Certain parts of Ireland’s paediatric audiology service work superbly, with a world-class cochlear implant centre in Dublin, yet at end-September 2020, 17,000 children and adults awaited initial audiology services nationwide. Of this total, over 7000 were children, with almost 8000 being adults over the age of 65. One-third of these children had waited over a year for their audiology appointment, with over 40% of the adults waiting a similar time.
On the speech and language therapy front, over 20,000 children and adults were awaiting initial reviews by therapists nationally, with many personnel assigned to covid tracing work in a double whammy for the clients affected. More recently, the Holy Family school for deaf children was reported to be at risk of losing its own on-site speech therapist to a community reorganisation of services.
Families’ Legal Challenges
Separately, in November 2020, one region of Ireland’s public hearing health service was described by a solicitor as practising “audiological negligence… on an industrial scale“. This observation followed a High Court award of €450k to the family of a 13 year old boy, whose quality of life was damaged when he received a cochlear implant aged eight, having lost access to sound in his formative years to a single audiologist in a public hearing service.
Up to 49 families in Ireland are said to be seeking similar legal settlements after a HSE review uncovered hearing care provision anomalies over a sustained time period. Before this case, Ireland’s Health Service Executive apologised to over 100 families between 2011 to 2015, for serious negative impact on their childrens’ prospects after look-back reviews of pediatric audiology services provided by one audiologist in this region.
The Situation Before 2011
From 2009 to 2010, Ireland’s National Audiological Review Group (NARG), consisting of hearing and medical professionals, mapped nationwide audiology services, to generate a new national services roadmap in 2011. Ireland has an open advanced economy, yet the resulting national audiology report confirmed that well before 2011, infants and children in Ireland routinely waited up to five years to get hearing aids via the public health service.
Pediatric speech therapy services were [and still are] equally thin on the ground. Families had limited access to hearing and speech services, a situation creating a neurological emergency for the children, whose listening brains were getting insufficient sound-input from hearing-aids, to learn to hear and speak. Every level of hearing loss experienced by these children increased their risk of educational struggle due to correlated linguistic challenges — which unfortunately happened in children born in Ireland before 2011.
Ireland’s Landscape After 2011
Today’s research shows the critical period of ‘learning’ [to hear] runs from a mother’s sixth month of pregnancy to the child’s second birthday, making early diagnosis and intervention essential. Infants detected today with significant hearing loss who receive digital hearing aids before the age of 6 months, and a cochlear implant between the ages of 7 months to 1 year can develop language skills similar to children with typical hearing, and start early years education with these vital building blocks for structured, spoken language.
Knowing this, Ireland’s move to introduce newborn hearing testing (through the National Audiological Review report, 2011) was a first step in the right direction. Secondly, the children need digital hearing-devices as early as possible, with sustained spoken-language intervention through regular auditory-verbal therapy (AVT) from a qualified practitioner, whether this person is actively practising in Ireland or via teletherapy from outside Ireland.
How Hearing Devices And AVT Help
Around the world, deaf babies are called million-dollar babies. Essentially, deaf “children who do not receive early intervention cost schools an additional $420,000 [to educate] and face overall lifetime costs of $1,000,000 in special education, lost wages and health complications.” (statistics: MASSHACC, 2012). Infants need digital hearing-devices to hear sounds and to acquire speech and language, the basis of communication for most people. Without access to hearing – and to spoken language, children risk lifelong social isolation and limited learning educationally and socially, even within their own family environments.
The earlier a baby accesses sound from hearing-devices, the sooner their brain can start to process speech and language tones. In babies aged six to 12 months, their brain processes speech sounds in the same area that manages motor movements for producing their own speech. When a baby has undetected hearing issues, they are incorrectly tracking sound, rhythm, grammar, phonemes and language use. Maybe sound is muffled to their ears, or they are missing the rhythm and intonation of your language.
When hearing issues are addressed, your child may have a slight intonation but a good speech pathologist will work with your family to smooth this out. Most importantly, if infant language windows are missed, the children will always play catch-up and may never have clear speech. Children need to hear words thousands of times before they can say these sounds and use them in words and finally recognise them in written form. Even when a child hears most sounds without hearing aids, they need to hear small sounds like “s” and “t,” and the other speech pitches and sounds we take for granted. This is where life-changing hearing-devices, parent coaching in spoken language strategy and spoken language-rich settings are needed for childrens’ brains to grow and develop.