Kids Need Two Ears!

Children with hearing loss are at high risk for delays in acquiring and advancing speech and language, and achieving psycho-educational success. This fact, well known for decades, escapes clear guidelines for treatment when the hearing loss is unilateral, sensorineural, and “unaidable.” The traditional definition of “unaidable” is challenged by modern cochlear implants, which provide a potential—albeit “off-label” solution—to provide bimodal or binaural hearing in cases of unilateral hearing loss. Unilateral hearing loss (UHL) is known to be handicapping, particularly in young children who are acquiring language and speech. Its consequences include difficulty with localization, difficulty understanding speech-in-noise, and difficulty when speech originates from the deaf/impaired side. Negative educational impact of UHL is common, and children are known to be at higher-risk for speech, language and social-emotional difficulties than children with normal hearing in both ears. Sub-optimal signal-to-noise ratios in classrooms, a common occurrence, exacerbate listening and learning difficulties for all children, but particularly those with hearing loss and unidentified/untreated unilateral hearing loss.

The prevalence of UHL in newborns and young children is largely unknown.  And when present at birth, it may be late to be identified unless the infant does not pass newborn hearing screening. With the advent of newborn hearing screening, it is apparent that hearing loss in children may not be identified in the birth-screen for a variety of reasons. The proportion of this group having severe-profound unilateral SNHL was not estimated. Unilateral hearing loss, if not present at birth, is often late to be identified.

It is common that physicians, and perhaps to a lesser extent, audiologists, assume that UHL is an inconvenience, but not a significant factor in acquiring language or achieving successful learning in the classroom. Yet the preponderance of research over the past 30 plus years shows this not to be the case for all children. While some children with UHL are able to achieve at grade-level (often with greater listening effort), many children with UHL experience academic challenges.

Listening effort is also a consideration—at what cost does a child with a UHL achieve success in the classroom? Stress and exhaustion associated with increased listening demands are known to be byproducts of classroom listening for children with UHL. Additionally, children with UHL may experience psycho-social impact (e.g., embarrassment) when they “mis-hear” casual conversation at school, or turn the wrong direction when their name is called out in the noisy school cafeteria.