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Hearing in Schools Study (HISS)
- What is HISS?
- The HISS Hearing Survey (2003)
- Schools Who Participated in HISS
- The HISS Impact Study (2004)
- HISS Information for Professionals
- HISS in the news
- Links to Hearing Related Websites
- Contact HISS
- Publications
What is HISS?
Slight and mild hearing loss may affect as many as 3-15 % of primary school children. Often parents and children don´t notice it. The Hearing in Schools Study (HISS) aimed to find out how many children in Victorian primary schools have slight or mild hearing loss, and how it affects their lives.
HISS has two parts: the Hearing Survey, and the Impact Study.
Why was HISS being done?
- Mild hearing loss may often go unnoticed by parents and teachers. We wanted to find out how common it is, and how it affects children.
- Genetic testing in relation to hearing loss is becoming more common. At the moment we donﾴt know what to tell parents whose children have a "deafness gene". This may happen when a brother or sister has more severe deafness. HISS aimed to help us accurately counsel these parents.
The HISS Hearing Survey (2003)
In the first part of HISS, the "Hearing Survey", we tested the hearing of more than 6,000 children from grades one and five in 89 primary schools in and around Melbourne.
Parents also filled out a questionnaire.
Hearing Survey Information for Children
Why did I have my hearing tested?
- So that we can find out how many children your age in Melbourne have a very small hearing loss
- Often parents and teachers don´t notice if children have a small hearing loss!
- Often the child doesn´t notice either!
- We also want to find out how a small hearing loss affects children´s lives, and whether they need some extra help with hearing or learning.
Hearing Survey Information for Parents
The questionnaire you completed assisted us to understand more about mild hearing loss. It asked about:
- any risk factors for hearing impairment, such as loud noise
- any symptoms or concerns about your child's hearing
- general health and behaviour
- information about hearing in your family
- some general information about your family which will help us describe the HISS group
The Hearing Test
Every child was given a card to bring home, with the hearing test results. If you gave us your contact details a member of the HISS study team should have contacted you to discuss the results if your child had a hearing loss.
Your child's results are confidential - only you will know. You can tell the teacher about your child's results if you wish.
What do the results of my child's HISS hearing test mean?
Pass: The hearing is normal, no further action is required
Slight/ Mild Loss: Often parents and children don't notice these hearing losses. We will contact you (by phone where possible) to discuss what this result means. There may be no action needed. The audiologist will discuss with you any further action that should be taken.
Moderate or greater hearing loss: We will contact you (by phone where possible) to discuss what this result means. A permanent (sensorineural) hearing loss of this level is likely to have a significant impact on your child. We will help you organise referrrals to assess the situation and offer treatment.
Glue Ear: If this box is ticked, an information leaflet about this condition should be attached to the results sheet (see below). If your child has glue ear causing temporary hearing loss, we recommend you follow up with your family doctor. Once the fluid "glue" goes, hearing almost always comes back to normal.
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ABOUT GLUE EAR |
Incomplete test: sometimes a hearing test can't be completed, if for example, the child was unhappy about being in the test booth. We will usually invite them back for another "turn", but no child was forced to have a hearing test. If you do want them to have a hearing test, you could contact an audiology service in your local area.
My child has a hearing loss - what should I do?
A member of the HISS team should have contacted you if your child was found to have a hearing loss. As mentioned, a slight loss often goes undetected, and children generally seem to be functioning quite normally. The results of this study will help us understand just how much such a hearing impairment does effect children.
If your child has a more significant hearing loss, we are able to refer you to expert paediatricians and audiologists for a more detailed checkup. A list of audiology centres can be found on the Audiology Society of Australia website.
Useful information can be found on the Australian hearing website: Children's hearing
Schools who Participated in HISS Hearing Survey
The Hearing in Schools Study would like to thank all of the parents and students who took part in the HISS Hearing Survey in 2003 and 2004. It was wonderful that your school agreed to participate in this major study which strives to answer some important questions about children's hearing.
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The HISS Impact Study 2004
In 2004, we invited all the children with slight/mild hearing loss in both ears to take part in a smaller follow-up study, the Impact Study. We also invited some children with normal hearing to take part. We compared both groups to find out how slight or mild hearing affects the language, learning and health of children.
