Studies explore disadvantages for children who are deaf, hard of hearing

ByRose Weldon

Fact checked byCarol L. DiBerardino, MLA, ELS

Key takeaways:

"Worse hearing is associated with worse quality of life" across all social groups, a UCSF researcher said.
These children also lost exposure to speech due to COVID-19 lockdowns, according to a Canadian study.

Children who are deaf or hard of hearing have worse quality of life, and COVID-19 lockdowns had disrupted their exposure to speech during important periods of development, according to a pair of studies published in JAMA Network Open.

Lower quality of life

“When it is more difficult for you to hear, you can struggle in social situations or noisy listening situations,” Dylan K. Chan, MD, PhD, FAAP, director of the Children's Communication Center at the University of California, San Francisco, told Healio. “You can mishear a friend or teacher and suffer social and educational consequences. Kids can either withdraw, because they have trouble engaging in conversation, or act out, because of attention-seeking or frustration with communication.”

Chan and colleagues investigated the issue using the Hearing Environments and Reflection on Quality of Life, a validated survey to assess the hearing-related quality of life (QOL) in children, at their multidisciplinary clinic for deaf or hard-of-hearing (DHH) children.

“We were interested in using this instrument to better understand the hearing-related QOL in the diverse population of DHH children that we care for in Northern California, so that we can better understand their needs and how we can address them,” Chan said.

Over the course of 8 years, from 2014 to 2022, the researchers administered the survey to 583 children attending the clinic. Patients aged 7 to 12 years received the 26-question child version of the survey, and those aged 13 to 18 years received a 28-question version meant for adolescents. The authors then examined the results to look for associations between QOL measurements and other sociodemographic and clinical variables. They also conducted an analysis examining the association of QOL with the Area Deprivation Index (ADI), a “measure based on home address that represents the overall social vulnerability of the child,” according to Chan.

Among those who completed the survey, 299 were chosen for inclusion in the study, and the overall ADI ranking was 3.92, indicating that 60.8% of census block groups in California were less socioeconomically disadvantaged than the study population.

“The main finding was that children with more hearing loss had worse quality of life,” Chan said. “This finding was present even when accounting for all of the demographic variables, showing that worse hearing is associated with worse QOL, overall, across all different social groups.”

Additionally, they found that worse ADI, or showing more deprivation, was associated with worse hearing-related QOL.

“The more socially vulnerable the child, the more likely they are to have poorer hearing-related QOL and be more affected by the hearing loss,” Chan said. “This means that we need to do a better job of understanding and improving hearing-related [QOL], especially in our vulnerable children.”

Chan added that he is interested in investigations that “identify, describe and measure ways to specifically improve hearing-related [QOL] that take into the unique needs of different groups of children” in the future.

Effects of lockdowns

The second study was conducted by researchers at Archie’s Cochlear Implant Laboratory at the Hospital for Sick Children in Toronto, who examined how school closures due to COVID-19 lockdowns were associated with reduced exposure to spoken communications among children using cochlear implants.

The cohort study involved 262 children who used implants, with 137 using simultaneous bilateral cochlear implants, 87 using unilateral cochlear implants and 38 using sequential bilateral cochlear implants. The authors noted a slight increase among preschool-aged children using bilateral cochlear implants during the pandemic.

The researchers measured sound environments via 2,746 datalogs from the implants during Jan. 1, 2018, to Nov. 11, 2021, which encompassed over a year of COVID-19 lockdowns in Ontario.

“Daily hours of sound were captured by the cochlear implant datalogging system and categorized into six auditory scene categories, including speech and speech-in-noise,” the authors wrote. “Time exposed to speech was calculated as the sum of daily hours in speech and daily hours in speech-in-noise.”

Before the pandemic, they found children had exposure to speech for about 50% of the time they used their cochlear implants across the board, but school-aged children experienced decreased speech exposures in the early pandemic period, with early pandemic decreases for users of bilateral cochlear implants (12.1%) and unilateral cochlear implants (15.5%) and late-pandemic decreases for users of bilateral cochlear implants (5.3%) and unilateral cochlear implants (11.2%) from the pre-pandemic baseline.

“This cohort study confirms earlier findings of reduced exposure to speech among school-aged children using cochlear implants at initial stages of the COVID-19 pandemic and demonstrates a sustained decrease over the following 2 years,” the authors noted. “The findings likely reflect experiences of many children through the pandemic and highlight the need for monitoring to prevent potential developmental sequelae of decreased speech exposure.”