Permanent Childhood Hearing Loss Research Articles

International experience and recommendations on audiological screening of schoolchildren: review.

Permanent childhood hearing loss is crucial for speech development and restricts learning abilities. Universal newborn hearing screening programs are well established to detect congenital hearing loss and address the need of hearing-impaired babies. Progressive or acquired permanent hearing loss can manifest later due to genetic causes, intrauterine or postnatal infections, middle ear diseases and excessive exposure to noise when listening the personal audio devices. The hearing loss prevalence in the population of 9 year-olds three times higher compared with newborns. School hearing screening is a part of hearing across the lifespan conception. The article presents international experience and recommendations for the organization of school hearing screening programs. A school-entry hearing test is mandatory, other grades might be screened also. The basic method is pure tone audiometry at frequencies of 500, 1 000, 2 000, 4 000 Hz at 20 dB. Otoscopy and tympanometry can be performed also, while whisper voice speech test is of low sensitivity. The main hearing screening issue is low follow-up of referrals to ascertain audiological assessment. Modern approaches to the prevention of hearing loss in schoolchildren and management of hearing impairements are described. Planning of hearing screening programs requires sufficient human and logistical resources, monitoring of results and quality improvement, all stakeholders engagement.

Evolving Essential and Desirable Requisites for Clinical Fellowship in Cochlear Implant Surgery.

Studies from developed countries show the prevalence of permanent childhood hearing loss to be 1 to 2 per thousand children. The estimated number of Ear, Nose, and Throat (ENT) specialists and otologists in India were 7000 and 2000. There is a great need for trained CI surgeons to care for that burden. Currently, only a handful of centres in the country provide CI training. This study aims to put together essential and desirable requisites for a clinical fellowship in CI surgery for ENT surgeons. A questionnaire was prepared and validated by 25 senior CI surgeons in India. Then the sixteen-question questionnaire was prepared and administered to 100 practising CI Surgeons (Group A) and 100 probable CI Fellowship Candidates (Group B). Group B involved surgeons currently pursuing their ENT post-graduation or have completed their postgraduate training and are inclined towards otology and CI surgery in the future. The responses ranged from 1 (Strongly Disagree) to 5 (Strongly Agree) on a Likert Scale. The responses from both groups were analyzed, and statistical analysis was performed using SPSS(Statistical Package for the Social Sciences) software. The results were analysed and tabulated from both groups. The weighted mean response and mean opinion to all the questions were calculated for both groups. Based on the response, "Essential" and "Desirable" criteria are given.

Awareness and Perceptions of University Nursing Students in Samoa Towards Childhood Hearing Impairment and Hearing Healthcare: A Cross-Sectional Study.

Pacific Islands have among the highest prevalence of pediatric hearing impairment in the world. Given the limited availability of ear and hearing specialists in the Pacific region, the broader health professional community plays a vital role in the prevention of avoidable pediatric hearing impairment. Nurses emerge as one of the ideal candidates for task-sharing in the administration of ear and hearing care at the public and primary healthcare levels. The aim of this study is to evaluate the awareness and perceptions of university nursing students in Samoa to pediatric hearing impairment and hearing healthcare. This study employed a cross-sectional study design. A 10-item questionnaire was administered to university nursing students in Samoa (N = 100). The statements aimed to evaluate perceptions towards childhood hearing impairment, as well as awareness of causal factors of permanent childhood hearing loss and available hearing healthcare. Participants were required to provide a response based on the five-point Likert scale "Strongly Agree," "Agree," "Neutral/Don't know," "Disagree," and "Strongly Disagree." Overall, 79% of participants responded "Disagree/Strongly Disagree" to the item "Hearing loss is not that important because it does not kill." Overall, 52% of respondents were aware of hearing impairment as a public health concern in Samoa. Early identification and intervention services for newborns with hearing impairment are nonexistent in Samoa, and awareness was low for the importance of early detection (62%) and amplification suitability for babies (49%). Overall, awareness was also low for causal factors of permanent sensorineural hearing loss. A borderline neutral/positive perception was found among our future nursing professionals to engage with pediatric hearing impairment in Samoa. Awareness regarding the causes of permanent childhood hearing impairment, as well as early identification and intervention services, could be integrated in the university curriculum.

