Presentation is loading. Please wait.

Presentation is loading. Please wait.

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

Similar presentations

Presentation on theme: "Management of Children With Bilateral Mild or Unilateral Hearing Loss Diane L Sabo Faye P McCollister Yusnita Weirather."— Presentation transcript:

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

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

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 dB13/1000 >45 dB 3/ 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




12 Classification of Hearing Loss StableLess than 10 dB decrease Progressive10 dB or more decrease Fluctuating20 dB or more improvement or decrease Delayed Onset Normal hearing documented, with later onset of loss

13 Etiology of Unilateral HL Unknown Heredity Meningitis Mumps Asphyxia Head trauma Measles Congenital CMV Fistula

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

15 Vigilant Surveillance Required Estimated that about % 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

16 Unilateral Atresia

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

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

19 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

20 Hard of Hearing Children Speech and Language Issues Vocabulary size Syntax and pragmatics Speech production

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

22 Academic and Speech/Language Greater difficulty in educational system

23 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

24 Educational Problems Reported Management strategies usually not appropriate Assumed to be normal

25 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

26 Other Reported Problems Withdrawal Embarrassment Regression Inferiority Fear Reactions Annoyance

27 Other Problems Reported Somatic Complaints Confusion Paranoia Helplessness Depression

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

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

30 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

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

32 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

33 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

34 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

35 Learning Environment Assessment Signal/Noise Ratio Lighting Traffic Patterns External Distracters

36 Needs Parents perspective Impact of degree of hearing loss on developing child

37 Study of 112 Children in Alabama with Unilateral Hearing Gender Female40 Male 72 Caucasian75 Black25 Other 3

38 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%)

39 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%)

40 Age Parent Recognized Hearing Loss 0-36 months 26 (29.3%) months 59 (66.3%) Not known 4 (4.5%)

41 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%)

42 Stability of Loss for 112 Children with Unilateral Hearing Loss Stable53 (55.8%) Better 5 (5.3%) Variable18 (18.9%) X X X X X O O O

43 In Which Ear Is Hearing Loss for 112 Children with Unilateral Hearing Loss Right52 (55.6%) Left45 (46.4%)

44 Perception of Hearing Difficulty By Student (Sometimes, Often, Always) Face to face25 (28.1%) Further than 3 feet46 (51.7%) In a group 55 (62.5%) On side of loss 72 (80.9%) In noise 59 (66.3%) Video, TV, movies38 (42.7%)

45 Risk Factors Reported By Parent for Childs 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%)

46 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%)

47 Additional Conditions Reported By Parent (2) Vision23 (24.2%) Other 8 (8.4%) Unknown problem14 (14.7%)

48 Grades Retained Kindergarten 4 (4.2%) Grades (22.1%) Grades (5.3%) Grades (4.2%) Grades (1.1%) Total35 (36.8%)

49 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%)

50 Resource Services Currently Received Speech/Language18 (19.6%) Preferential seating66 (71.1%) Tutoring/Resource help 29 (32.2%) Management of HI needs 33 (36.3%)

51 Parental Involvement Meet with teacher about HL54 (60.0%) Meet with teacher about school66 (73.3%) Send medical reports to school21 (23.3%) Send audiology reports to school34 (37.8%) None of the above 6 (6.7%) Other activities of involvement 9 (10.0%

52 Parents Interested In Receiving Additional Information About UHL >70% about their role >60% about teaching methods and the teacher and school role for helping their child >60% expected educational performance >60% protection of hearing in their childs good ear >50% their childs social development, development of self confidence, and safety issues related to UHL

53 Parent Training Very Beneficial

54 Educational Concerns for Children with Unilateral Hearing Loss May need resource service from speech/language/hearing, education, and/or psychology Will need attention to acoustics and lighting in learning environment Will need technological assistance to improve signal to noise ratio Will need frequent monitoring of hearing as well as educational performance

55 Medical Considerations for Children With Unilateral Hearing Loss Avoid noise exposure Avoid ototoxic medications unless essential Obtain prompt medical attention for otitis media Radiologic evaluation and laboratory test results obtained to evaluate etiology Torch test results Genetic consult report Vestibular findings

56 Considerations for Parent/ PCP/ Others Involved in Childs Care Provide printed material on hearing, speech, language, development Provide information regarding risk factors identified, give additional resources for further reading, web sites, etc Give handout on signs and behaviors associated with changes in hearing Give return date for reassessment and advise parent to notify you for reassessment if changes in hearing suspected Document in your report that you did all this


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

Similar presentations

Ads by Google