Clinical practice for children with mild bilateral and unilateral hearing loss

Abstract

Objective: Historically, children with mild bilateral and unilateral hearing loss have been reported to experience difficulties related to language and academic functioning. In the context of Universal Newborn Hearing Screening, there is an increasing focus on determining optimal clinical interventions for this population of children. The objectives of this study were to determine the prevalence of mild bilateral or unilateral hearing loss identified in a clinical population from 1990 to 2006 and to document clinical practices related to recommendations and uptake of amplification.

Design: This population-based study consisted of a detailed retrospective chart review of all children identified with mild bilateral or unilateral hearing loss in a Canadian pediatric center between 1990 and 2006. Hearing loss and patient characteristics were extracted to describe the clinical population. Amplification recommendations and uptake of amplification were documented. Clinical decisions regarding amplification practices were explored as a function of age of identification and severity of hearing loss.

Results: A total of 670 children were identified with permanent hearing loss during the 16-yr study period, of which 291 were presented with a mild bilateral or unilateral hearing loss. Detailed reviews of the 255 available medical charts showed that at diagnosis, 178 children presented with mild bilateral, 31 with mild bilateral high frequency, and 46 with unilateral hearing loss. Eighty percent of children had been referred through conventional medical processes before the implementation of universal hearing screening and 20% had been exposed to screening. The average age of identification for the entire group was 54.2 mos (interquartile range, 30.1 to 76.9 mos). Amplification was prescribed for 91.4% of children but there was considerable delay from confirmation of hearing loss to amplification for both children identified with and without screening. Overall, 54.1% received an initial recommendation for amplification and a further 37.3% received a recommendation more than 3 mos after hearing loss confirmation. Practice patterns varied according to category of hearing loss with 60.1% of children with mild bilateral hearing loss receiving an initial recommendation compared with 26.1% of those with unilateral hearing loss. Clinical decision making relative to amplification needs was also changed during the course of audiologic care. The decision to amplify was significantly related to age at identification and degree of hearing loss in the mild bilateral group but not in the unilateral group. Although, more than 90% of children received a recommendation for amplification, chart documentation revealed that less than two thirds of children consistently used their amplification devices. Use of amplification did not vary among children with mild bilateral, mild bilateral high frequency, and unilateral hearing loss.

Conclusions: : This research suggests that there is considerable uncertainty related to clinical recommendations of intervention for this population of children. The impact of parental indecision regarding the benefits of amplification is unknown. Further studies are required to document the potential benefits and factors affecting amplification recommendations and use in the current practice environment where children with mild bilateral or unilateral hearing loss are identified early through newborn hearing screening.