difficulty in educational system

  21. Educational Performance of Students with Unilateral HL • 24-35% failed at least one grade • 15% needed resource services Bess & Tharpe, 1986 Oyler, Oyler & Matkin 1987

  22. Educational Problems Reported • Management strategies usually not appropriate • Assumed to be normal

  23. Teacher Reported Problems of Students with Unilateral HL • Student is: • More dependent • More easily frustrated • More emotionally labile • More often aggressive • Gives up easily • More behavior problems

  24. Other Reported Problems • Withdrawal • Embarrassment • Regression • Inferiority • Fear • Reactions • Annoyance

  25. Other Problems Reported • Somatic Complaints • Confusion • Paranoia • Helplessness • Depression

  26. Additional Concerns • Safety with mobility, can not localize sound • Stability of loss • Additional disabilities • Etiology • Amplification for child, sound field FM • Developmental progress

  27. Intervention • When? • At identification • When confirmed with behavioral findings if physiologic data only available • At time of mobility • At school age • Delays apparent

  28. Intervention For Unilateral Hearing Loss • Early Identification • Hospital based newborn hearing screening • Routine periodic school screening • Frequent Audiological Monitoring • Children with identified loss • Children with risk indicators for progressive hearing loss

  29. Management • Hearing aids • issues with unilateral losses • Other assistive listening technology • Classroom management • Other supplemental support services (EI or in school)

  30. Impact of Early Identification • Early research (1960s-1980s) indicated early detection and intervention of educationally significant hearing loss are crucial • recent research (1990s) showed children with hearing loss are likely to achieve normal speech and language skills by age 5 when detection and habilitation are initiated before 6 months of age

  31. Intervention From Audiology • Cross hearing aid • FM auditory trainer • Hearing aid for impaired ear • Counsel regarding acoustic management of learning environment • Monitor hearing loss for stability

  32. Intervention For Unilateral Hearing Loss • Interdisciplinary assessment to identify any additional conditions • Early intervention program • Training to empower child/parent to optimize learning opportunities • Parent training regarding federal legislation/state/local regulations developed to address needs of children with disabilities

  33. Learning Environment Assessment • Signal/Noise Ratio • Lighting • Traffic Patterns • External Distracters

  34. Needs • Parents perspective • Impact of degree of hearing loss on developing child

  35. Study of 112 Children in Alabama with Unilateral Hearing • Gender • Female 40 • Male 72 • Caucasian 75 • Black 25 • Other 3

  36. Type Loss for 112 Children with Unilateral Hearing Loss • Permanent or chronic conductive 18 (18.6%) • Sensorineural 66 (68.0%) • Mixed 11 (11.3%) • Not Available 2 (2.1%)

  37. Discovery of Unilateral Hearing Loss • Hearing screening in school 43 (45.2%) • Child complaints 14 (14.7%) • Parental observation 15 (15.8%) • Newborn screening 5 (5.3%)

  38. Age Parent Recognized Hearing Loss • 0-36 months 26 (29.3%) • 37-108 months 59 (66.3%) • Not known 4 (4.5%)

  39. Degree of Loss for 112 Children with Unilateral Hearing Loss • Mild (21-45 dB) 32 (33.0%) • Moderate (46-70 dB) 31 (31.9%) • Severe (71-90 dB) 14 (13.8%) • Profound (>90 dB) 15 (16.0%) • No measurable hearing 5 (5.3%)

  40. Stability of Loss for 112 Children with Unilateral Hearing Loss • Stable 53 (55.8%) • Better 5 (5.3%) • Variable 18 (18.9%) X X X X X O O O

  41. In Which Ear Is Hearing Loss for 112 Children with Unilateral Hearing Loss • Right 52 (55.6%) • Left 45 (46.4%)

  42. Perception of Hearing Difficulty By Student (Sometimes, Often, Always) • Face to face 25 (28.1%) • Further than 3 feet 46 (51.7%) • In a group 55 (62.5%) • On side of loss 72 (80.9%) • In noise 59 (66.3%) • Video, TV, movies 38 (42.7%)

  43. Risk Factors Reported By Parent for Child’s Unilateral Hearing Loss • Low birth weight (<3000 grams) 15 (15.8%) • Placed in an incubator 12 (12.6%) • Breathing problems 8 (8.4%) • Low APGAR scores 2 (2.1%) • Elevated bilirubin 21 (22.1%) • Oxygen required 8 (8.4%) • Other 14 (4.7%)

  44. Additional Conditions Reported By Parent • Attention Deficit /Hyperactivity 19 (20.0%) • Behavior Disorder 12 (12.6%) • Cerebral Palsy 2 (2.1%) • Cleft Palate 1 (1.1%) • Learning Disability 4 (4.2%) • Mental Retardation 3 (3.2%) • Seizures 3 (3.2%) • Speech Language Problems 17 (17.9%)

  45. Additional Conditions Reported By Parent (2) • Vision 23 (24.2%) • Other 8 (8.4%) • Unknown problem 14 (14.7%)

  46. Grades Retained • Kindergarten 4 (4.2%) • Grades 1-3 21 (22.1%) • Grades 4-6 5 (5.3%) • Grades 7-9 4 (4.2%) • Grades 10-12 1 (1.1%) • Total 35 (36.8%)

  47. Resource Services Received • LD 19 (27.9%) • EC 3 (4.4%) • Gifted 4 (5.9%) • HI 19 (27.9%) • AD/HD 3 (4.4%) • Other 13 (19.1%)

  48. Resource Services Currently Received • Speech/Language 18 (19.6%) • Preferential seating 66 (71.1%) • Tutoring/Resource help 29 (32.2%) • Management of HI needs 33 (36.3%)

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