by Sarah McKay and Aruna Iyer
Children with unilateral hearing loss (UHL) can be at risk for academic, speech-language, social, and emotional problems, and often require special services to address these needs. Approximately 16 to 19 out of every 1,000 school-aged children have UHL (Brookhauser, Worthington, & Kelly, 1991).
Children with UHL do not have the advantages of binaural hearing, and consequently have difficulty localizing sounds, detecting/understanding speech directed to the impaired side, and understanding speech in noisy and/or reverberant environments (Bess et al, 1986).
Based on available evidence, the Center for Childhood Communication (CCC) at The Children's Hospital of Philadelphia (CHOP) has established the following guidelines for the management of children with UHL.
Audiologic Evaluations
A complete comprehensive audiologic evaluation during the initial assessment includes: air and bone conduction threshold assessment, speech reception thresholds, measures of word recognition ability, tympanometry, ipsilateral and contralateral acoustic middle ear muscle reflex threshold assessment, and evoked otoacoustic emission testing. In addition, children are administered several functional outcome measures (SIFTER, Preschool SIFTER, CHILD). Frequency-specific auditory brainstem response (ABR) evaluation is completed for young children who cannot be tested reliably with behavioral measures; high-level click-ABR is used to determine whether the UHL is sensory or neural.
Medical and Non-Medical Evaluations
Evaluations by specialists in otolaryngology, ophthalmology, genetics, speech-language pathology, and early intervention are recommended. A neurologic evaluation is recommended when retrocochlear hearing loss is suspected. All families are provided resources including written materials on strategies to help their child at home and at school.
Candidacy for Amplification
Criteria for hearing aid (ear-level, advanced technology; DSL prescriptive approach) candidacy include:
- children 3 years of age or older (younger children are considered candidates for amplification only when ear and frequency-specific threshold information is available)
- mild to moderately severe (25 to 65 dB HL) sensory or permanent conductive hearing loss in one ear
- useable word recognition in the affected ear
FM systems are recommended for all children with UHL including those with severe to profound hearing loss or poor word recognition abilities. Bone conduction and CROS (contra-lateral routing of signal) systems are not standard recommendations, but may be considered on a case-by-case basis if deemed appropriate.
A UHL hearing aid/FM system loaner bank is available, which provides an opportunity for a trial period with the recommended type of amplification.
In 2001, a questionnaire was developed at the CCC/CHOP to examine families' and children's perceptions about the use of amplification technology. We queried 20 cases of UHL and found most families and children reported improved listening in situations they had experienced difficulty with prior to their fitting. To date, the CCC/CHOP has fit over 100 children with UHL with hearing aids. CCC/CHOP management guidelines are continually evolving and our future efforts will focus on specific management guidelines for infants. (The questionnaire can be found on the Audiology Online Web site. The questionnaire was primarily for children fit with a hearing aid in the impaired ear. Some may have had FM along with their hearing aid.)
This article is based upon a poster session presented at the 2004 Audiology Convention at ASHA.
Aruna Iyer has been an audiologist at The Children's Hospital of Philadelphia for six years. She currently participates in all aspects of patient care in her department but has a special interest in unilateral hearing loss and pediatric amplification. Contact her at iyer@email.chop.edu.
Sarah McKay has been an audiologist at The Children's Hospital of Philadelphia for 15 years and has a special interest in unilateral hearing loss. Contact her at mckay@email.chop.edu.