Furthermore, we also investigated the relationship of a well known "deafness gene" to mild hearing impairment and its effects. Parents were asked to give permission to take a sample for genetic testing. To take the sample, each child brushed the inside of their cheek. These samples were then analysed at the Murdoch Childrens Research Institute.
Impact Study Information for Children/ Parents
The Impact Study was conducted in three parts:
PART A: SCHOOL ASSESSMENT
We assessed children at school. This was done during school time and took approximately two hours. During this assessment each child:
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had his/ her language abilities tested by a member of the HISS team. This involved activities such as repeating words and completing sentences
- had his/ her learning abilities tested by a member of the HISS team. This involved activities such as reading, puzzles and looking for patterns
- completed a short questionnaire about his/her health with the help of a member of the HISS team
- had another type of hearing test to find out more about his/her hearing. This involved placing a small earphone in each child's ear which gave off a sound and measured the echoes in their ear (called otoacoustic emissions).
If a child was in Grade 2, we asked their school for the results a reading test he/she has already done with their teacher. If a child was in Grade 6, we asked the school for his/her AIM test results.
PART B: TEST A GENE ASSOCIATED WITH HEARING LOSS
At the same time as the school assessment, we asked each child:
- for a sample for genetic testing. This involved each child rubbing the inside of their cheek with a very small soft brush for about 20 seconds and placing it in an envelope. It was done individually, in a private room at the school. Each child was assisted by a member of the HISS team. It is not a painful procedure. It did not involve a blood test. This sample was then be sent to our laboratory to test for a gene we know is associated with hearing loss.
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questions about his/her feelings about being involved in the research, using "smiley face" scales.
PART C: PAEDIATRICIAN ASSESSMENT
If a child had a hearing loss, we offered each parent and their child to see a paediatrician. The paediatrician examined each child, looking for any possible causes of the hearing loss and asked about each parents' hearing. We also offered to check parents' hearing, and the hearing of any other of their children. The appointment took approximately one hour, and was free.
Impact Study Information for Teachers
Following the Hearing Survey, we invited children who were found to have a mild hearing impairment, as well as a number of their classmates with normal hearing, to participate in the Impact Study. In this second phase of the study we assessed the impact of hearing impairment on a child's learning and social abilities as well as health-related quality of life.
Assessments were performed at school by an audiologist, speech pathologist and psychologist.
- The psychologist tested each child's learning abilities. Reading comprehension, and widely used tests of cognition were used.
- The pscyhologist assisted the child to complete a questionnaire addressing each child's own perspective of their health-related quality of life.
- The speech pathologist assessed each child's language abilities. This involved activities such as repeating words and completing sentences
- With parental consent, the children provided us with a sample for genetic testing. Each child rubbed the inside of their cheek with a very small brush and placed it in an envelope, which was sent to A/Prof Dahl's genetic laboratory at the Murdoch Childrens Research Institute.
The Impact Study in 2004 involved a similar process to the hearing survey, except the assessment for children participating involved an absence from class of approximately 90 minutes. Two to three children were assessed concurrently. We did not use sound-proof booths for this stage of the study. A reasonably quiet room was sufficient.
HISS Information for Professionals
What is HISS?
The Hearing in Schools Study was the first large scale epidemiological study of its kind in Australia, and is the most comprehensive study yet to address the impacts and genetics of mild childhood hearing impairment.
The study consisted of two main stages. The first stage, the Hearing Survey involved screening over 6,000 children in grades one and five in primary schools in and around Melbourne in order to estimate prevalence of slight/mild hearing loss in Victorian children.
The second stage, the Impact Study, assessed the impact of slight/mild hearing loss on language, academic, and social development as well as health-realted quality of life. This stage involved the recruitment of children identified with a hearing loss along with a control group with normal hearing. Detailed assessments were performed in schools by a psychologist and speech pathologist. Standard academic tests were also accessed.
The Impact Study also aimed to establish any relationship between the impacts of slight or mild hearing impairment, and Connexin 26 mutations, one of the most common "deafness genes". This information is invaluable to the development and evaluation of counselling services provided to families of children identified with genes related to deafness.
HISS received funding from the US National Institutes of Health and is considered to be of international significance. Please see findings from HISS for the outcomes of the Hearing Survey and the Impact Study.
