Dr Zeffie Poulakis1,2,3, Ms Danielle Edgar1, Ms Christine Poulis4, Ms Alison King5, A/Prof Valerie Sung1,2,3,6
1Centre for Community Child Health, Royal Children’s Hospital Melbourne, Parkville, Australia, 2Department of Paediatrics, University of Melbourne, Parkville, Australia, 3Population Health, Murdoch Children’s Research Institute, Parkville, Australia, 4Department of Audiology, Royal Children’s Hospital Melbourne, Parkville, Australia, 5Hearing Australia, Macquarie University, Australia, 6Department of General Medicine, Royal Children’s Hospital Melbourne, Parkville, Australia
Universal newborn hearing screening has enabled early detection, intervention and management of congenital hearing loss. Although the target screening condition is permanent bilateral moderate to profound hearing loss, advancing technology in hearing screening and diagnostic devices has also resulted in detection of mild/unilateral hearing loss.
Earlier amplification/intervention for children with moderate to profound hearing loss has been empirically demonstrated to lead to improved language/communication outcomes. However, for those children with mild/unilateral loss diagnosed following a positive newborn hearing screen result, there is lack of evidence on effectiveness of early amplification/intervention. Children with mild/unilateral loss account for almost 50% of children with congenital hearing loss and despite the absence of evidence it is this group with the greatest increase in device fitting by Hearing Australia over time. Not only are there significant resource implications, there are differing opinions about the impact of such losses, leading to lack of uniformity of care.
Screening programs may classify mild/unilateral hearing loss as a “false positive” result, while clinicians feel morally obliged to act. Meanwhile, families bear the burden of making decisions without adequate information, and at times contradictory information, on potential outcomes – many parents choose hearing aid fitting in the hope of potentially avoiding negative outcomes, yet there are potential harms: frequent audiology visits to adjust moulds as the child grows, parental stress guilt when children are non-compliant, equipment and cost issues. Most of all, are we potentially doing harm by prematurely labelling, overservicing or diverting attention away from children who need more help?
This paper will discuss the challenges faced by screening programs, clinicians, and parents when an infant is diagnosed with a condition where there are differences in opinions in their management.
Biography:
Zeffie Poulakis (zeffie.poulakis@rch.org.au) is a psychologist and co-director of the Victorian Infant Hearing Screening Program (VIHSP). Danielle Edgar (danielle.edgar@rch.org.au) is a teacher of the deaf, and manager of the VIHSP Early Support Service. Christine Poulis (christine.poulis@rch.org.au) is a Senior Audiologist and Manager of Audiology at the Royal Children’s Hospital Melbourne. Alison King (alison.king@hearing.com.au) is the Principal Audiologist for Hearing Australia’s Paediatric Service. Valerie Sung (valerie.sung@rch.org.au) is a paediatrician and research fellow who leads a hearing loss research group at the Murdoch Children’s Research Institute, and a paediatric hearing loss clinic at the Royal Children’s Hospital in Melbourne.