Butcher, Emma Jane;
(2020)
A lifecourse perspective on childhood hearing loss: prevalence, risk factors, and outcomes.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Childhood hearing loss (HL) varies in impact and can present, and resolve, at any age. Universal newborn hearing screening (UNHS) was introduced in the UK to facilitate early HL detection. This thesis addressed uncertainties over the frequency, patterns, and mental health impact of childhood HL, and evaluated UNHS programme performance. I examined the prevalence and patterns of HL between ages 9 months and 14 years using longitudinal data from children and their parents in the UK-based Millennium Cohort Study. I developed a lifecourse classification system for HL trajectories and fitted multivariable regression models to study the associations between HL and demographic and individual characteristics, as well as peer victimisation, depressive symptoms, and self-harm. Alongside this, I completed a systematic literature review and meta-analysis to estimate the UNHS-detected prevalence of permanent HL and evaluate screening programme performance. By age 14 years, HL was reported on at least one occasion for 21.1% (95% confidence interval [CI]: 19.7-22.5%) of children. This was classified into five groups by timing of onset and resolution, with most HL presenting and resolving in early childhood. Those of male sex, white ethnic background, or with limiting longstanding illness, were at higher risk of HL. HL was associated with depressive symptoms and self-harm at age 14 years, and more strongly associated with peer victimisation in females than males. In the meta-analysis, pooled prevalence of UNHS-detected HL was 1.2 (95% CI: 1.0-1.4) per 1000 screened infants. Prevalence was higher for children admitted to neonatal intensive care. UNHS performance was generally good although the limited follow-up period of most studies restricted my evaluation. These findings indicate that over 20% of children experience HL during childhood and emphasises the need for further research, and careful planning of screening, clinical care and educational services to reduce the impact on adolescent mental health.
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