| Description |
Children with monaural hearing have poorer speech understanding in noise. This problem is significant
as many classrooms provide an unfavorable signal to noise ratio that is challenging for even children
with normal binaural hearing. In addition, monaural hearing makes it difficult to determine the direction
of sound, distance and movement of sound. Compensation strategies may be difficult for children to
implement, especially as they typically have little control over their listening environment. Research in
adults has shown that unilateral hearing loss impacts quality of life, especially in the areas of social and
emotional well-being. Compensation strategies require attention and may be exhausting. It was thought that children with unilateral hearing loss “will be able to go through school and learn just like any other child” (Northern & Downs, Hearing in Children, 1978) until the 1980s when several studies demonstrated a 10 fold increased risk of grade failure and an increased need for educational support services (Bess & Tharpe 1984; Oyler, Oyler & Matkin 1988; Culbertson & Gilbert 1986), as well as behavioral problems and less social confidence. More recent studies have demonstrated preschool spoken language delays (Kiese-Himmel 2002; Sedey 2002; Borg 2002). Recent studies of 6 to 12 year olds revealed poorer speech and language and increased need for IEP and SLP services as well as continued behavioral problems and need for IEP despite three years of intervention (Lieu 2010, 2012). Studies of brain activation of children with severe to profound unilateral hearing loss have demonstrated differences in activation of attention areas of the brain as well as differences in networks involving working memory, executive function and oral motor function. Although much additional research is needed, the aforementioned findings are beginning to change
audiological and otological management of these children. At Lurie Children’s we are often recommending amplification when it likely to be beneficial for children with unilateral loss. One caveat is the need to be cautious with infants and young children when only auditory brainstem evoked data is available. For children with loss in the severe to profound range, fitting with traditional amplification is typically not recommended when the opposite ear has normal auditory thresholds. However, there is newly available CROS aid technology that may be beneficial for school aged children. Case examples will
be provided. In addition, for children with unilateral conductive loss that cannot benefit from traditional
amplification, use of a bone conduction device will be discussed. Use of these devices on a head band
for preschool children and as a surgical implant with an external processor for children age 5 years and
older will be discussed. Recent findings that have created interested in cochlear implantation to address
unilateral deafness will be touched upon.
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