Neonatal bacterial meningitis: hearing screening and audiological monitoring outcomes

Objective This study reviewed the outcomes of universal newborn hearing screening (UNHS) and ongoing hearing monitoring in children following recovery from neonatal bacterial meningitis to determine (a) whether screening may be a suitable alternative to diagnostic audiology for detecting permanent childhood hearing loss (PCHL) and (b) whether infants who pass UNHS should be monitored throughout childhood. Design Retrospective analysis of a UNHS database. Study sample Data were extracted from the state-wide UNHS database for all children born in Queensland Australia between 1 September 2004 and 30 June 2020 with the risk factor of bacterial meningitis (in isolation or in combination with other risk factors) identified at the time of the UNHS. This cohort included 231 children. Results Results showed that all post-meningitic infants diagnosed with PCHL had a refer result on the UNHS or were medically excluded from screening. Additionally, no cases of PCHL were identified through the targeted surveillance program following a pass result on UNHS. Conclusions UNHS may be sufficient to detect PCHL in post-meningitic neonates and routine audiological monitoring may not be required for children who pass the screen.

School hearing screening: international experience and recommendations

Permanent childhood hearing loss is crucial for speech development and restricts learning abilities. Universal newborn hearing screening programs are well established to detect congenital hearing loss and address the need of hearing-impaired babies. Progressive or acquired permanent hearing loss can manifest later due to genetic causes, intrauterine or postnatal infections, middle ear diseases and excessive exposure to noise when listening the personal audio devices. The hearing loss prevalence in the population of 9 year-olds three times higher compared with newborns. School hearing screening is a part of hearing across the lifespan conception. The article presents international experience and recommendations for the organization of school hearing screening programs. A school-entry hearing test is mandatory, other grades might be screened also. The basic method is pure tone audiometry at frequencies of 500, 1 000, 2 000, 4 000 Hz at 20 dB. Otoscopy and tympanometry can be performed also, while whisper voice speech test is of low sensitivity. The main hearing screening issue is low follow-up of referrals to ascertain audiological assessment. Modern approaches to the prevention of hearing loss in schoolchildren and management of hearing impairements are described. Planning of hearing screening programs requires sufficient human and logistical resources, monitoring of results and quality improvement, all stakeholders engagement.

Newborn Hearing Screening Benefits Children, but Global Disparities Persist.

There is substantial evidence that newborn hearing screening (NHS) reduces the negative sequelae of permanent childhood hearing loss (PCHL) if performed in programs that aim to screen all newborns in a region or nation (often referred to as Universal Newborn Hearing Screening or UNHS). The World Health Organization (WHO) has called in two resolutions for the implementation of such programs and for the collection of large-scale data. To assess the global status of NHS programs we surveyed individuals potentially involved with newborn and infant hearing screening (NIHS) in 196 countries/territories (in the following text referred to as countries). Replies were returned from 158 countries. The results indicated that 38% of the world’s newborns and infants had no or minimal hearing screening and 33% screened at least 85% of the babies (hereafter referred to as UNHS). Hearing screening programs varied considerably in quality, data acquisition, and accessibility of services for children with PCHL. In this article, we summarize the main results of the survey in the context of several recent WHO publications, particularly the World Report on Hearing, which defined advances in the implementation of NHS programs in the Member States as one of three key indicators of worldwide progress in ear and hearing care (EHC).

Predicting 9-Year Language Ability from Preschool Speech Recognition in Noise in Children Using Cochlear Implants.

The presence of congenital permanent childhood hearing loss has a negative impact on children’s development and lives. The current literature documents weaknesses in speech perception in noise and language development in many children with hearing loss. However, there is a lack of clear evidence for a longitudinal relationship between early speech perception abilities and later language skills. This study addressed the evidence gap by drawing on data collected as part of the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study. Cross-lagged regression analyses were used to examine the influence of speech perception in noise at age 5 years on language ability at age 9 years and vice versa (i.e. the influence of language ability at age 5 years on speech perception in noise at age 9 years). Data from 56 children using cochlear implants were analysed. We found that preschool speech perception in noise was a significant predictor of language ability at school age, after controlling for the effect of early language. The findings lend support to early intervention that targets the improvement of language skills, but also highlight the need for intervention and technology to enhance young children’s auditory capabilities for perceiving speech in noise in early childhood so that outcomes of children with hearing loss in school can be maximized.

