Dr Amanda Hall

Lecturer, Audiology Aston University

  • Birmingham

Dr Hall's research focuses on the causes and impact of hearing loss in children, at both the individual and the population level.

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Association between early childhood symptoms of common ear, nose and throat problems and autism – new research

Researchers find an association between autistic traits and young children with ear, nose and throat problems The study used data from the Children of the 90s study which found 177 children were identified with a probable diagnosis of autism – 139 boys and 38 girls The study looked at data from over 10,000 children from birth to four years old. Ear, nose and throat (ENT) problems, relating to the ears, hearing and the upper respiratory system, are more common in young children with a subsequent diagnosis of autism, or who have demonstrated high levels of autism traits finds new research published in BMJ Open. The study, which was led by researchers from the University of Bristol and Aston University, looked at data from over 10,000 young children from birth to four years old, who were part of the Bristol’s Children of the 90s study. The team investigated whether early ear and upper respiratory signs are associated with the development of autistic traits. Previous studies have found increased prevalence of ENT and related hearing conditions in children with autism compared with typically developing children, but much of this research has been carried out using health records, which can be biased. In the new study, researchers used data from Children of the 90s study, a general population cohort which recruited over 14,000 pregnant women from the Bristol area between 1991 and 1992 and has followed the lives of their offspring ever since. Within Children of the 90s, 177 children were identified with a probable diagnosis of autism – 139 boys and 38 girls. Those with autism traits were defined as the 10% of the sample with the highest trait scores. The team analysed responses to three questionnaires in which mothers recorded the frequency of nine different signs and symptoms relating to the ears, hearing problems and upper respiratory system when their child was aged 18 to 42 months. These included signs such as mouth breathing, snoring, pulling/poking of the ears, ears going red, worse hearing during a cold, ear discharge and rarely listening. The results found that the frequency of these symptoms was associated with high scores on each of the autism traits: social communication, coherent speech, sociability and repetitive behaviours, plus those with a clinical diagnosis of autism. Pus or sticky mucus discharge from the ears was especially associated with autism (an increased risk of 3.29) and for impaired hearing during a cold (an increased risk of 2.18). Dr Amanda Hall, senior lecturer in audiology, at Aston University, said: “Thanks to the data available from Children of the 90s, we were able to analyse results from a large number of children. We found that common ear and upper respiratory signs and symptoms appear to be more prevalent in those with a subsequent diagnosis of autism or demonstrated high levels of autism traits. “However it is also important to note that these ENT symptoms are very common in childhood and most children who experience these signs and symptoms do not go on to be diagnosed with autism. “For example, of the group of around 1,700 children who snored at age 30 months, most of those 1,660 children did not get a later diagnosis of autism. Our results suggest the need for increased awareness of possible ENT conditions.”

Dr Amanda Hall

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Biography

Dr Hall is a lecturer in Audiology at Aston University, and a registered clinical scientist with Bristol Children’s Hearing Service. Amanda is also the ENT Specialty Lead and Audiology champion for the West of England NIHR Clinical Research Network.

Amanda’s research focuses on the causes and impact of hearing loss in children, at both the individual and the population level. She is also working on developing interventions to improve shared decision making within clinical services.

Areas of Expertise

Audiology
Shared Decision Making
Audiology Health Services Research
Causes and Impact of Childhood Hearing Loss
Longitudinal Cohort Studies
RF Otorhinolaryngology

Articles

Iodine status during child development and hearing ability - a systematic review

British Journal of Nutrition

2022

Iodine, through the thyroid hormones, is required for the development of the auditory cortex and cochlea (the sensory organ for hearing). Deafness is a well-documented feature of endemic cretinism resulting from severe iodine deficiency. However, the range of effects of suboptimal iodine intake during auditory development on the hearing ability of children is less clear. We therefore aimed to systematically review the evidence for the association between iodine exposure (i.e. intake/status/supplementation) during development (i.e. pregnancy and/or childhood) and hearing outcomes in children. We searched PubMed and Embase and identified 330 studies, of which thirteen were included in this review. Only three of the thirteen studies were of low risk of bias or of good quality, this therefore limited our ability to draw firm conclusions. Nine of the studies (69 %) were in children (one RCT, two non-RCT interventions and six cross-sectional studies) and four (31 %) were in pregnant women (one RCT, one cohort study and two case reports). The RCT of iodine supplementation in mildly iodine-deficient pregnant women found no effect on offspring hearing thresholds. However, hearing was a secondary outcome of the trial and not all women were from an iodine-deficient area. Iodine supplementation of severely iodine-deficient children (in both non-RCT interventions) resulted in improved hearing thresholds. Five of six cross-sectional studies (83 %) found that higher iodine status in children was associated with better hearing. The current evidence base for the association between iodine status and hearing outcomes is limited and further good-quality research on this topic is needed.

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Exploring how parents of children with unilateral hearing loss make habilitation decisions: a qualitative study

International Journal of Audiology

2021

Objective
This study sought to explore the decision making needs of parents managing the hearing and communication needs of children with unilateral hearing loss.

Design
An inductive, qualitative method was used. The data were analysed using a constant comparative approach, consistent with Grounded Theory method.

Study sample
Twenty one families participated in interviews yielding data on twenty two children. Each of these families had at least one child with unilateral hearing loss. The age range of the children varied from four months to sixteen years old. All parents were English speaking and received care from National Health Service Audiology departments across the United Kingdom.

Results
Parents valued professionals’ opinions, but information provision was inconsistent. As their children mature, parents increasingly valued their child’s input. Parent-child discussions focussed on how different management strategies fit their child’s preferences. Parents were proactive in obtaining professional advice, and integrating this with their own iterative assessment of their child’s performance.

Conclusions
Decision making is an iterative process. Parents make nuanced decisions which aim to preserve a sense of what is normal for them. Clinicians need to recognise the parental view, including where it may contrast with a medicalised or clinical view.

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Factors associated with the development of paediatric chronic otitis media by age nine: A prospective longitudinal cohort study of 6560 children

Journal of Laryngology and Otology

2020

OBJECTIVE: This study aimed to analyse social, health and environmental factors associated with the development of chronic otitis media by age nine.

METHOD: This was a prospective, longitudinal, birth cohort study of 6560 children, reviewed at age nine. Chronic otitis media defined as previous surgical history or video-otoscopic changes of tympanic membrane retraction, perforation or cholesteatoma. Non-affected children were used as the control group.

RESULTS: Univariate analysis demonstrated an association between chronic otitis media and otorrhoea, snoring, grommet insertion, adenoidectomy, tonsillectomy, hearing loss, abnormal tympanograms and preterm birth. Multivariate analysis suggests many of these factors may be interrelated.

CONCLUSION: The association between chronic otitis media and otorrhoea, abnormal tympanograms and grommets supports the role of the Eustachian tube and otitis media (with effusion or acute) in the pathogenesis of chronic otitis media. The role of snoring, adenoidectomy and tonsillectomy is unclear. Associations suggested by previous studies (sex, socioeconomic group, parental smoking, maternal education, childcare, crowding and siblings) were not found to be significant predictors in this analysis.

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