Specific Aims of HISS
The aims of this project were to:
1. Ascertain in a large community sample of elementary school-aged children:
- Phenotype-genotype relationships between slight/mild hearing impairment and Connexin 26
- Language, academic, social and quality of life outcomes of slight/mild hearing impairment
- Prevalence of slight/mild hearing impairment2. Develop and trial informed consent procedures on the use of DNA specimens for genetic testing for primary school children with slight/mild hearing impairment
3. Describe the impact of genetic testing on primary school children with slight/mild hearing impairment and their families
4. Develop and evaluate education and counselling approaches to facilitate comprehension of genetic information provided regarding slight/mild hearing impairment detected through population screening.
Design
This study had three major components.
We conducted a cross-sectional observational study for a random clustered probability sample of 3,000 Victorian children in each of Years 1 and 5 of schooling (6000 total). This base cohort was used to establish the prevalence of undiagnosed slight, mild and moderate or greater hearing impairment in the population at the two year levels, and provide an unbiased sample for the nested case-control study. This component occurred between July 2003 and March 2004.
A nested case-control study was drawn from the base cohort for more in-depth study. This comprised all children who met study critieria for slight/mild hearing impairment ("cases") and a random sample of children with normal hearing ("controls"). In this component, we studied the prevalence of mutations in Cx26 gene, its contribution to slight/mild hearing impairment, and phenotype-genotype relationships. This included developing informed consent procedures on the use of DNA specimens for genetic testing for primary school children. It also allowed study of language, academic, social and quality of life outcomes of slight/mild hearing impairment. This component occurred between April and August 2004.
Download the findings from HISS
HISS in the news
'Slight and mild hearing loss in primary school children' (Annotation) J. Paediatr. Child Health 2004; 40:11-13
'Gene test to catch deafness' in The Age, 12 September 2003
"Loud and clear call for testing" in Education Times, 12 June 2003
Association of Independent Schools website
'How many primary school children are hard of hearing?' Audiology Now! 2003 Issue 13 (Winter):41-2
Links to Hearing Related Websites:
What's inside my ear?
Australian hearing - How do we hear?
http://www.hearingcenteronline.com/ear2.shtml
How do I hear?
Australian hearing - How do we hear?
Ear, Nose, and Throat Facts: Oregon Health & Sciences University
What is a hearing loss?
What is a hearing loss?
Causes of Hearing Loss:
Australian Hearing - Types of hearing loss
| Website: | www.rch.org.au/ccch/hiss |
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Methodology: |
The Hearing Survey: cross-sectional observational study Impact of Mild Hearing Loss Study: case-cohort study |
| Date: | Start: June 2002 Finish: June 2005 |
| Funding: | US National Institutes of Health (NIH) - National Institute of Deafness and Communication Disorders |
| Contacts/Staff involved: |
Sherryn Tobin Dr Zeffie Poulakis Professor Melissa Wake |
Publications
Slight and mild hearing loss in primary school children (Annotation) J Paediatr Child Health 2004; 40:11-13
How many primary school children are hard of hearing? Audiology Now! 2003 Issue 13 (Winter):41-2
Gillam L, Poulakis Z, Tobin S, Wake M. Enhancing the ethical conduct of genetic research: Investigating parents’ views about involving their healthy children in a genetic study of mild hearing loss. Accepted J Medical Ethics Nov 2005
Cone-Wesson B, Wake M, Tobin S, Poulakis Z. Risk Factors and Clinical Characteristics in Elementary School Children with Slight-Mild Sensorineural Hearing Loss. Ear & Hearing (Submitted June 2006)
Wake M, Tobin S, Cone-Wesson B, Dahl H-H M, Gillam L, McCormick L, Poulakis Z, Rickards FW, Saunders K, Ukoumunne OC, Williams J. Slight/mild sensorineural hearing loss. Accepted Pediatrics July 2006
Dahl H-H, Tobin SE, Poulakis Z, Rickards FW, Xu X, Gillam L, Williams J, Saunders K, Cone-Wesson B, Wake M. The contribution of GJB2 mutations to slight/mild hearing loss in Australian elementary school children. J Med Genet Published Online First: 13 July 2006