Comprehensive Notes on Hearing Loss in Children

Hearing Loss in Children & Supporting Families

About 1 billion people worldwide are at risk of avoidable hearing loss.
WHO estimates that over 400 million people, including 34 million children, live with disabling hearing loss, affecting their health and quality of life.

Causes and types of hearing loss in children.
Impacts for children and their families.
Variable outcomes.
Factors contributing to positive outcomes.
Parental experiences with otitis media, hearing loss, and auditory processing disorder.
Wellbeing.
Protective factors for children and families.

Permanent: noise damage, infection, head trauma, ototoxic medications, genetic factors.
Transient: otitis media/middle ear infection and/or fluid (“glue”).

Perinatal events: infection and trauma, genetic causes.
Usually sensorineural, but could be congenital conductive loss (e.g., congenital ossicular fixation in the middle ear, or atresia).

Focus on medical treatment.
Hearing aids, speech-language therapy, and educational support may be needed if longstanding or accompanied by other risk factors.

Speech perception, speech production, and receptive and expressive language.
Access to the educational curriculum, especially literacy.
Behavior.
Relationships with peers and family.
Participation in school and other activities.
Self-esteem and identity.
Cognitive skills, e.g., working memory and attention.
Employment.
Impact not just dependent on hearing loss severity; other factors determine impact.

Degree of impairment may not be as important as habilitation and other factors such as educational and family support.
Degree of impairment has a relatively small impact on outcomes when timely, appropriate habilitation is provided.
Duration of hearing loss and age at detection & intervention are more important predictor variables than severity of hearing loss.
Early habilitation is key to achieving optimal spoken and/or sign language outcomes.
Habilitation usually consists of hearing technology, speech language therapy, educational and family support.
If hearing loss is identified early, but supporting factors are not in place, good outcomes will not be achieved.

Considerable variation in speech perception outcomes for DHH children.
Environmental factors: habilitation, use of hearing aids and implant speech processors, family size and economic status, peer group.

Early identification and treatment (hearing aids, cochlear implants, sign language instruction, etc.).
Family factors e.g., child language input, access to support & resources.
Consistent use of hearing devices (hearing aids, cochlear implants).
Support – e.g., Classroom support (Resource Teacher of the Deaf [RTD], Resource Teacher Learning and behavior [RTLB]), Family support (Adviser on Deaf Children [AODC]).
Environment: Clear speech, Good acoustic signal (classroom acoustics, amplification), Language environment, Classroom teacher knowledge and support.
Speech and language therapy.

Early identification of hearing loss, appropriate fitting and consistent use of hearing technology.
Universal newborn hearing screening (UNHS), mandated in many countries, introduced throughout NZ in 2008-9.
Goal is to identify significant permanent hearing loss.
Outcomes better when diagnosis and habilitation occurs before 6 months of age, regardless of degree of hearing loss.
New evidence suggests should “treat” by 3 months to support better language development (oral or sign language).
Supportive factors: newborn hearing screening, early ID and treatment.

UNHS introduced to ensure congenital hearing loss is identified early to reduce impacts on development (language, psychosocial, learning, behavior).
Diagnosis of hearing loss after UNHS may be delayed if child has middle ear disease or other health conditions, barriers to accessing audiology services, or progressive hearing loss.
Early diagnosis associated with better child outcomes, but challenging for parents.
Later diagnosis may contribute to parental stress and anxiety.

Early intervention is key for optimizing language outcomes in children with hearing loss.

Studies of children with healthy hearing also contribute to our understanding of factors affecting language development.
Risk factors for language delay for all children, excluding hearing loss (which is an additional risk factor).
Factors include family history of speech and language delay, male gender, perinatal factors (prematurity, birth difficulties, low birth weight), lower educational levels of parents, childhood illnesses, later birth order, younger mother, family factors (size, overcrowding).

High quantity of language input in young children supports language development.
Recorded verbal interactions in families showed differences in quantity of words heard by children based on family socioeconomic status.