Child: care, health and development 1976, 2, 107-111
Follow-up at 11 years of 46 children with severe unilateral hearing loss at 7 years C A T H E R I N E S. P E C K H A M Senior Medical Research Officer, National Children's Bureau, 8 Wakley Street, London ECi MARY D. S H E R I D A N Consultant Paediatrician Emeritus, Gufs Hospital and the Nuffield Centre of Speech and Hearing, London WCi Accepted for publication 7 January 1976
SUMMARY In the ongoing NCDS, 44 children of the 46 identified at 7 years as having a serious unilateral hearing loss were followed up at 11 years. Half of them had recovered normal bilateral hearing, the remainder still had serious deafness in one ear. Although at 7 years the 46 children as a group had shown backwardness in oral ability, speech and reading, at 11 years both the 'recovered' and the 'persistent' were similar to their age peers in scholastic attainment. Despite their original apparent difficulty it was encouraging to find that several children in both subgroups were noted as possessing outstanding academic ability. It is concluded that with prompt follow-up by an alerted school doctor, children with unilateral deafness at age 7 years are likely to progress satisfactorily in later childhood.
We have been unable to discover any reported information in the literature about the long-term effects on a child, of unilateral hearing loss. The National Child Development Study (NCDS) (Davie et al. 1972), which is an ongoing study of the developmental progress of all children in England, Scotland and Wales born in one week in 1958, provided such an opportunity. At 7 years of age pure-tone audiograms were carried out on 11 276 of the children in the NCDS sample. This identified severe unilateral hearing loss of 55 dB or greater on two or more of the speech frequencies in 46 children, 23 boys and 23 girls, a prevalence of 4 per 1000 (Sheridan 1972). A detailed study of these 46 children revealed that in addition to a hearing loss, they were reported as a group to show poor oral ability, speech difficulties and backwardness in reading as compared with children who had normal hearing (Peckham et al. 1972). The longitudinal nature of the study has enabled us to re-examine the medical and educational status of these same children at 11 years of age. The 107
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Catherine S. Peckham and Mary D. Sheridan
related individual reports at 7 and at 11 years provided information of considerable clinical interest. The follow-up procedure at 11 years was similar to that carried out at 7 years. Three detailed reports were again requested for every child together with a pure-tone audiogram. A parental report was filled in by the health visitor who interviewed the parents at home. A medical report was provided by the examining doctor. An educational form was completed by the teacher, who also administered an arithmetic test and a reading test, which were developed by the National Foundation for Educational Research (NFER).
STUDY CHILDREN
Information at 11 years was available for all but two of the 46 children identified at 7 years. The parents of these two missing children refused to participate in the ii-year-old follow-up. One of them, who had also been reported to be clumsy, to have poor motor coordination, to be microcephalic and 'maladjusted', had already been formally ascertained as educationally subnormal (ESN) at 7 years. The other child had no apparent additional handicap at 7 years and speech was reported to be satisfactory. At II years, two of the 44 children for whom information was available had, since 7 years, been formally ascertained as being in need of special educational treatment as ESN (Figure i). One who was attending a special school, still demonstrated a severe unilateral hearing loss. The second child, who was attending a private school, had a heart defect (Fallot's tetralogy) operated on at the age of eight years, a spinal deformity, poor motor coordination and difficulty in visual perception. She was reported to have a permanent left hearing loss and poor speech. The one child reported to be attending a partially hearing unit at 7 years was now satisfactorily placed in an ordinary school. Two of the 42 children in ordinary schools were receiving remedial help for educational backwardness. One was in a remedial class although the teacher considered that she would benefit from attendance at a special school for ESN children. She had been in foster care and was reported to be backward at 7 years; her audiogram at 11 years was normal. The other child was the youngest of a large family. At 7 years he was reported to have poor speech, to be clumsy and uncooperative. His audiogram at 11 years revealed a continuing severe right hearing loss which was clinically confirmed.
Follow-up of children with severe unilateral hearing loss
109
7 years — 46 children 11 years — No information 2 children Information
1 ESN
44
children
1 ESN and physically handicapped
42 In ordinary schools
FIGURE I . School placement.
Audiograms and hearing assessment at ii years
We were able to obtain pure-tone audiograms for 32 of the 42 children attending ordinary schools. Severe unilateral hearing loss was still present in 18 of the 32 children (56%), 12 in the right ear and 6 in the left. One child now had a residual moderate unilateral loss, and 13 had recovered normal hearing. No audiogram was available for 10 children. Four of these were still assessed on clinical evidence as having a unilateral hearing loss, one child had a congenital absence of the right ear and no chnical or audiometric information was available for the remaining five children. Audiometric and/or medical evidence was therefore available for 37 of the 42 children attending ordinary schools. Twenty of them were judged by the examining doctor to have a significant hearing loss. This was considered to be severe enough to interfere with everyday functioning in 11 children but none of them had ever worn a hearing aid. Parental information strongly supported the medical findings. In fact, 23 children (i.e. an additional 3) were considered by their parents still to have a significant hearing loss. Speech
At 7 years a higher proportion of the study group than of children with normal hearing were reported to have speech difficulties. At 11 years, however, only 4 of the group were reported by teachers still to have poor speech intelligibility, 2 of whom were assessed by the doctor to have a defect of articulation. None of the group were reported to be having speech therapy or to have ever had it in the past.
no
Catherine S. Peckham and Mary D. Sheridan
Motor coordination A significantly higher proportion of the children with severe unilateral deafness than children with normal hearing were reported by their teachers at 7 years to be clumsy (Peckham et al. 1972). At 11 years, this was no longer so marked, 19% being rated as having poor coordination, whereas this applied to 14% of the whole population.