Aetiology of permanent childhood hearing loss at a population level

To evaluate and describe results of aetiological investigations offered to a population level cohort of babies who had confirmed permanent hearing loss after they either (i) failed universal neonatal hearing screening or (ii) passed newborn screening but were detected with a permanent hearing loss in early childhood. Descriptive analysis of results of investigations offered to neonates and young children in whom permanent hearing loss was detected as part of a statewide newborn hearing screening programme. A total of 306 285 newborns were screened between 2013 and 2017. The failed screening results were confirmed by a diagnostic audiological assessment battery. Medical evaluation for the identification of the cause of the hearing loss was performed by a paediatrician or otolaryngologist, investigations were ordered using a stepwise approach, and aetiology was assigned using a coding scheme. Permanent hearing loss was confirmed in 967 children (0.3%). Data were available for 873. An aetiological factor was identified or presumed in 61.3% of cases. Genetic causes were present in 26.8% and structural causes were present in 24.9% of cases. Congenital cytomegalovirus was present in 4.4%. Use of a coding scheme is feasible at a population level and allows collation of data from multiple sites and will allow outcome mapping and service planning.

765The impact of childhood hearing loss on language and psychosocial outcomes: The LOCHI study

Abstract Background The Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study is a prospective study commenced in 2005 that was aimed to examine the effect of age of hearing loss identification and intervention on outcomes for children with hearing loss, such as language and psychosocial development. Permanent childhood hearing loss has a significant impact on child development. Methods 450 children identified with permanent sensorineural hearing loss prior to 3 years of age in New South Wales, Queensland and Victoria completed comprehensive speech, language and audiological assessments at defined age intervals. Multiple regression analysis and structural equation modelling (SEM) were completed to determine factors influencing outcomes at 5 and 9 years of age. Results Regression models indicated outcomes were significantly influenced by age of hearing loss intervention, nonverbal cognitive ability, maternal education level and communication mode. A significant predictive effect of early language skill was seen on later language development. SEM found that the impact of age of hearing loss intervention on language outcomes was mediated by its effect on cognitive development and speech perception. Language ability influenced psychosocial development. Conclusions Early identification and intervention of hearing loss improves language and psychosocial development, via its influence on cognitive development and speech perception. Key messages Early hearing loss identification and intervention improves language and psychosocial development for children with permanent sensorineural hearing loss. Evidence from the LOCHI study has guided clinical management guidelines of children with hearing loss.

Expanding the Role of Educational Audiologists After a Failed Newborn Hearing Screening: A Quality Improvement Study.

Purpose Lack of timely and proximal access to diagnostic hearing evaluation using auditory brainstem response (ABR) testing hampers the effectiveness of Early Hearing Detection and Intervention (EHDI) programs in the United States. This study measured the impact of a state-based quality-improvement (QI) project that provided diagnostic ABR equipment and training to educational audiologists distributed throughout Iowa in regional special education centers. Method We used de-identified administrative data generated by the state EHDI program to analyze markers of access to early hearing health care for infants in a preproject condition ("Baseline") compared to the implementation of diagnostic ABRs at the regional special education centers ("QI Project"). Results Our findings revealed that the QI Project was associated with improvements in timeliness of first hearing evaluation, distance traveled for first hearing evaluation, and likelihood of receiving on-guideline audiology care during the first hearing evaluation. Conclusions Following the onset of the QI Project, infants and their families had greater access to initial hearing evaluation after failed newborn hearing screening. This improvement could have cascading effects on timeliness of later intervention among those with confirmed permanent childhood hearing loss.

Permanent Childhood Hearing Loss in Infants with Hypoxic Ischaemic Encephalopathy: Incidence and Risk Factors

Objective: To study the incidence of permanent hearing loss in infants with hypoxic ischaemic encephalopathy (HIE) and the risk factors associated with hearing loss.

Bilateral Permanent Childhood Hearing Loss and Health-Related Quality of Life in Adolescence.

