Hearing Health and Development Following Adoption

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All my life I have been blessed with excellent hearing perception and health. Now due to my mold allergies, I have started to have fluid in my middle ear when the humidity and mold count rises above normal. The extra fluid in my ears has annoyingly affected my hearing acuity and balance. On one hand, I now understand how children feel when they have otitis media but on the other hand, I want to get rid of this ailment as quickly as I can! Naturally I sought the advice of an audiologist who completed impedance testing. As it turns out, my tympanograms showed only a small loss of flexibility in the tympanic membrane and fell in the low normal range. Typically most medical professionals would not treat a patient who exhibited these symptoms preferring to wait until the patient demonstrated consistent flat tympanograms or infection. Although I exhibit neither of these conditions, the small amount of fluid in my ear has significantly reduced my hearing acuity especially in noisy environments like the classroom. I wonder how can children focus and learn when they have fluid in the middle ear?

Children who reside in orphanages around the world may receive less than adequate medical care. Otitis media is often untreated and children’s hearing is not tested or monitored (Bledsoe & Johnston, 2004; Johnson, 2000). Due to the lack of attention to hearing health, it is not unusual for children to become accustomed to the symptoms of ear pain, imbalance, and poor hearing acuity. When parents adopt these children, they may expect the children to demonstrate behaviors of discomfort when ill. However, because of the lack of attention to hearing health, the children do not show symptoms of pain or lack of balance and the parents may not recognize when to seek medical care. At the International Adoption Clinic at Saint Louis University, I have seen children with undiagnosed hearing loss and ear infections, some of whom had previously seen a pediatrician the day before.

Additionally, children residing in orphanages are cared for by a rotation of adults where the child to adult ratio may be high. Johnson reported on conditions of care in Romanian orphanages where children were often left in their cribs/beds, received little if any social interaction from caregivers, and had few experiences with toys or educational stimulation. As a result, children’s hearing experiences were unmentored and they may not have learned which sounds were meaningful to attend to or what certain sounds meant.

Sometimes years after they were adopted, some children who passed a hearing screening and audiological evaluation did not alert to environmental sounds (whistles, knocks on the door, telephones, or their name being called). I have also seen children who have difficulty attending to and discriminating speech from noise as well as children with an undetected/undiagnosed hearing loss. Without careful assessment by professionals with expertise with internationally adopted children, these children may slip through the cracks and not receive appropriate services.

It is important to conduct a thorough evidence-based assessment when an internationally adopted child is referred or presents with hearing, speech, language, or attention problems. Hearing screenings including otoscopic evaluation, impedance audiometry and sound field or pure tone audiometry should be included unless the child has recently been evaluated by an audiologist. An in-depth case history of hearing, attention, speech and language behaviors and development should be collected. If the child passes all audiological measures, the speech-language pathologist should also assess the child’s knowledge of meaningful sounds as well as hearing discrimination and perception in quiet and noise and in some cases, additional audiological assessment for auditory processing disorder may be warranted.

References

Bledsoe, J. M., & Johnston, B. D. (2004). Preparing families for international adoption.
Pediatrics in Review, 25(7), 241-249. Retrieved from: http://bit.ly/kEy1iU

Johnson, D.E. (2000). Medical and developmental sequelae of early childhood
institutionalization in Eastern European adoptees. In C.A. Nelson (Ed.), The
Minnesota symposia on child psychology: The effects of early adversity on
neurobehavioral development (Vol. 31, pp.113-162). Minnesota Symposium on
Child Psychology.

Deborah Hwa-Froelich, Ph.D., CCC-SLP, is a Saint Louis University professor and Director of the International Adoption Clinic with interests in social effects on communication such as culture, poverty, parent-child interaction, maternal/child health, and disrupted development.