Scholastic attainments
Although at 7 years the 46 study children as a group had shown backwardness in oral ability and reading, by the age of 11 years there was little difference in test scores for reading and arithmetic between children with severe unilateral deafness and the whole sample (Figure 2). In addition, and contrary to our expectation, scrutiny of individual records revealed that the children with persistent severe unilateral deafness and those who had recovered normal bilateral hearing showed very similar levels of attainment, some being reported to be of outstanding academic ability and promise. Unilateral deafness group
Poor ability
Medium ability
Good ability
L J NCDS sample
Poor ability
Medium ability
Good ability
FIGURE 2. Reading and arithmetic scores at 11 years.
COMMENT
Of the children identified as having severe unilateral hearing loss at 7 years, half had recovered normal hearing by 11 years of age. This suggests that the cause of deafness at 7 years in those who had recovered was probably con-
Follow-up of children with severe unilateral hearing loss
111
ductive and temporary in nature. Although at 7 years unilaterally deaf children were reported by their teachers to have more speech problems than normally hearing children, these had subsequently resolved satisfactorily. Since none of the study children had received speech therapy this improvement apparently occurred spontaneously. As a group, the unilaterally deaf children were reported to be doing as well as their age peers at school. This encouraging finding was confirmed by the results of educational tests used in the survey. ACKNOWLEDGEMENTS This work was supported by a grant from the Department of Health and Social Security, the Department of Education and Science and the Social Science Research Council.
REFERENCES & GOLDSTEIN H . (1972) From Birth to Seven. Longman, London, in association with the National Children's Bureau PECKHAM C.S., SHERIDAN, M . D . & BUTLER N.R. (1972) School attainment of sevenyear-old children with hearing difficulties. Developmental Medicine and Child Neurology 14, 592 SHERIDAN M.D. (1972) Reported incidence of hearing loss in children of 7 years. Developmental Medicine and Child Neurology 14, 296 DAVIE R., BUTLER N . R .
Follow-up at 11 years of 46 children with severe unilateral hearing loss at 7 years C A T H E R I N E S. P E C K H A M Senior Medical Research Officer, National Children's Bureau, 8 Wakley Street, London ECi MARY D. S H E R I D A N Consultant Paediatrician Emeritus, Gufs Hospital and the Nuffield Centre of Speech and Hearing, London WCi Accepted for publication 7 January 1976
SUMMARY In the ongoing NCDS, 44 children of the 46 identified at 7 years as having a serious unilateral hearing loss were followed up at 11 years. Half of them had recovered normal bilateral hearing, the remainder still had serious deafness in one ear. Although at 7 years the 46 children as a group had shown backwardness in oral ability, speech and reading, at 11 years both the 'recovered' and the 'persistent' were similar to their age peers in scholastic attainment. Despite their original apparent difficulty it was encouraging to find that several children in both subgroups were noted as possessing outstanding academic ability. It is concluded that with prompt follow-up by an alerted school doctor, children with unilateral deafness at age 7 years are likely to progress satisfactorily in later childhood.
We have been unable to discover any reported information in the literature about the long-term effects on a child, of unilateral hearing loss. The National Child Development Study (NCDS) (Davie et al. 1972), which is an ongoing study of the developmental progress of all children in England, Scotland and Wales born in one week in 1958, provided such an opportunity. At 7 years of age pure-tone audiograms were carried out on 11 276 of the children in the NCDS sample. This identified severe unilateral hearing loss of 55 dB or greater on two or more of the speech frequencies in 46 children, 23 boys and 23 girls, a prevalence of 4 per 1000 (Sheridan 1972). A detailed study of these 46 children revealed that in addition to a hearing loss, they were reported as a group to show poor oral ability, speech difficulties and backwardness in reading as compared with children who had normal hearing (Peckham et al. 1972). The longitudinal nature of the study has enabled us to re-examine the medical and educational status of these same children at 11 years of age. The 107
io8
Catherine S. Peckham and Mary D. Sheridan
related individual reports at 7 and at 11 years provided information of considerable clinical interest. The follow-up procedure at 11 years was similar to that carried out at 7 years. Three detailed reports were again requested for every child together with a pure-tone audiogram. A parental report was filled in by the health visitor who interviewed the parents at home. A medical report was provided by the examining doctor. An educational form was completed by the teacher, who also administered an arithmetic test and a reading test, which were developed by the National Foundation for Educational Research (NFER).
