In the past, doctors and audiologists usually reassured parents of a child with unilateral hearing loss (hearing loss in only one ear) that speech and language would develop appropriately with one normally hearing ear. Some studies from the 1980s and 1990s suggested, however, that more children with unilateral hearing loss may have educational and / or behavioral problems, compared to their normally hearing peers. To learn more about whether unilateral hearing loss has an impact on the development of speech and language and educational achievement, I reviewed articles published between 1966 and 2003 that focused on this problem in children.
Speech and language delays were reported in some but not all studies that looked at toddlers, pre-school and school-age children. In one study that reported a delay in speech, the age at which toddlers spoke their first two-word sentence was delayed an average of five-months, even though the age at which they spoke their first word was not delayed. A study done in pre-school children reported language delays among the children with unilateral hearing loss, but did not describe what specific delays they had. Another study done in older children with severe-to-profound unilateral hearing loss (little if any usable hearing in one ear) showed that they had lower vocabulary scores, but it was not believed to be significant.
Like speech and language delays, educational problems were reported in many but not in all studies. Problems in school included a 22-35% rate of repeating at least one grade, and 12-41% receiving additional educational assistance, such as tutoring and remedial classes. Behavioral issues were also reported at an increased rate. such as perceived lack of attention in class.
The advantage of having two ears that hear rather than just one ear has been documented in many studies. People have a much easier time figuring out where a sound is coming from when two ears hear compared with only one ear. In the "cocktail party effect," people who have normal hearing in two ears have an easier time engaging in conversation in a room where other people talking, compared with people who have any hearing loss. In school, children commonly have to deal with significant background noise (others talking, shuffling papers and feet, building noise, etc.) so that any hearing loss may affect their ability to hear and understand what a teacher is saying.
The studies I reviewed suggested that several risk factors may put children with unilateral hearing loss at increased risk of speech-language or educational problems. If the hearing loss begins as an infant or toddler, speech and language delay may occur and affect subsequent learning in school. Medical problems that occurred at birth or shortly after birth may result in global developmental or cognitive delay that can affect educational progress. Children with severe to profound unilateral hearing loss have little if any usable hearing in the impaired ear, and have considerable problems with background noise at school.
A couple of studies have looked at using hearing aids or FM systems for children with unilateral hearing loss. FM systems help children hear and understand words better than hearing aids in the setting of background noise, but they can only be used indoors. Hearing aids may help children with unilateral hearing loss when they are not in school or at home, but not all children benefit from using them.
School-aged children with unilateral hearing loss appear to have increased rates of grade failures, need for additional educational assistance, and perceived behavioral issues in the classroom. Speech and language delays may occur in some children with unilateral hearing loss, and it is unclear if children "catch up" as they grow older. Further research into this area is necessary to clarify these issues and to determine whether interventions may prevent potential problems.
Dr. Judith Lieu graduated from UC Davis and Washington University School of Medicine. She is pediatric otolaryngologist at St. Louis Children's Hospital and an Assistant Professor at Washington University School of Medicine. She is currently doing a study to investigate the factors that put children with unilateral hearing loss at risk for poor school performance. She and her husband have two young children.
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