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Unilateral hearing loss in children: a retrospective study and a review of the current literature

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Abstract

Despite the introduction of universal newborn hearing screening (UNHS), unilateral hearing loss (UHL) is sometimes recognized late. This diagnostic delay has adverse repercussions, given the importance of binaural hearing for the development of normal auditory processing. It is incorrect to maintain that unilateral hearing is the minimum requirement for adequate speech development and that hearing aid provision is consequently unnecessary. In our retrospective study, hearing aid provision resulted in improved directional and selective hearing (quiet and noisy environments) and, compared with their chronically ill counterparts, the children in our study displayed superior health-related quality of life (HRQoL) scores in all areas. On the basis of the results, the authors conclude that even mild hearing losses (from an auditory threshold of 30 to 40 dB) should have the opportunity for hearing aid provision. A selective literature review was conducted in PubMed and textbooks and with reference to national and international guidelines. Early diagnosis and treatment of UHL have a positive effect on verbal-cognitive, linguistic, communicative, and socio-emotional development, as demonstrated by neurophysiological studies. Among the treatment modalities with differing effects on the quality of binaural hearing, cochlear implants are now used increasingly in children with hearing loss bordering on deafness.

Conclusion: Published evidence and clinical experience support early diagnosis and treatment. Wherever feasible, hearing aid provision before or at the end of the first year of life is recommended for children with UHL.

What is Known:

• Almost 30 years ago, poor academic performance was reported in children with unilateral hearing loss (UHL).

• Despite improvements in treatment options, it is traditionally held that unilateral hearing is the minimum requirement for adequate speech development and hearing aid provision is unnecessary.

What is New:

• Academic and behavioral deficits in children with UHL may be mediated by deficiencies in the default mode network.

• Published evidence supports the recommendation for hearing aid provision before or at the end of the first year of life in children with UHL.

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Abbreviations

BAHA:

Bone-anchored hearing aids

BERA:

Brainstem evoked response audiometry

BTE:

Behind-the-ear (hearing aids)

CI:

Cochlear implant(s)

CMV:

Cytomegalovirus

CROS:

Contralateral routing of signal

CT:

Computed tomography

DGPP:

German Society of Phoniatrics and Pediatric Audiology

DMN:

Default mode network

FAST:

Frequency Animal Sound Test

FM:

Frequency modulation (systems)

HRQoL:

Health-related quality of life

mFAST:

Multi-Frequency Animal Sound Test

OAE:

Otoacoustic emission(s)

SNHL:

Sensorineural hearing loss

SNR:

Signal-to-noise ratio

TEOAE:

Transient evoked otoacoustic emission(s)

UNHS:

Universal newborn hearing screening

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Acknowledgements

We would like to thank all the families for their time in participating in the retrospective study. We also owe a debt of gratitude to the DISABKIDS Project, in particular for the support of the Coordination Center in Hamburg (project partners: Professor Dr. Monika Bullinger, Professor Dr. Silke Schmidt, and Dr. habil. Corinna Petersen-Ewert) in providing the DISABKIDS software.

Authors’ contributions

A-KR and JF are joint principal authors who contributed equally to the retrospective study and to the literature review presented here. A-KR, JF, FM, and TW participated in the concept, design, and interpretation of the manuscript. JF and A-KR coordinated the study centers and patient inclusion, and JF was responsible for the practical conduct of the retrospective study. MH, TW, and MR provided the patients for the study, and ABr and AS were responsible for diagnostic testing. JF, FM, A-KR, and TW conceptualized the data analysis. JF, ABo, and TW developed the questionnaires for the retrospective study. A-KR, FM, TW, and JF drafted the manuscript, and all the listed authors have reviewed and approved the final version of the manuscript as submitted.

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Authors and Affiliations

  1. Department of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Martinistrasse, 52 20246, Hamburg, Germany

    Anna-Katharina Rohlfs, Johannes Friedhoff, Achim Breitfuss, Markus Hess & Frank Müller

  2. Department for ENT and Communication Disorders, University Medical Center of the Johannes Gutenberg University, Mainz, Langenbeckstraße 1, 55131, Mainz, Germany

    Andrea Bohnert

  3. KIND Hörgeräte, Erdkampsweg, 55 22335, Hamburg, Germany

    Anke Strauch

  4. Community Practice for Otorhinolaryngology, Phoniatrics and Pediatric Audiology, Pestalozzistraße, 24 22305, Hamburg, Germany

    Marianne Röhrs

  5. Department of Phoniatrics and Pediatric Audiology, Werner Otto Institut, Bodelschwinghstrasse, 23 22337, Hamburg, Germany

    Thomas Wiesner

Authors
  1. Anna-Katharina Rohlfs
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  2. Johannes Friedhoff
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  9. Thomas Wiesner
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Corresponding author

Correspondence to Anna-Katharina Rohlfs.

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Funding

This study was not funded.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the ethics committee of the Hamburg regional medical board. All procedures performed in this study involving human participants were in accordance with the ethical standards of the ethics committee of the Hamburg regional medical board.

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Informed consent was obtained from all individual participants included in the study or their parents/legal guardians.

Additional information

Communicated by Peter de Winter

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Rohlfs, AK., Friedhoff, J., Bohnert, A. et al. Unilateral hearing loss in children: a retrospective study and a review of the current literature. Eur J Pediatr 176, 475–486 (2017). https://doi.org/10.1007/s00431-016-2827-2

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