Little is known about the impact of bilateral permanent childhood hearing loss (PCHL) on health-related quality of life (HRQoL). The objective of this study was to describe preference-based and non-preference based HRQoL outcomes in adolescence, from both self and proxy perspectives, amongst participants of the Hearing Outcomes Project. The Health Utilities Index Marks II (HUI2) and III (HUI3) and the PedsQLTM Version 4.0 Generic Core Scales were used to measure HRQoL based on self and parent proxy reports in 114 adolescents aged 13–19 years, 76 with bilateral PCHL and 38 with normal hearing, recruited from a population sample that was followed up from birth to adolescence. Descriptive statistics and multivariable analyses were used to estimate the relationship between severity of PCHL and HRQoL outcomes. PCHL was associated with decrements in mean multi-attribute utility score that varied between 0.078 and 0.148 for the HUI2 (p = 0.001) and between 0.205 and 0.315 for the HUI3 (p < 0.001), dependent upon the national tariff set applied and respondent group. Multivariable analyses revealed that, after controlling for clinical and sociodemographic covariates, mean HUI3 multi-attribute utility scores were significantly lower in adolescents with moderately severe, severe and profound hearing loss than in adolescents with normal hearing. Significant differences in physical functioning, social functioning, psychosocial functioning and total PedsQLTM scores were only observed when assessments by parents were relied upon, but these dissipated in the multivariable analyses. Bilateral PCHL is associated with poorer HRQoL outcomes in adolescence. Further studies conducted are needed to understand the trajectory and underpinning mechanisms of HRQoL outcomes following PCHL.

Parental views on informational counselling provided by audiologists for children with permanent childhood hearing loss.

BackgroundThe absence of best practice guidelines on informational counselling, has caused lack of clarity regarding the information audiologists should provide to parents and caregivers following the diagnosis of a hearing loss. Research shows that informational counselling provided by audiologists is limited and often biased, with little evidence of how parents experience this service.ObjectivesTo explore the nature and practice of informational counselling by audiologists.MethodThis study was descriptive in nature and adopted a survey design to obtain information on the current practices of informational counselling from the perspective of parents and primary caregivers. Ninety-seven face-to-face semi-structured interviews were conducted across KwaZulu-Natal province of South Africa. Descriptive statistics and thematic analysis using Nvivo software were conducted.ResultsThe majority of the parents reported receiving some form of informational counselling. However, the information provided by audiologists was considered to be biased as it included a favoured communication option, school and rehabilitative technology. There was a lack of information related to aural rehabilitation and family-centred intervention. The provision of all communication options, school options and rehabilitative technology were identified as gaps that contribute to an unfavourable decision-making process.ConclusionThere are inefficiencies experienced by families of deaf and hard of hearing children during informational counselling. However, this understanding, together with the identified gaps by parents, can help address the professional response to caring for families with deaf and hard of hearing children.

Cytomegalovirus-A Risk Factor for Childhood Hearing Loss: A Systematic Review.

Permanent hearing loss is an important public health issue in children with consequences for language, social, and academic functioning. Early hearing detection, intervention, and monitoring are important in mitigating the impact of permanent childhood hearing loss. Congenital cytomegalovirus (CMV) infection is a leading cause of hearing loss. The purpose of this review was to synthesize the evidence on the association between CMV infection and permanent childhood hearing loss. We performed a systematic review and examined scientific literature from the following databases: MEDLINE, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R), Embase, and CINAHL. The primary outcome was permanent bilateral or unilateral hearing loss with congenital onset or onset during childhood (birth to 18 years). The secondary outcome was progressive hearing loss. We included studies reporting data on CMV infection. Randomized controlled trials, quasi-experimental studies, nonrandomized comparative and noncomparative studies, and case series were considered. Data were extracted and the quality of individual studies was assessed with the Qualitative Assessment Tool for Quantitative Studies (McMaster University). The quality and strength of the evidence were graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). A narrative synthesis was completed. Sixty-five articles were included in the review. Prevalence of hearing loss at birth was over 33% among symptomatic CMV-infected newborns and less than 15% in asymptomatic infections. This difference in prevalence was maintained during childhood with more than 40% prevalence reported for symptomatic and less than 30% for asymptomatic CMV. Late-onset and progressive hearing loss appear to be characteristic of congenital CMV infections. Definitions of hearing loss, degree of loss, and reporting of laterality varied across studies. All degrees and both bilateral and unilateral loss were reported, regardless of symptomatic and asymptomatic status at birth, and no conclusions about the characteristics of hearing loss could be drawn. Various patterns of hearing loss were reported including stable, progressive, and fluctuating, and improvement in hearing (sometimes to normal hearing) was documented. These changes were reported in children with symptomatic/asymptomatic congenital CMV infection, presenting with congenital/early onset/late-onset hearing loss and in children treated and untreated with antiviral medication. Symptomatic and asymptomatic congenital CMV infection should be considered a risk factor for hearing loss at birth and during childhood and for progressive hearing loss. Therefore, CMV should be included as a risk factor in screening and surveillance programs and be taken into account in clinical follow-up of children with hearing loss.

