The present study was devised to gather epidemiological information to aid in understanding the etiology, identification, and management of children with permanent hearing losses in Lower Saxony as a defined geographical area of Germany. All infants and preschool children were identified in the Department of Phoniatrics and Pediatric Audiology during a 1-year period (October 1994 until October 1995). Forty-four hearing-impaired children were identified, of whom 41 (93%) had sensorineural losses and 3 had pure conductive losses. Thirty-two children (73%) had bilateral hearing impairments. The causes of hearing loss were unknown in 17 children (39%). The median age of identification for the study group was 32 months, with a median age of 35.5 months when fitting hearing aids. Severity of hearing loss was inversely associated with age of identification. Prelingually deaf children had the worst comprehension levels of all children tested psychologically. Results were tabulated and special references to other studies were discussed. Our findings show again that the successful out-come of speech and language development depends on early identification and management of the hearing loss, and on continued assessment of the progress of habilitation. These require a basic assessment of the stage of language development (in perception and expression) as relevant rehabilitation measures. The next step is the treatment of existing linguistic deficits followed by retests at regular intervals.

Specific hearing aid selection and careful fitting are essential for successful rehabilitation of hearing-impaired children. For this reason the different hearing aid types prescribed, the type and frequency of hearing aid insufficiencies reported and the effectiveness and regularity of our follow-ups were studied evaluating 253 followup exams in 39 children (71 ears) suffering of a sensorineural hearing loss, including all degrees, supplied with a behind-the-ear hearing aid. Most of the devices had been prescribed outside our department on an initial trial basis. After critical evaluation, the number of hearing aid types was reduced from 33 to 23 when corresponding devices failed to match well with the degrees and types of hearing losses present. A further decrease in hearing aid types could not be achieved as a consequence of many being already end-prescribed. Insufficiencies (n = 222) were found in 60% of the hearing aid evaluations: 59% involved dynamic hearing aid adjustments requiring better amplification (37%), distortion (18%) and dynamics (4%). Additionally, 16% affected hearing aid function and another 16% form (9%) and material (4%) of the otoplasty and the tube (3%). The last 9% of the deficiencies concerned the potentiometer cap: it hadn't been fitted in about half of the cases and had been lost in the other half despite being needed. Routine followup evaluations of the hearing aids occurred regularly in 76% of the cases with an effectiveness of 73%. Our results confirm the importance and necessity for pedaudiologic qualitative hearing aid controls in children.

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