Mild and Unilateral Hearing Loss in Children

What is mild hearing loss?

Hearing loss is determined by the softest sound a person can hear in decibels. In adults, mild hearing loss occurs when the softest sounds a person can hear on average fall between 26 and 40 decibels. In children, mild hearing loss occurs between 16 and 40 decibels.

What is unilateral hearing loss?

Unilateral hearing loss occurs when one ear can hear within the normal hearing range, while the contralateral ear has some degree of hearing loss.

What are some issues that children with mild hearing loss or unilateral hearing loss may experience?

• Sound cannot be heard well from the ear/s that has/have hearing loss. This might seem obvious, but it is important to remember this when talking to a child, especially if they have unilateral hearing loss. It is also important to think about classroom seating. The appropriate seating arrangement can make a big difference in a child’s ability to hear and learn. Preferential seating does not always mean sitting in the front of the classroom, and this varies depending upon the classroom. Generally for unilateral hearing loss, the normal hearing ear should be closest to the teacher and farthest away from potential noise sources e.g. hallway, windows, fans and other equipment.
• Sounds and speech need to be louder. Hearing loss makes it harder to listen for long periods of time. Children may become easily exhausted by having to focus on hearing instead of using those resources and attention to focus on learning and development. Consider appropriate treatment with amplification such as a hearing aid in one or both ears or use of a personal amplification system while at school. 
• It can be hard to hear speech when there is background noise. This is true for both unilateral and mild hearing loss. The ability to distinguish speech from noise becomes difficult with hearing loss. It will be harder for children to understand what someone is saying when there is a lot of noise in the background or if the speaker is located farther away.
• It is hard to know where sounds are coming from. This is particularly true for children with unilateral hearing loss. Our ability to tell where sounds come from is a result of hearing with both ears. Children may have to focus on searching for the source of sounds, or are unable to find out where a sound has come from. By the time children are able to detect where the sound or speech is coming from, they may have missed out on important information. 
• Sound quality is lost. Depending on the configuration of the hearing loss, it may be difficult to distinguish specific sounds. Speech is constructed of specific sounds that can denote tense, plurality, possessives, etc. Hearing loss hinders the ability to hear those specific sounds. Furthermore, this can be particularly challenging for children, as they are still learning language and cannot fill in those missing pieces of speech as well as an adult can.

How do unilateral and mild hearing loss impact children?

When left undetected, hearing loss of any degree, including mild bilateral and unilateral, has been shown to negatively affect speech, language, and academic and psychosocial development. Studies have also found that these children are more likely to feel more stressed over school and exhibit poorer self-esteem than their normal-hearing peers. Because children with mild and unilateral hearing loss do not hear the full picture they are more likely to experience difficulty in the following areas:

• Speech-language delay
• General communication difficulties
• Psycholinguistic dysfunction (ability to learn language)
• Social-emotional problems
• Quality of life effects
• Academic and behavioral difficulties

Evidence suggests that children with any type and degree of hearing loss are at increased risk for developmental delays, particularly when the hearing loss is identified and treated after approximately 6 months of age. It is vital for children with mild hearing loss to have a consistent support system in place at school as well as at home.

What can be done to help children with mild or unilateral hearing loss?

Early diagnosis and intervention is crucial and supports language development and learning. Babies with hearing loss since birth whose hearing loss is identified at or before six months of age, and who receive appropriate early intervention services have significantly larger vocabularies and better receptive and expressive language skills than those whose hearing loss is discovered later. This is why it is important to identify hearing loss as early as possible. The following suggestions can help children in everyday listening situations in conjunction with the recommendations of an audiologist:

• Ask for the most appropriate seating in the classroom and good lighting
• Try to limit background noise especially in the classroom (ex. tennis balls on chairs, carpets, window coverings)
• Provide a quiet area to study at home
• Make sure that hearing is checked regularly – at least once per year
• Consider using assistive listening devices, like an FM system or hearing aid, to help make listening easier    
• Use headphones as necessary (e.g. with personal home devices or TV)
• Teach your child how to use visual cues to locate sources of sound.  For example, look for the signal at a railway track, or watch for cars while playing outside
• Promote assertiveness for better hearing and understanding-for example, ask for clarification when a speaker is not clearly heard, move in closer to the signal source, position yourself accordingly so to lend your better hearing ear to the speaker