Download Unilateral Hearing Loss in Infants

Unilateral Hearing Loss in Infants Why one ear is not enough
Ye6a ABRAHAMS, Aleisha DAVIS, Ka@e NEAL 14th Symposium on Cochlear Implants in Children December 11-­‐13, 2014 at the Omni Nashville Hotel – Nashville, TN Diagnosis of UHL-­‐ the impact •  UHL is diagnosed in the UNHS programs in Australia •  WHO guidelines for screening (Wilson’s Criteria 1968) 1. 
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The condiQon should be an important health problem. There should be a treatment for the condiQon. FaciliQes for diagnosis and treatment should be available.
•  Many families sQll advised that they don’t need to do anything •  Children with a UHL in Australia are not eligible for the same services as children with bilateral hearing loss: BeWer Start Funding, Carers Allowance, Hearing Support Services in educaQon •  Parental stress and uncertainty aYer diagnosis is less related to degree of hearing loss and more related to the family themselves Problems with one ear/device • 
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May be harder to listen in quiet (no redundancy) Increased difficulty in background noise Increased difficulty listening to signal on the poor side/noise on the beWer side Loss of binaural advantage: binaural summaQon, head shadow, localisaQon, spaQal release from masking The reasons we advocate for 2 hearing devices are the same reasons we should consider improving access to sound for someone with unilateral hearing The evidence suppor@ng binaural/bilateral access to sound for people using 1 HA/1 CI is the same evidence suppor@ng us providing improved access to sound with unilateral hearing The impact for children’s listening • 
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35% of children repeated one grade at school 13% needed special assistance at school Recommended preferenQal seaQng but liWle impact Syllable idenQficaQon poorer than matched controls in various noise levels Poorer listening in noise when signal on the side of the poorer ear Demonstrated difficulty with sound localisaQon Poorer speech and language scores than sibling controls Bess, F. H. & Tharpe, A. M. (1984). Unilateral hearing impairment in children. Pediatrics, 74, 206 – 216. Bess, F. H., Klee, T. & Culbertson, J. L. (1986). IdenQficaQon, assessment, and management of children with unilateral sensorineural hearing loss. Ear and Hearing, 7(1), 43 – 51. Ericson, H., Svard, I., Hogset, O., Devert, G. & Ekstrom, L. (1998). Contralateral rouQng of signals in unilateral hearing impairment. Scandanavian Audiology, 17, 111 – 116. Lieu, J. E. C., Tye-­‐Murray, N. & Fu, Q. (2012). Longitudinal study of children with unilateral hearing loss. Laryngoscope, 122(9), 2088-­‐2095. The impact for the brain •  f-­‐MRI study invesQgaQng differences in auditory listening and execuQve funcQoning images between children with unilateral hearing loss and age matched normal hearing siblings •  Some brain areas showed different funcQon with UHL •  Evidence of compromised development of execuQve funcQoning •  Observed impact on auditory funcQon AND cogniQve funcQon Propst, E., Greinwald, J.H., Schmithorst, V. (2010) Neuroanatomic Differences in Children With Unilateral Sensorineural Hearing Loss Detected Using FuncQonal MagneQc Resonance Imaging -­‐ Arch Otolaryngol Head Neck Surg. 136(1):22-­‐26. TibbeWs, K., Ead, B., Umansky, A., Coalson, R., Schlaggar, B. L., Firszt, J. B. & Lieu, J. E. (2011). Interregional brain interacQons in children with unilateral hearing loss. Otolaryngology – Head and Neck Surgery, 144(4), 602 – 611. Demographics at The Shepherd Centre Incidence of unilateral hearing loss in infants approximately 1:10,000 (ASHA) AmplificaQon choices n=53 Age at fiPng: ranges between 3 mths-­‐5 years Unilateral SNHL
Unilateral Conductive
Unilateral Mixed
Unilateral ANSD
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ENT/medical consideraQons •  7 permanent conducQve: microQa + atresia (counselling needs) •  3 with possible progressive or hearing that has further progressed to significant bilateral HI •  2 with head injury/fracture through cochlea •  13/28 (46%) children with profound UHL have significant cochlear/auditory nerve anomalies (not all children have had MRI) Unilateral Hearing loss: Last Standard Language Assessment (n = 32) We need to consider measurements beyond standardised assessment of language and speech What gaps are we seeing? Theory of Mind skills RecepQve/expressive gaps Delayed auditory progress Need to consider the populaQon we have in EI Unilateral Hearing Loss: Auditory Comprehension and Expressive CommunicaQon
WHOLE GROUP Expect Auditory Comprehension to be higher than Expressive CommunicaQon in typical development 130 120 110 100 90 80 70 60 50 40 30 20 10 0 Auditory Comprehension Expressive CommunicaQon UNILATERAL HEARING LOSS 19/32 (59%) have an auditory comprehension standard score the same, or below, their expressive communicaQon standard score.
160 150 140 130 120 110 100 90 80 70 60 50 40 30 20 10 0 Auditory Comprehension Expressive CommunicaQon Unilateral Hearing Loss: Listening Progress The Shepherd Centre Auditory Hierarchy © 2013 Early IntervenQon model •  Children may aWend weekly/fortnightly/monthly AVT sessions with audiology & Family Counselling support •  Progress to 1/mth for monitoring (centre-­‐based/remote) •  Early MRI scan to support family future choices •  Hearing devices & CI evaluaQon as required •  Children using their listening deserve an opportunity to access binaural listening if possible •  Research evidence supports diagnosis, thorough invesQgaQon and access to EI and educaQonal support •  The available choices may change over Qme •  The right soluQon may change over Qme ConsulQng with literature The Shepherd Centre team “ Thanks for listening this much!”