Predicting hearing loss from 10 years of universal newborn hearing screening results and risk factors

Objective This study investigated whether demographic variables, risk factor presence or absence and universal newborn hearing screening (UNHS) results can be used to predict permanent childhood hearing loss (PCHL) in infants referred from screening. Design Retrospective analysis of a UNHS database. Study sample Data were extracted from the state-wide UNHS database storing details of the 613,027 infants who were born in Queensland, Australia between 1 January 2007 and 31 December 2016 and participated in UNHS. This study included the 6735 children who were referred from the UNHS program for diagnostic audiology due to failing the screen in one or both ears or bypassing screening. Results Factors with a significant positive association with PCHL that were incorporated into a logistic regression model were: female gender, non-indigenous status, family history of PCHL, craniofacial anomalies and syndromes associated with PCHL, and a bilateral refer result on screening. Conclusions Odds of PCHL vary among infants referred for diagnostic assessment from UNHS programs. When an infant refers on the newborn hearing screen, information about their gender, indigenous status, identified risk factors and specific screening outcome can be used to predict the likelihood of a congenital PCHL diagnosis.

Outcome of cochlear implantation in children with congenital Cytomegalovirus infection: A retrospective case control study

IntroductionTo date, cCMV represents the most frequent non-genetic congenital cause of permanent sensorineural hearing loss (SNHL) in childhood and the leading infectious cause of developmental and neurologic disabilities. The aim of this paper is to describe the outcome of cochlear implantation in children affected by severe-to-profound sensorineural hearing loss, due to a symptomatic or asymptomatic cCMV infection, particularly comparing their performance results to that of matched mutated Connexin 26 (Cx26) implanted patients. MethodsRetrospective case control study. The clinical data of symptomatic cCMV and asymptomatic cCMV patients were collected and compared to those of Cx26 patients matched for age and pre-CI (cochlear implant) linguistic category; all subjects were affected by bilateral severe-to-profound SNHL and were treated by CI and speech therapy rehabilitation. The Speech Perception Category, the language stage and the linguistic level scores, at 6 months, 1 year, and 3–4 years after CI of the three groups (symptomatic cCMV, asymptomatic cCMV and Cx26 mutation) were collected and compared. ResultsStatistical analysis did not show any significant difference in pre-CI perception category and linguistic level among the three groups; the symptomatic cCMV group showed a statistically worse performance of the language stage over time (p = 0.017). ConclusionsOur data support that children affected by cCMV have improved language abilities over time, although the symptomatic cCMV group achieved a lower language stage 3–4 years after CI compared to the asymptomatic cCMV and Cx26 mutation groups. Nonetheless, to date, CI supported by speech therapy can be considered an effective intervention for children affected by cCMV-related severe-to-profound hearing loss.

Effects of 'Perinatal Risk Factors Associated with Hearing Loss' on Auditory Outcomes in Cochlear Implant Recipient Children.

Cochlear implantation (CI) is used for rehabilitation of children with bilateral severe to profound permanent childhood hearing loss (PCHL). Recently, treatment of such children has been influenced by diagnostic technological advances. Children with perinatal risk factors associated with PCHL can undergo CI. The primary aim of this study was to determine the effects of 'perinatal risk factor associated with PCHL' on post-CI auditory outcomes. In this prospective study at a tertiary care centre we evaluated 50 cochlear implanted children from October 2011 to March 2013. The case group consisted of 6 (12%) children who had presence of 'perinatal risk factor associated with PCHL' and control group consisted of 44 (88%) children without any 'perinatal risk factor associated with PCHL'. All patients received auditory and speech rehabilitation and we evaluated their auditory perception outcomes by categories of auditory performance (CAP) and meaningful auditory integration scale (MAIS) scores at 1year post-CI. There were significantly decreased mean MAIS scores (decrease of 8.6%) and mean CAP scores (decrease of 6.7%) in CI recipient children with 'perinatal risk factor associated with PCHL' as compared to those who were without any 'perinatal risk factor associated with PCHL' at 1year after CI. However, in children with 'perinatal risk factor associated with PCHL', mean CAP & MAIS scores (auditory perception outcomes) were still more than 80% of maximum achievable CAP & MAIS scores. In this study, CI recipient children who were without any 'perinatal risk factor associated with PCHL' had significantly better mean MAIS & CAP scores (auditory perception outcomes) 1year post-CI. However, even in children who had 'perinatal risk factor associated with PCHL', there was substantial improvement in auditory perception outcomes at 1year post-CI and CI was still helpful in these children. Hence, knowledge of 'perinatal risk factor associated with PCHL' can provide reasonable help in predicting the auditory perception outcome and optimal counselling of families of CI candidates.

