Mild-moderate congenital hearing loss: secular trends in outcomes across four systems of detection. Interview with:

Peter Carew Lead author, MCRI PhD student  Clinician

Peter Carew

Peter Carew
Lead author, MCRI PhD student
The University of Melbourne What is the background for this study?

Response: The age at diagnosis of a congenital hearing loss has dropped over time. This has allowed for earlier fitting of amplification (hearing aids, cochlear implants) and earlier access to education intervention programs, all intended to lessen the impact of hearing loss on development. Much research has focused on the outcomes achieved by children with severe and profound losses, but relatively little attention has been given to milder hearing losses (mild and moderate). Despite this lack of evidence, we are observing children with mild loss being fitted with hearing aids earlier than ever before. From a historical age of fitting not uncommonly at 2 years of age or older, today the largest number of children under 12 months who receive a hearing aid for the first time in Australia have a mild hearing loss in their better hearing ear. To this end, clinical practice may have jumped ahead of the evidence in terms of understanding any benefits children with mild hearing loss receive from having hearing aids earlier. What are the main findings?

Response: This study compared the language outcomes of over 140 children at age 5-8 years of age born across a 20-year period. These children with mild and moderate hearing loss were divided into four groups, which only differed on the system of hearing loss detection in operation at the time they were born. This ranged from detection essentially by chance, through risk factor screening to the systematic early identification and fitting seen today. We found that unlike children with moderate loss, those with mild hearing loss did not show consistent improvement in language outcomes as age at diagnosis and hearing aid fitting reduced. What should readers take away from your report?

Response: The earlier application of a “treatment”, in this case hearing aids, has not been shown to improve the outcomes of children with mild hearing loss in the way benefit was seen for children with moderate hearing loss. Readers should be asking why! There are a range of potential contributing factors which require further investigation. What recommendations do you have for future research as a result of this study?

Response: We need a greater understanding of the factors considered and decisions made by parents and clinicians on the timing of hearing aid fitting for mild hearing loss. Ultimately, a controlled trial of hearing aids versus no hearing aids would likely be our best chance of understanding how to improve outcomes in these children. Such a trial would need to look carefully at the amount of hearing aid use, and assess both broad and specific language skills. Is there anything else you would like to add?

Response: These results may not fully generalise to children with intellectual disability, or to children with mild hearing loss who do not wear hearing aids. These children were not represented in the research presented. Thank you for your contribution to the community.

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This is via pubmed.

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Last Updated on June 24, 2017 by Marie Benz MD FAAD