Dr Teresa YC Ching is Professorial Fellow at NextSense Institute (formerly the research arm of the Royal Institute for Deaf and Blind Children) in Australia, and Conjoint Professor in Special Education and Disability Studies at Macquarie University. She is also an Honorary Professor at The University of Queensland. She has led population-based research on speech, language, psychosocial and quality of life outcomes of children who are deaf or hard of hearing in one ear or both ears, including those with or without additional disabilities. The research findings have generated evidence-based guidelines for clinical management to improve outcomes of children with hearing loss.
Regardless of whether you consider a hearing device for the child who is affected with unilateral hearing loss, the two pieces of advice that are most important to help the child grow.
Q: What audiology test/s is/are recommended for assessing hearing ability in noisy situations e.g. a classroom.
Dr Ching: Speech perception in noise tests. One method to assess hearing ability in noisy situations was shown in the presentation when performance was compared between two listening conditions: in one condition, speech and noise were presented from the same location in front; and in a second condition, speech was presented from the frontal loudspeaker and noise from loudspeakers on both sides. Children who achieved better performance when the location of speech was separated from that of the noise than when speech and noise were collocated demonstrated an ability to use binaural cues and would have less difficulties listening in noisy situations. Griffin et al (2023) Doi: 10.1097/AUD.0000000000001310 reported on the performance of school-aged children with unilateral hearing loss listening to speech in noise when they were using different hearing devices.
Q: Are there studies showing impact of sign language intervention for children with UHL? With/without listening devices
Dr Ching: This is a good question! As spoken language is accessible via the normally functioning ear in a child with unilateral hearing loss and to some extent via the affected ear (depending on the severity and whether hearing devices are used), the desired mode of communication is generally spoken language. If that is the case, emphasize spoken language. Enrich their language environment, read aloud, sing songs and chant nursery rhymes. Develop the auditory brain by speaking, reading and singing to support learning. Always orientate the child’s normally functioning ear (good ear) to the dominant sound source. Reinforce head turning to the sound source.
I am not aware of high-quality studies that investigated the effectiveness of sign language intervention for children with unilateral hearing loss. For deaf and hard of hearing children, a systematic review in 2016 (Fitzpatrick et al (2016) Pediatrics. 2016;137(1):e20151974) concluded that there was insufficient high-quality evidence that sign language in combination with oral language therapy is more effective than oral language therapy alone. For children who required cochlear implantation, Geers et al (2017) (Pediatrics 140(1): e20163489; doi: 10.1542/peds.2016-3489) showed that there was no advantage to parents’ use of sign language either before or after cochlear implantation.
Q: Have any studies looked at remote mic on poorer ear vs. better ear? And unilateral remote mic vs. bilateral?
Dr Ching: Schafer et al (2020) provides a comprehensive description of remote microphone technology for children with hearing loss or auditory processing issues (Seminars in Hearing 2020, 41(4):277-290. Doi: 10.1055/s-0040-1718713).
Q: With regard to loss by frequency – how do low frequencies fare as I heard these are more difficult to diagnose in an ABR and variance can be greater (+/- 20db)?
Dr Ching: Electrophysiological measurements such as ABR records brain responses to electrical stimulation. These are used for diagnosis to provide an estimate of hearing. The gold standard for assessing hearing thresholds is behavioural audiometry, typically from 250 Hz to 8000 Hz. Frequencies from 500 to 4000 Hz are important for understanding speech.
Q: I’m confused, was told it’s best to talk to the aided ear not the good ear. Only talk to good ear when unaided. Thank you.
Dr Ching: The good ear functions normally. So, it sends the best quality input to the brain. As the affected ear may not hear sounds well, aiding enables sounds to be audible in that ear, albeit at a lower quality compared to sounds in the good ear. Aiding also allows the potential use of binaural hearing cues for localisation and for listening to speech in noise.
Disclaimer: The information contained on this website is not intended as a substitute for independent professional advice.