Features

Disability: hear to help

04 October 2018

In a new series on how you can help clients living with disability – from sensory impairments to mobility issues, journalist Anna Scott looks at hearing loss in children.

The number of children with hearing impairments living in the UK is growing.

Children and teenagers with hearing loss number 45,631 in England and 2642 in Wales – an 11% increase between 2016 and 2017 in both countries (CRIDE, 2018a; 2018b). In Northern Ireland, 1553 children were reported to have hearing impairments in 2017, an increase of 4% (CRIDE, 2018c).

The latest figures available for Scotland suggest the opposite – a 4% decrease in the number of children living with a hearing impairment to 2942 (CRIDE, 2018d).

But the overall picture in the UK shows that one in six people – that’s 10 million – has hearing loss or is deaf (Action on Hearing Loss, 2018), and one to two babies in every 1000 is born with permanent hearing loss in one or both ears (NHS, 2018a).

In supporting those people and their families, it’s vital that community practitioners understand the specific needs of their clients facing hearing loss.

‘People with sensory impairments need to receive the best care possible without any barriers,’ says Vaitheki Maheswaran, audiologist at Action on Hearing Loss. ‘They should be treated equally and have the same access to quality services as others.’

Developing hearing loss

Reasons for hearing loss in different age groups are many and varied (see Causes of hearing loss, below). ‘In adults, hearing loss and deafness are the result of sound signals not reaching the brain due to a problem in the hearing system,’ Vaitheki says.

‘Children can be born deaf or become deaf in childhood. It is not always possible to identify the reason, but parents may be offered further tests to try to establish the cause,’ she adds.

All children born in the UK are offered a newborn screening test at birth. ‘When that was introduced, there was a lot of confusion that it could eliminate the idea of future hearing loss,’ says Jim Harrigan, head of paediatric audiology at NHS Greater Glasgow and Clyde.

‘Children can still develop a hearing loss later on. All that we can tell [during the test] is whether at that point in time the hearing was within normal range or not.’ Some causes of hearing loss, such as cytomegalovirus, are picked up on the Guthrie card following the newborn heel prick test, he adds.

For any hearing loss in a child, says Jim, ‘the red flags would be things like poor speech development, chronic and repeated ear infections, children who are nasal or congested, some speech impediments and deteriorating behaviour.’

But looking for these signs isn’t without its complexities. ‘A two-year-old with speech that is not developing well can be very different from a 10-year-old with a reasonable vocabulary,’ he says.

‘If the parent has a concern then they should be referred – the parent knows their own child best. Each local audiology department will have its own referral criteria for community practitioners to consult.’

NHS Greater Glasgow and Clyde has a standard form that health visitors and school nurses use for referrals. The audiology department also routinely flags up to health visitors any family of a newborn baby diagnosed with a significant hearing loss.

‘It’s about awareness that the family has received some bad news, and it’s important for health visitors and those in regular contact to keep an eye on the parents.’


Causes of hearing loss in children

Before birth:

  • Genetics – family history of hearing loss
  • Infections during pregnancy, such as measles and cytomegolavirus
  • Ototoxic medication used during pregnancy
  • Disorder of the brain or nervous system
  • Genetic syndromes such as Usher, Down’s and Waardenburg

During childhood:

  • Birth complications, which could include a serious infection present at birth; the baby requiring a blood transfusion; or the use of drugs for respiratory life-sustaining measures on a premature infant.
  • Glue ear
  • Untreated middle-ear infections
  • Infections, such as meningitis, mumps, measles or whooping cough
  • Perforation of the eardrum
  • Excessive noise
  • Serious injury to the head
  • Ototoxic medication

Identifying hearing loss

Babies may have hearing loss if they:

  • Aren’t startled by loud noises
  • Seem to hear some sounds but not others
  • Notice you when you see them but not when you call their name
  • Don’t turn towards voices by the time they are four months old
  • Haven’t started to say any recognisable words by the age of 15 months.

Children may have hearing loss if they:

  • Are slow to talk or not clear when they speak
  • Don’t reply when you call them
  • Talk very loudly
  • Ask you to repeat yourself or respond inappropriately to questions
  • Turn the TV volume up very high.

Action on Hearing Loss, 2018; NHS, 2018a


Supporting children with sensory impairments

Community practitioners should also understand the kinds of issues children with hearing impairments and their families face every day. ‘In the early days, acceptance can be difficult for some families,’ says Vicki Kirwin, development manager (audiology) at the National Deaf Children’s Society.

‘Strangers might comment on the baby’s hearing aids, or family friends and extended family may offer well-meaning but unwanted advice or go hunting for information on cures for deafness.’

Families need to get used to technology as well – checking hearing aids work well, changing batteries, learning about improving acoustic environments to make listening as easy as possible, and supervising children so they can’t put hearing aids in their mouths and choke.

