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Impact of childhood hearing loss on early development, health and educational outcomes

Supervisors: Dr Rachel Knowles

Background:

Around 112 per 100,000 UK children are living with a permanent childhood hearing loss (HL) and many more have intermittent or unilateral HL.1 HL has implications for a child’s development and presents considerable educational, occupational and social challenges throughout life. The causes of HL have changed over the decades, as the survival of low birth weight and preterm infants improves, and childhood immunisation programmes have reduced congenital infections, such as rubella, that cause deafness. Children with bilateral HL may be offered hearing aids, speech and language therapy, and/or electronic cochlear implants. Despite this, they remain at risk of delayed speech and language development, which has an adverse impact on their school-readiness, maths and literacy skills, and mental health.1,2,3 Over 40% of hearing impaired children leave primary school without achieving expected levels in reading, writing and maths.4

In 2006, the NHS introduced the universal Newborn Hearing Screening Programme (NHSP)5; around 3% of babies are referred for diagnostic investigations after a positive screen result. However some infants will inevitably be missed while others have progressive or delayed onset HL which cannot be detected until later in childhood. It is unclear how many children are diagnosed late and whether they are more likely to experience adverse health and educational outcomes as a consequence. This study will use population surveillance methods to identify later diagnosed cases and investigate the contemporary epidemiology of childhood HL in the era of newborn screening. Data linkage to key national datasets (e.g. National Disease Registers (NDRS], Hospital Episode Statistics [HES], National Pupil Database [NPD]) will be used to explore health and educational outcomes of children diagnosed with HL, comparing those who are and are not detected by screening.

This study aims to improve understanding of the disease burden, care pathways and outcomes of HL, inform health and education policy, and support improvements in screening programme performance and clinical practice to optimise the health, development, and school achievement of children with HL. The studentship will be based within the Population, Policy and Practice Programme at UCL Great Ormond St Institute of Child Health. It offers an opportunity to gain generic and specific research skills during the conduct of a population-based study within a life course framework. The studentship will provide high quality training in data science techniques, life course epidemiology, population surveillance and child public health.

Aims/Objectives:
This project will explore (1) the frequency of childhood HL in a population with universal newborn hearing screening, (2) childhood health and educational outcomes and (3) identify early life factors that predict worse outcomes. 

Methods:
This mixed methods project will involve (1) critical literature review, (2) data linkage of routine screening, health and education datasets and the application of statistical and epidemiological approaches to quantitative data analysis and (3) qualitative primary data collection (semi-structured interviews) and thematic analysis. 

Timeline:
Months 0-12: Obtaining NHSP data and analysing the population frequency of HL in newborns by sex, ethnicity and HL severity; initiating national surveillance for late HL diagnoses; literature review of child educational outcomes following newborn screening detection; training in data linkage, life course and statistical analysis techniques.
Months 13-24: Describing the frequency, distribution by sex, ethnicity and age of late diagnosed cases. Undertaking individual data linkage between NHSP, mortality, hospital attendance or admission data (HES) and pupil-level education data (NPD) to support investigation of outcomes for children with HL identified by newborn screening or surveillance.
Months 25-36: Completing analyses of linked datasets to investigate the individual child characteristics or early life exposures that predict worse educational outcomes that might be mitigated through improved early detection and treatment. Final writing up and submission of thesis.

References:
1.    Davis A, et al. A critical review of the role of neonatal hearing screening in the detection of congenital hearing impairment. Health Technol Assess 1997;1(10):i-iv,1-176.
2.    Pimperton H, et al. The impact of universal newborn hearing screening on long-term literacy outcomes: a prospective cohort study. Arch Dis Child 2016;101(1):9-15.
3.    Butcher E, et al. The association between childhood hearing loss and self-reported peer victimisation, depressive symptoms, and self-harm: longitudinal analyses of a prospective, nationally representative cohort study. BMC Public Health. 2022;22(1):1045. 
4.    NDCS note on Department for Education figures for attainment for deaf children in 2014. London: National Deaf Children's Society, 2015.
5.    Wood SA, et al. Performance and characteristics of the Newborn Hearing Screening Programme in England: The first seven years. Int J Audiol 2015;54(6):353-8.