Unilateral Hearing Loss: Is intervention still necessary?

15 August 2017

Unilateral hearing loss (hearing loss in one ear) can often be dismissed as not worth intervention since the child has ‘one good ear’. However, the Joint Committee on Infant Hearing Guidelines (2013) states, “All children who are identified with hearing loss of any degree, including those with unilateral or slight hearing loss...(should) receive appropriate monitoring and immediate follow-up intervention services”.

Impact of Universal Hearing Loss

Just because a child has ‘one good ear’ does not mean that they are immune from the impact of hearing loss on their development. Research shows that there are a number of adverse impacts associated with unilateral hearing loss.  

Probably the most obvious issues that a person with unilateral hearing loss has are difficulty in localising the source of a sound, as two ears are required to give the necessary timing and intensity cues for identifying a sound source (Bess et al, 1986).

It is understandable that children with a unilateral hearing loss would have difficulty hearing speech using their ear with hearing loss, however it has been show that children with a unilateral sensorineural hearing loss also have difficulty discerning speech directed to their good ear (Cole & Flexer, 2008).

This lack of ability to discern speech in either ear can also lead to auditory deprivation, which alters the normal development of the auditory neural cortex of the brain during critical development period (Emmer, 1999).

This, in turn can then lead to a significant delay in the development of children using 2 word utterances (Kiese-Himmel, 2002). Anderson (2011) reported that 1/3 of children with unilateral hearing loss would be expected to exhibit language delays by the age of 15-18 months.

Once a child has entered school, a whole new set of challenges arise. In the past, when educational practice was for children who were behind their peers academically to be held back a grade, children with unilateral hearing loss were 10 times more likely to fail a grade than children with normal hearing (Bess & Tharpe, 1986). English and Church (1999) also found that 54% of children with unilateral hearing loss received individualised special education services.

These issues are significant, but can be minimised, if not completely counteracted by effective management and early intervention.

Intervention for children with a unilateral hearing loss

In accordance with the Joint Committee on Infant Hearing Guidelines (2013) guidelines the Cora Barclay Centre recommends a multi-disciplinary team approach to the management of children with unilateral hearing loss.

When families begin with the Cora Barclay Centre they are enrolled into a 6 week intensive parent-child support program, which includes:

  • education on the impact of unilateral hearing loss for the family
  • emotional support, including dealing with issues of attachments and bonding, for the family
  • parent education regarding normal development of auditory skills, speech and language.
  • strategies to maximise the child’s oral language development and early literacy skills
  • access to specialist groups to develop social-emotional support (it is suggested that this continue as much as possible)

Once the intensive program has been completed the Centre continues to monitor children with unilateral hearing loss according to the recommendations of Joint Committee on Infant Hearing Guidelines. The continued support includes:

  • an Early Intervention therapist meeting with the family on a quarterly basis to informally assess and plan activities to enhance the child’s speech, language and general development
  • assistance with education around development of a positive acoustic environment, care of hearing aid and FM’s, preparation for kindergarten and school etc
  • annual formal assessment of the child’s speech and language 
  • support for a smooth transition to pre-school / school
  • an invitation to attend Bright Start, our transition to school program
  • audiological monitoring

By providing support for children with unilateral hearing loss we can reduce the risk of speech and language delay.

If your child has a unilateral hearing loss and would like to talk to someone about receiving support for speech and language development, please contact the Cora Barclay Centre.

References

Anderson, K. L. (2011). Your child with hearing loss in one ear. A presentation to Pediatric audiologists, early intervention teachers of the deaf/ hard of hearing and speech language pathologists.

Bess, F. H., Dodd-Murphy, J. D., and Parker, R. A. (1998). Children with minimal sensorineural hearing loss and its aetiology in childhood: the contribution of computerized  tomography in aetiological diagnosis and management. International Journal of Pediatric Otolaryngology. 51,91-99.

Bess, F. H., and Tharpe, A. M. (1986). Case history data on unilaterally hearing impaired children. Ear and Hearing, 7, 14-17.

Cole, E. B., and Flexer, C. (2008) Children with hearing loss: Developing listening and talking: Birth to six. Plural Publishing Inc. Abingdon, UK.

Emmer, M. B. ((1999). Review of late-onset auditory deprivation and clinical implications. Hearing Journal, 52(11), 26-30.

Kiese-Himmel, C. (2002). Unilateral sensorineural hearing impairment in childhood: Analysis of 31 consecutive cases. International Journal of Audiology, 41, 57-63.

Prieve, B., Dalzell, L., Berg, A., et al. (2000). The New York State universal newborn hearing screening demonstration project: Outpatient outcome measures. Ear and Hearing, 21, 104-117.

Joint Committee on Infant Hearing. (2013). Supplement to the 2007 position statement: Principles and guidelines for early intervention after confirmation that a child is deaf or hard of hearing. Pediatrics. Available here


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