STUDY CHILDREN
Information at 11 years was available for all but two of the 46 children identified at 7 years. The parents of these two missing children refused to participate in the ii-year-old follow-up. One of them, who had also been reported to be clumsy, to have poor motor coordination, to be microcephalic and 'maladjusted', had already been formally ascertained as educationally subnormal (ESN) at 7 years. The other child had no apparent additional handicap at 7 years and speech was reported to be satisfactory. At II years, two of the 44 children for whom information was available had, since 7 years, been formally ascertained as being in need of special educational treatment as ESN (Figure i). One who was attending a special school, still demonstrated a severe unilateral hearing loss. The second child, who was attending a private school, had a heart defect (Fallot's tetralogy) operated on at the age of eight years, a spinal deformity, poor motor coordination and difficulty in visual perception. She was reported to have a permanent left hearing loss and poor speech. The one child reported to be attending a partially hearing unit at 7 years was now satisfactorily placed in an ordinary school. Two of the 42 children in ordinary schools were receiving remedial help for educational backwardness. One was in a remedial class although the teacher considered that she would benefit from attendance at a special school for ESN children. She had been in foster care and was reported to be backward at 7 years; her audiogram at 11 years was normal. The other child was the youngest of a large family. At 7 years he was reported to have poor speech, to be clumsy and uncooperative. His audiogram at 11 years revealed a continuing severe right hearing loss which was clinically confirmed.
Follow-up of children with severe unilateral hearing loss
109
7 years — 46 children 11 years — No information 2 children Information
1 ESN
44
children
1 ESN and physically handicapped
42 In ordinary schools
FIGURE I . School placement.
Audiograms and hearing assessment at ii years
We were able to obtain pure-tone audiograms for 32 of the 42 children attending ordinary schools. Severe unilateral hearing loss was still present in 18 of the 32 children (56%), 12 in the right ear and 6 in the left. One child now had a residual moderate unilateral loss, and 13 had recovered normal hearing. No audiogram was available for 10 children. Four of these were still assessed on clinical evidence as having a unilateral hearing loss, one child had a congenital absence of the right ear and no chnical or audiometric information was available for the remaining five children. Audiometric and/or medical evidence was therefore available for 37 of the 42 children attending ordinary schools. Twenty of them were judged by the examining doctor to have a significant hearing loss. This was considered to be severe enough to interfere with everyday functioning in 11 children but none of them had ever worn a hearing aid. Parental information strongly supported the medical findings. In fact, 23 children (i.e. an additional 3) were considered by their parents still to have a significant hearing loss. Speech
At 7 years a higher proportion of the study group than of children with normal hearing were reported to have speech difficulties. At 11 years, however, only 4 of the group were reported by teachers still to have poor speech intelligibility, 2 of whom were assessed by the doctor to have a defect of articulation. None of the group were reported to be having speech therapy or to have ever had it in the past.
no
Catherine S. Peckham and Mary D. Sheridan
Motor coordination A significantly higher proportion of the children with severe unilateral deafness than children with normal hearing were reported by their teachers at 7 years to be clumsy (Peckham et al. 1972). At 11 years, this was no longer so marked, 19% being rated as having poor coordination, whereas this applied to 14% of the whole population.
Scholastic attainments
Although at 7 years the 46 study children as a group had shown backwardness in oral ability and reading, by the age of 11 years there was little difference in test scores for reading and arithmetic between children with severe unilateral deafness and the whole sample (Figure 2). In addition, and contrary to our expectation, scrutiny of individual records revealed that the children with persistent severe unilateral deafness and those who had recovered normal bilateral hearing showed very similar levels of attainment, some being reported to be of outstanding academic ability and promise. Unilateral deafness group
Poor ability
Medium ability
Good ability
L J NCDS sample
Poor ability
Medium ability
Good ability
FIGURE 2. Reading and arithmetic scores at 11 years.
COMMENT
Of the children identified as having severe unilateral hearing loss at 7 years, half had recovered normal hearing by 11 years of age. This suggests that the cause of deafness at 7 years in those who had recovered was probably con-
Follow-up of children with severe unilateral hearing loss
111
ductive and temporary in nature. Although at 7 years unilaterally deaf children were reported by their teachers to have more speech problems than normally hearing children, these had subsequently resolved satisfactorily. Since none of the study children had received speech therapy this improvement apparently occurred spontaneously. As a group, the unilaterally deaf children were reported to be doing as well as their age peers at school. This encouraging finding was confirmed by the results of educational tests used in the survey. ACKNOWLEDGEMENTS This work was supported by a grant from the Department of Health and Social Security, the Department of Education and Science and the Social Science Research Council.
REFERENCES & GOLDSTEIN H . (1972) From Birth to Seven. Longman, London, in association with the National Children's Bureau PECKHAM C.S., SHERIDAN, M . D . & BUTLER N.R. (1972) School attainment of sevenyear-old children with hearing difficulties. Developmental Medicine and Child Neurology 14, 592 SHERIDAN M.D. (1972) Reported incidence of hearing loss in children of 7 years. Developmental Medicine and Child Neurology 14, 296 DAVIE R., BUTLER N . R .
