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Published on: January 25, 2016
Differences in Hearing Devices and Speech Therapy Utilization Between Children With Permanent Unilateral Versus
Kara D Brodie1, Michelle M Florentine1, Emily Taketa2
1Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, California, USA.
Insights
Children with unilateral hearing loss are diagnosed later and receive fewer interventions like hearing devices and speech therapy compared to those with bilateral hearing loss, despite similar hearing loss severity.
Area of Science:
- Pediatric Audiology
- Developmental Pediatrics
- Speech-Language Pathology
Background:
- Early diagnosis and intervention are crucial for children's educational and social development.
- Limited understanding exists regarding diagnostic and resource utilization disparities between unilateral and bilateral hearing loss in children.
Purpose of the Study:
- To compare diagnosis timing and the utilization of auditory and speech/language interventions.
- To analyze differences between children with permanent unilateral hearing loss and bilateral hearing loss.
Main Methods:
- Retrospective cohort study of 382 children (0-18 years) with permanent unilateral or bilateral hearing loss.
- Evaluation in a multidisciplinary hearing loss clinic at a tertiary care pediatric hospital.
Main Results:
- Children with bilateral hearing loss were diagnosed significantly earlier (mean 3.6 years) than those with unilateral hearing loss (mean 5.0 years).
- Despite similar hearing loss severity in the poorer ear, unilateral hearing loss cases were less likely to receive hearing devices (53% vs. 78%) or speech/language therapy (36% vs. 54%).
- Bilateral hearing loss and earlier diagnosis age were associated with increased hearing device use.
Conclusions:
- Children with unilateral hearing loss face delayed diagnosis and underutilization of audiological and speech/language services.
- Evidence supports improved outcomes with hearing devices for unilateral hearing loss, indicating a need for better identification and service provision.
- Lower rates of speech therapy utilization in unilateral hearing loss may partly reflect fewer language delays compared to bilateral hearing loss.
Objectives:
In this study, we aimed to describe differences in diagnosis and both auditory and speech/language intervention utilization between children with permanent unilateral hearing loss as compared with bilateral hearing loss.
Design:
A retrospective cohort study was performed of children evaluated in a multidisciplinary hearing loss clinic at a tertiary care pediatric hospital. Children aged 0 to 18 years with either permanent unilateral or bilateral hearing loss were included.
Results:
One hundred fourteen children with unilateral hearing loss and 268 children with bilateral hearing loss were studied for a total of 382 children. There were no demographic differences between children with permanent unilateral versus bilateral hearing loss. Rates of newborn hearing screening and referred screening results were similar between those with unilateral and bilateral hearing loss. Despite similar rates of referred newborn hearing screening, those with bilateral hearing loss were diagnosed at a younger age (mean 3.6 years, SD 3.8 years) as compared with those with unilateral hearing loss (mean 5.0 years, SD 4.2 years). Children with unilateral hearing loss had similar severity of hearing loss in their poorer hearing ear as compared with children with bilateral hearing loss, yet they were significantly less likely to be fitted with hearing devices (53% versus 78%) or receive speech/language therapy (36% versus 54%) as compared with children with bilateral hearing loss. Multivariate analysis found that bilateral hearing loss and earlier age of hearing loss diagnosis were associated with hearing device use.
Conclusions:
Early diagnosis and intervention for childhood hearing loss have a significant impact on a child's educational success and social relationships. However, little is known about differences in diagnosis and resource utilization between children with permanent unilateral hearing loss versus bilateral hearing loss. Children with unilateral hearing loss were diagnosed at a later age and were less likely to utilize hearing devices or speech/language therapy compared with those with bilateral hearing loss, despite having similar severity of hearing loss in the poorer hearing ear. There is a strong body of evidence that children with unilateral hearing loss have improved hearing outcomes with hearing devices, which suggests there is room for improvement in identifying unilateral hearing loss and providing adequate services to optimize educational success. However, speech therapy is generally implemented in response to language delays. Therefore, children with unilateral loss may have lower rates of language delays as compared with those with bilateral hearing loss, thereby explaining differences in speech therapy utilization.
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