Paediatrics (RCH) - Theses
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ItemMild and moderate congenital hearing loss in childhood: trends and associations with language outcomes( 2018)Background: Children born with mild and moderate bilateral hearing loss experience poorer language outcomes than peers without hearing loss. Following implementation of universal newborn hearing screening (UNHS) in the early 2000s, most children are now fitted with hearing aids very early, even without firm evidence of efficacy. Filling this knowledge gap would support clinicians and families to make appropriate decisions for affected children. Aims: In population-based samples of children born with mild and moderate bilateral hearing loss in two age groups, I aimed to describe the: 1) language and child wellbeing outcomes at 5-8 years of age examined both by system of hearing loss detection and age at detection; 2) relationship between measures of hearing ability (aided and unaided) and speech/language outcomes at 5-7 years of age; and 3) expressive vocabulary of children at age 1-3 years, with comparison to same-aged children without hearing loss. Methods: All participants were drawn from population-based studies or databanks with comparable measures and demographic composition in Victoria and New South Wales. In Aim 1, 21 directly assessed children (5-7 years) were analysed with 125 children (5-8 years) from historical hearing loss cohorts and 1217 children (7 years) without known hearing loss. For Aim 2, hearing aid data were obtained for 19 directly assessed children. In Aim 3, questionnaire data were compared between 20 children (1-3 years) with and 1711 children (2 years) without known hearing loss. Language was assessed or parent-reported, with additional data collected by parent questionnaire. Aim 1 was analysed using unadjusted and adjusted regression models, with potential confounders identified a priori. For Aims 2 and 3, analyses were descriptive and exploratory. Results: Outcomes for 5-7 year olds with moderate loss improved across detection systems spanning opportunistic through to UNHS (mean expressive language p for trend .05, receptive vocabulary p for trend .06) and were better when diagnosed before age 6 months. Children with mild loss did not show similar benefit, despite trends toward earlier diagnosis and hearing aid fitting. Children with mild-moderate loss had poorer expressive language than children without loss (adjusted mean difference -8.9 points, 95% CI -14.7 to -3.1). Audibility measures correlated with unaided hearing (r=-.60 to -.79, p=.02 to <.001) and speech recognition ability (r=-.63 to -.73, p=.04 to .01). Unaided and aided hearing measures did not show associations with speech and language. On average 1-3 year olds with, versus without, hearing loss had lower expressive vocabulary raw scores even though older at assessment. Language of children with mild loss was on average 9 months behind expectations (SD 5.6 months), moderate loss on average 6.6 months behind (SD 6.7 months). Conclusions: Children with mild and moderate hearing loss show early language delays that persist into primary school. Children with moderate loss showed some benefit from earlier detection and fitting with hearing aids. Children with mild loss did not, which is concerning given the current practice of earlier hearing aid fitting. A population-based trial of hearing aids for mild losses would clarify the benefits versus costs of this approach.