The impact of permanent early-onset unilateral hearing impairment in children – A systematic review

Abstract

Background: Decision-making on treatment and (re)habilitation needs to be based on clinical expertise and scientific evidence. Research evidence for the impact of permanent unilateral hearing impairment (UHI) on children's development has been mixed and, in some of the reports, based on fairly small, heterogeneous samples. Additionally, treatment provided has been highly variable, ranging from no action taken or watchful waiting up to single-sided cochlear implantation. Published information about the effects of treatment has also been heterogeneous. Moreover, earlier reviews and meta-analyses published on the impact of UHI on children's development have generally focused on select areas of development. Objectives: This systematic review aimed to summarize the impact of children's congenital or early onset unilateral hearing impairment on listening and auditory skills, communication, speech and language development, cognitive development, educational achievements, psycho-social development, and quality of life. Methods: Literature searches were performed to identify reports published from inception to February 16th, 2018 with the main electronic bibliographic databases in medicine, psychology, education, and speech and hearing sciences as the data sources. PubMed, CINALH, ERIC, LLBA, PsychINFO, and ISI Web of Science were searched for unilateral hearing impairment with its synonyms and consequences of congenital or early onset unilateral hearing impairment. Eligible were articles written in English, German, or Swedish on permanent unilateral hearing impairments that are congenital or with onset before three years of age. Hearing impairment had to be of at least a moderate degree with PTA ≥ 40 dB averaged over frequencies 0.5 to 2 or 0.5 to 4 kHz, hearing in the contralateral ear had to have PTA 0.5-2 kHz or PTA 0.5-4 kHz ≤ 20 dB, and consequences of unilateral hearing impairment needed to be reported in an unanimously defined population in at least one of the areas the review focused on. Four researchers independently screened 1,618 abstracts and 566 full-text articles for evaluation of study eligibility. Eligible full-text articles were then reviewed to summarize the results and assess the quality of evidence. Additionally, data from 13 eligible case and multi-case studies, each having less than 10 participants, were extracted to summarize their results. Quality assessment of evidence was made adapting the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) process, and reporting of the results adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Results: Three articles with the quality of evidence graded as very-low to low, fulfilled the eligibility criteria set. Due to the heterogeneity of the articles, only a descriptive summary could be generated from the results. Unilateral hearing impairment was reported to have a negative impact on preverbal vocalization of infants and on sound localization and speech perception both in quiet and in n...

Benefits of Cartilage Conduction Hearing Aids for Speech Perception in Unilateral Aural Atresia

“…Unilateral hearing deficit deprives individuals of the benefits of binaural hearing naturally present in individuals with normal hearing and disturbs auditory development [ 1 , 2 , 3 , 4 ]. Thus, auditory intervention is required for unilateral hearing disability as well as for binaural disability.…”

Decision-making following identification of an infant's unilateral hearing loss: Parent and professional perspectives

“…In their study, 35% of the 60 children who had normal hearing thresholds in one ear and some degree of hearing loss in the other had failed at least one grade at school, and a further 13% required some additional support in the classroom. The past decade has seen many published articles on UHL in both children and adults, although high-quality evidence on outcomes and interventions remains scarce [3].…”

“…Recent systematic reviews have examined a number of topics related to children with UHL, including auditory outcomes of conventional hearing aids, bone-conduction devices, remote microphone systems and contralateral routing of signal aids [4], speech and language outcomes [5], the impact of early onset UHL on children [3], bone-conduction devices [6], 1 A child is considered to have a unilateral hearing loss (UHL) if they have hearing thresholds in the normal range in one ear and any degree of hearing loss in the other. Children with hearing thresholds in the normal range in one ear and a hearing loss that could not be helped with acoustic amplification are described as having single-sided deafness.…”

Newborn Hearing Screening and Intervention in Children with Unilateral Hearing Impairment: Clinical Practices in Three Nordic Countries

“…Among the types of hearing impairment (HI), unilateral hearing impairment (UHI) is relatively common, comprising around 20–50% of all congenital HIs [ 1 , 2 , 3 , 4 ]. Still, compared to especially severe and profound bilateral HI, research on the outcomes of congenital or early-onset UHI is scarce [ 5 ], and recommendations for the timing, scope and content of early intervention for this group are based on limited empirical evidence [ 6 ]. This allows much room for individual practices, and clinics may vary in their approaches to diagnostic procedures and habilitation.…”

“…Heterogeneity in reported outcomes can be attributed to various factors, such as methodological issues and variations in the study samples regarding aetiology and access to early intervention [ 24 , 26 , 27 , 28 ]. As shown by recent systematic reviews [ 5 , 28 ], only a few high-quality studies have addressed development in children with early-identified UHI. Overall, the dearth of studies and inconsistency of outcomes leave clinicians with limited evidence base, which, in turn, may induce heterogeneity in routines regarding diagnosis and habilitation [ 27 ].…”