Is There a Right Ear Advantage in Congenital Aural Atresia?

Objectives: To compare speech/language development and academic progress between children with right versus left congenital aural atresia (CAA).

Study Design: Case control survey and review of audiometric data.

Setting: Tertiary care academic practice.

Patients: Children with unilateral CAA.

Main Outcome Measures: Demographic and audiometric data; rates of grade retention, use of any hearing or learning resource, and behavioral problems.

Results: No significant differences in grade retention rate, utilization of amplification, speech language therapy, use of an individualized education program, or frequency modulated system were found between children with right versus left CAA. Children with left CAA were significantly more likely to be enrolled in special education programs (p = 0.026). Differences in reported communication problems approached significance with more difficulty noted in the right ear group (p = 0.059). Left CAA patients were also more likely to have reported behavioral problems (p = 0.0039).

Conclusion: Contrary to the hypothesis that a normal hearing right ear confers a language advantage in patients with unilateral hearing loss, children with left CAA (normal right ear) were statistically more likely to be enrolled in a special education program and have behavioral problems. Reported communication problems were more common in right CAA patients, but this did not reach statistical significance. No differences were found in use of amplification, frequency modulated system, individualized education program, or grade retention. Further investigation of both the clinical implications and underlying psychoacoustics of unilateral hearing loss and the identification and habilitation of "at risk" unilateral hearing loss children is warranted.