Cognitive ability and academic attainment in unilateral microtia
Research type
Research Study
Full title
Association between cognitive abilities and academic achievement in children with unilateral microtia.
IRAS ID
272777
Contact name
Robert Nash
Contact email
Sponsor organisation
Great Ormond Street Hospital for Children NHS Foundation Trust
Duration of Study in the UK
1 years, 11 months, 27 days
Research summary
Research Summary:
Microtia is a condition that describes being born with one (or occasionally two) abnormally small, or even absent, external ear(s). This is almost always associated with the ear canal not forming, and the middle ear not functioning correctly. Microtia therefore has a cosmetic effect, but it also causes hearing loss. The cognitive and academic effects of that hearing loss on children with unilateral microtia has not been studied. Whilst there are hearing devices that can rehabilitate this hearing loss, many children with microtia do not use them, and very few children with microtia receive additional support at school to ensure that their learning is optimised. This may be due to a perception (amongst parents, clinicians and educators), that because a child is developing spoken language, and their academic skills may be within the average range, their hearing loss is not having a detrimental impact. However, previous evidence suggests that it is possible that while these children are making academic progress, their rate of progress may not be what should be expected relative to their cognitive potential, i.e. there is a discrepancy between what they are capable of achieving, and what they are actually achieving. The aim of this study is to compare academic attainments in literacy and numeracy with those predicted on the basis of intellectual ability, in children with unilateral microtia.
Participants will be children aged 6 to 13 years with unilateral microtia, recruited at Great Ormond Street Hospital for Children by a member of the clinical care team. They will undertake standardised tests of cognitive ability and academic attainment (literacy and numeracy). This will require one visit to the hospital as an outpatient, and is an addition to their routine clinical care, which will not change.
The research is being funded by the charity Microtia UK.
Summary of Results:
Microtia is a condition affecting the outer ear, usually just one side, which causes hearing loss in that ear. Children with this condition often use a hearing device that sends sound through the bone of the skull rather than through the ear canal.
This project looked at two things in children aged 6 to 13 with unilateral (one-sided) microtia. The first part compared children's general intelligence with their performance in reading, writing, spelling, and maths, to see whether they were achieving as well as their intelligence would predict. The second part looked more closely at intelligence itself, and in particular at "auditory working memory" - the ability to hold onto and work with information heard aloud, which can be harder for children who only hear well on one side.
Nineteen children took part in the academic testing and twenty in the cognitive testing. On average, both groups scored within the normal range for their age on intelligence and on academic skills, and there was no overall sign that the group as a whole was falling behind where their intelligence would predict. This is a reassuring finding.
However, looking at individual children told a different story. In the academic study, over half the children (11 of 19) showed at least one area -usually reading, spelling or maths - where their actual performance fell meaningfully below what their intelligence predicted, even though their score still looked "average" on a standard test. In the cognitive study, over a third of children showed auditory working memory as a genuine personal weak spot compared with their own other abilities, a rate clearly above what would be expected by chance. Children whose parents already had concerns about their learning scored, on average, 26 points lower on tests of working memory than children whose parents had no such concerns -a large and statistically robust difference.
Together, these findings suggest that many children with unilateral microtia are coping well, but that a meaningful minority have real learning-related difficulties that don't show up if you only look at whether their score falls in the "average" range. Relying on group averages, or on a single test score compared to the general population, risks missing children who need support. The results support assessing each child's own pattern of strengths and weaknesses, rather than average-range performance alone, when deciding whether extra help is needed at school, and support taking parents' concerns seriously even when test scores look fine.
REC name
South Central - Hampshire A Research Ethics Committee
REC reference
20/SC/0456
Date of REC Opinion
1 Feb 2021
REC opinion
Further Information Favourable Opinion