Question
Can you please discuss some appropriate treatment options for children with low frequency hearing loss? We know that children with mild, minimal and unilateral hearing loss have a greater incidence of academic difficulties, but when hearing above 1kHz is normal, and the child is doing well academically, what would be some audiological or treatment considerations?
Answer
This is an interesting question and one for which we do not have much empirical data. In 1968, the Vanderbilt University Hereditary Deafness Study Group described a multi-generational family with dominantly-inherited, low-frequency hearing loss. Over 25 years later, this family was contacted again and 69 persons from three generations of the family were included in another study (Hall, San Agustin, & Bess, 1995). The family members ranged in age from three months to 59 years and none of them were successful hearing aid users. That finding is consistent with my clinical experience. Children and adults with low-frequency hearing loss typically do not perceive themselves as having a hearing handicap, thus, do not see a need for amplification. This lack of a perceived hearing handicap is likely because of the generally good speech perception skills noted at average conversational speech levels.
Despite the lack of reported need for traditional amplification in children with low-frequency hearing loss, a conservative management approach would call for ongoing audiological monitoring. This should include functional auditory assessments so "real world" listening can be assessed. If deficits in academics or with listening-in-noise tests occur, trial use of FM system technology in the classroom setting should be undertaken. As with all childhood hearing loss, a complete examination by an otologist is recommended to determine etiology.
References:
Hall JW, San Agustin TB, Bess FH. (1995). Nonsyndromic, dominant, progressive, low frequency, cochlear hearing loss unlinked to chromosome 5q31 in a multigenerational family. Retrieved 1-28-09 from www.aro.org/archives/1995/352.html.
Lesperance MM, Hall JW III, Bess FH, Fukushima K, Jain PK, Plopils B, San Agustin TB, Skarka H, Smith RJH, Wills M, Wilcox ER (1995). A gene for autosomal dominant nonsyndromic hereditary hearing impairment maps to 4p16.3. Human Molecular Genetics, 4(10):1967-1972.
The Vanderbilt University Hereditary Deafness Study Group (1968). Dominantly inherited low-frequency hearing loss. Arch Otolaryngol, 88:40-48.
Anne Marie Tharpe is a Professor in the Department of Hearing and Speech Sciences at the Vanderbilt Bill Wilkerson Center and is the Associate Director of Education for the National Center for Childhood Deafness and Family Communication at Vanderbilt University. Dr. Tharpe's clinical and research interests are in the area of pediatric audiology. Primary research goals include identifying the special auditory needs of children with multiple disabilities, and examining the developmental implications of hearing loss in infants and children, including minimal degrees of loss. Recent studies have focused on the development of visual attention, emotion recognition, and environmental exploration in children with hearing loss.
