Unilateral Hearing Loss in the Classroom

 

Many students who receive itinerant services, either direct or consult, from an itinerant teacher for deaf/hard of hearing students, have a unilateral hearing loss.

 

Possible effect on understanding language and speech:

         

Child can "hear" but will have difficulty understanding in certain situations, such as hearing faint or distant speech, especially if weaker ear is closer to the person speaking.

Will usually have difficulty localizing sounds and voices using hearing alone. The unilateral listener will have greater difficulty understanding when environment is noisy and/or reverberant, especially with normal ear toward the overhead projector or other sound source and poor hearing ear toward the teacher.

Exhibits difficulty detecting or understanding soft speech form the side of the poor hearing ear, especially in group discussions.

 

Possible psychosocial impact:

 

Child may be accused of selective hearing due to discrepancies in speech understanding in quiet versus noise.

Social problems may arise as child experiences difficulty understanding in noisy cooperative learning, lunch, or recess situations.

May misconstrue peer conversations and feel rejected or ridiculed.

Child may be more fatigued in classroom setting due to greater effort needed to listen, especially if class is active or has relatively poor acoustics.

May appear inattentive, distracted, or frustrated, with behavior or social problems sometimes evident.

 

Potential educational accommodations and services:

 

Allow child to change seat locations to direct the better ear toward the most effective listening position.

Student is at risk for educational difficulties as half of students with unilateral hearing loss experience significant learning problems.

Often have difficulty learning sound/letter associations in typically noisy kindergarten and first grade settings. Educational monitoring is warranted.

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.

Unilateral Hearing Loss: Tips for Parents

Infants with unilateral hearing loss are being identified within the first few months of life subsequent to the newborn hearing screening test before hospital discharge. Approximately 2 babies in every 1000 births have a unilateral hearing loss. There are many strategies parents can use to enhance their child's listening skills. There are also specific changes than can be made to the home environment to make listening easier for your child.

"Why does a unilateral hearing loss make it more difficult for my child to hear?"

  • Hearing in noise: The important sound, often the speech of the caregiver, is harder to hear and not as clear.
  • Finding or localizing a sound: For most children, it is difficult to find a sound when you don't hear the same way in each ear
  • :Language development: Children say what they hear. If a child doesn't hear speech clearly, it may be more difficult for the child to develop clear speech.
  • Attending to auditory information: Soft voices and deep voices may be more difficult for a child to understand.

What strategies can I use at home to make listening easier for my child?

  • Move away from noises when you want your child to listen to you.
  • Position your baby so that the normally hearing ear is directed toward the sound you want the child to hear.
  • When you want your child to hear you, notice if there are other sounds around you. Try to make the environment quieter so that your child will hear you better.
  • When you are talking to your baby, minimize the distance between you. Come even closer in a noisy environment.

How can I speak to my baby to make my words clearer?

  • Make your speech a little louder by getting closer to your baby.
  • Provide visual clues when you speak or make a sound by letting your baby see your lips. Be sure there is good lighting, and add gestures.
  • Get your child's attention and then start to talk.
  • Provide occasional pauses in what you say to allow more time for your baby to understand the message.
  • Place more emphasis on key words in a phrase.

Parents can carefully observe their child and note any warning signs that hearing loss is affecting development. Consider these tips:

  • If your child has an ear infection, go to your doctor right away. An ear infection may make it harder to hear in the good ear.
  • Have your child's hearing tested on a regular basis as recommended by your audiologist.
  • Have an assessment of speech, communication, language and functional hearing every 6 months to check your child's development in these areas.
  • Obtain help from an early interventionist who can teach your family specific techniques to help your baby hear.
  • Learn some strategies to develop good listening skills in your child (called auditory training)