Logistics can be an issue. ‘If only one parent was able to attend the child’s hospital appointment, it becomes their responsibility to pass on information to other family members, at a time when they may feel they don’t fully understand the implications themselves,’ Vicki says.

‘If the baby is profoundly deaf and parents want to start learning sign language, they can find it impossible for both to attend classes. They have to deal with lots of additional professionals in their lives and learn to support their child to develop spoken language.’

The whole family is affected – siblings may resent the extra time and attention a deaf child receives.

Daily life for hearing-impaired children

Children with hearing loss may experience a strain on relationships because they miss parts of conversations. ‘Older children may become very frustrated at losing the ability to communicate easily,’ Vicki says.

‘They may have psychological difficulties related to accepting their deafness – not wanting to be different to their friends, or having to wear hearing aids for the first time. And it can be isolating for the child to only have one or two members of their family who sign with them.’

Children’s ability to learn speech can be affected, and they may have difficulties at school hearing the teacher and their peers in noisy classrooms, leading to reduced concentration levels.

‘It may be harder for people with hearing loss to hear what is being said if they are tired, everyone is talking at once, they have tinnitus or there is noise in the background,’ Vaitheki says.

Similar issues apply to adults at work, at home and in social settings, and can lead to isolation and depression. Hearing loss is associated with many other co-morbid conditions, including cardiovascular disease, diabetes and dementia, Vaitheki adds.

Signposting to support

‘Deaf children, with the right support, can do everything their hearing siblings and peers can. There is lots of support available from local services as well as the National Deaf Children’s Society,’ Vicki says.

Both adults and children with hearing loss are entitled to free hearing aids on the NHS, Vaitheki explains. ‘Additionally, a range of assistive listening devices are available. At work, people could have their communication support and equipment, such as a telephone amplifier, textphone or hearing loop.’

‘Local sensory teams offer home visits to assess how the sensory loss affects the individual’s day-to-day life. They may be able to provide appropriate equipment such as a vibrating pad which is linked to a smoke alarm, a baby alarm or wrist receiver that has been specially adapted to alert deaf parents of their baby crying,’ Vaitheki adds.

What CPs should consider

‘Each patient’s needs should be identified and met appropriately,’ Vaitheki says. ‘When communicating with an individual with hearing loss, they should be aware that even if someone is wearing hearing aids, they may still have some difficulties hearing.’

She adds that community practitioners should ensure they carry out the following:

  • Have the person’s attention before starting to speak
  • Use their name to attract their attention – people usually hear their name better than they hear other words
  • Do not approach people from behind, or tap them on the back to attract their attention – approach from the side or the front
  • Find a place to talk that has good lighting, away from noise and distractions
  • Turn your face towards the individual so they can easily see lip movements
  • Speak clearly, not too slowly, and use normal lip movements, facial expressions and gestures
  • Check what they’re saying is being understood
  • Rephrase what they have said if it not understood rather than repeat it
  • Keep your voice down: it’s uncomfortable for a hearing aid user if you shout, and it looks aggressive
  • Use plain language and get to the point.

Community practitioners have a crucial role to play in helping children communicate and allowing parents to understand the local services available. Vicki says: ‘Being able to refer children to the right place at the right time can have a significant impact on that child’s emotional, social and educational development.’

Resources

References

Action on Hearing Loss. (2018) Hearing loss and deafness. See: actiononhearingloss.org.uk/hearing-health/hearing-loss-and-deafness/ (accessed 12 September 2018).

CRIDE (Consortium for Research in Deaf Education). (2018a) CRIDE report on 2016/17 survey on education provision for deaf children in England. See: ndcs.org.uk/professional_support/national_data/cride.html#contentblock1 (accessed 12 September 2018)

CRIDE. (2018b) CRIDE report on 2016/17 survey on education provision for deaf children in Wales. See: ndcs.org.uk/professional_support/national_data/cride.html#contentblock1 (accessed 12 September 2018)

CRIDE. (2018c) CRIDE report on 2016/17 survey on education provision for deaf children in Northern Ireland. See: ndcs.org.uk/professional_support/national_data/cride.html#contentblock1 (accessed 12 September 2018)

CRIDE. (2018d) CRIDE report on 2014/15 survey on education provision for deaf children in Scotland. See: ndcs.org.uk/professional_support/national_data/cride.html#contentblock1 (accessed 12 September 2018).

National Deaf Children’s Society. (2018) New data shows councils cutting £4million for deaf children. See: ndcs.org.uk/for_the_media/press_releases/cuts_deaf_children.html (accessed 23 July 2018).

NHS. (2018a) Newborn hearing screening. See: nhs.uk/conditions/pregnancy-and-baby/newborn-hearing-test (accessed 12 September 2018).

NHS. (2018b) Signs of hearing loss in babies. See: nhs.uk/conditions/hearing-loss/symptoms/#signs-of-hearing-loss-in-babies (accessed 12 September 2018).

Image credit | iStock

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