Parental experiences of the diagnosis of permanent childhood hearing loss: a phenomenological study

Objective: The objective of the study was to discover the nature of parental lived experiences of the diagnostic process of Permanent Childhood Hearing Loss (PCHL) and to construct an emotional life‐world of parent experience around PCHL.Design: Through an Interpretive Phenomenological Analytical (IPA) framework and subsequent purposive sampling, parents were invited to semi‐structured interviews.Sample: Ten parents of children who were identified with PCHL as one or the only permanent childhood disability diagnosed during early childhood were interviewed.Results: Five themes emerged; (a) a received disability, (b) casualties, (c) acceptance in real-time, (d) the unique signature of family life, and (e) audiologists are essential and appreciated guides. The emotional landscape chronicled two concurrent, non-linear affective groupings: the spiral of disorientation, and protective states of righting.Conclusion: Parents require a level of emotional support that exceeds frameworks of counselling. We propose the Dual Process Model as an intermediary model of emotional literacy to address both grieving and coping during the passage from diagnosis to early management. We believe it provides an effortless articulation with the principles of Family-Centred Care philosophies (top down) and behaviours (bottom up) by providing a taxonomy of grieving, coping and parents’ movement between the two orientations.

NIEDOSŁUCH PRZEWODZENIOWY W PROGRAMIE UNIWERSALNYCH BADAŃ PRZESIEWOWYCH SŁUCHU U NOWORODKÓW: PRZEGLĄD SYSTEMATYCZNY

BackgroundUniversal Newborn Hearing Screening (UNHS) attempts to identify children with a permanent, bilateral, moderate or greater hearing loss at birth. However, children who are referred from UNHS programs may have conductive hearing loss (CHL), sensorineural, or mixed hearing loss. The aim of this review was to investigate the prevalence, sub-classifications, audiological diagnosis, and medical management of CHL within UNHS programs.Material and MethodsA systematic literature search was completed in the scientific databases PubMed, CINAHL, and Embase. Studies were reviewed with reference to the inclusion criteria, then graded to assess the internal and external validity, leaving 25 studies for review.ResultsThe prevalence of conductive hearing loss ranged from 0.4% to 64.5%. ‘Genetic’ and ‘Permanent’ were the only two sub-classifications of CHL identified, with no uniform terminology evident. Given CHL is not a target condition of UNHS, audiological assessment was consistent with the diagnosis of Permanent Childhood Hearing Loss (PCHL). There was little evidence of audiological review, onward referrals, or medical management for CHL within UNHS programs. Of the evidence obtained, no alternative pathway was found for children identified with CHL through UNHS.ConclusionsIn view of the limited evidence for CHL within UNHS, further investigation into the prevalence, sub-classification, and appropriate management of CHL within a UNHS program is recommended to better guide evidence-based assessment and management of these children.

Parental reaction to diagnosis of infant hearing loss

ABSTRACTObjectiveThis study aimed to investigate parental reactions to a diagnosis of Permanent Childhood Hearing Loss (PCHL) and the implications for engagement in medical investigations and early intervention services. The study sought to determine the impact of type of hearing loss, presence of parental depression or anxiety, and parental reflective function on timely engagement with services for children with bilateral PCHL.MethodQuestionnaires were completed by 27 parents of babies aged 3-5 months, diagnosed with bilateral hearing loss. Measures included the DASS 21, DMRF (Diamond Maternal Reflective Function Scale), and demographic items. Clinical charts were accessed six months later to ascertain timing of engagement with medical and early intervention services.Results86% of families attended all required medical appointments following diagnosis. Early intervention services were attended by 65.5% of families. Parental anxiety was the only significant factor in engagement with early intervention services. There was no impact of reflective functioning, parent education and additional medical needs of the child on engagement. The participants also had lower levels overall of anxiety and depression (compared to normative data) but higher levels of stress on the DASS.DiscussionWhile many factors may impact on the likelihood of timely attendance at medical appointments and engagement with early intervention services (EI), support needs to be tailored to each family to ameliorate any potential barriers and ensure that access is easily available, particularly when there may be parental anxiety. This study shows that higher levels of anxiety were significantly associated with decreased engagement with EI.