19. The hard of hearing and deaf child’s symptoms, examination and treatment. Infant’s screening of hearing.

what are the causes of pediatric hearing loss

• Hereditary genetic causes

• Acquired causes

what are the hereitary genetic causes of hearing loss

• Congenital- mandibulofacial dysostosis

• Occuring postnatally or later o Congenital syphilis, rubella syndrome, hyperbilirubinemia syndrome

what are the types of acquired causes

• In utero
• Perinatally
• Postnatally or later

what are the acquired in utero causes of HL

• Infectious o Rubella, toxoplasmosis, congenital syphilis
• Drug toxicity o Alcohol, thalidomide, quinine

what are the acquired perinatally causes of HL

• Infectious o CMV, HSV
• Metabolic o Kernicterus, asphyxia
• Obstetric trauma o Intracerebral/ intracochlear haemorrhage

what are the acquired postnatally causes of HL

• Infectious o Meningitis, ottitis media, labyrinthitis, measles
• Drug toxicity- aminoglycosides
• Traumatic- noise, head trauma

what are the signs of hearing loss in children

• Newborn does not react to sounds
• Tone of crying is unusual
• Babbling period does not appear
• Visual orientation is dominant
• Speech development is delayed
• Tone, pitch, intensity, melody and rhythm of the speech is pathologic
• Articulation disorders, worse reading + writing skills

what are the effects of bilateral HL

• Impaired speech
• Impaired personality development

what are the effects of mild degree of hearing loss

• 20-40dB
• Articulation problems
• Delay in language acquisition
• Possible learning difficulties

what are the effects of moderate degree of hearing loss

• 40-60dB
• Abnormal speech development with reading/ writing difficulties
• Deficient vocabulary
• Poorly understandable speech

what are the effects of severe degree of hearing loss

• 60-90dB
• Absence of spontaneous speech development

what are the effects of unilateral hearing loss

• Mild to moderate unilateral hearing loss has usually no adverse effects
• Severe unilateral HL can cause impaired speech development

what is the physical examination for checking HL in children

• Check external defects or obstructions that block sound conduction (foreign bodies_
• Perform pneumatic otoscopy to detect current or chronic infections
• Check head and neck to rule out other abnormalities that could lead to hearing loss

what are behavioural audiometric tests for children

• Reflex audiometry: o Auditory stimulus → sucking responses, motor responses, change in respiratory pattern
• Response audiometry: o Auditory stimulus → infant will turn head toward the sound source that is outside the visual field o Distraction test or visual reinforcement audiometry (VRA)
• Play audiometry: o Variant of pure tone audiometry
• Pediatric speech audiometry: o Verbally instruct child to select a certain toy or picture that is on a table at increasing distance
• Pediatric speech intelligibility (PSI) test: o An audiometric speech test

How do you screen infants for HL

• Risk screening
• Universal screening o Otoacoustic emissions o Brainstem evoked response audiometry

what is risk screening for infants

• Selective program tha tonly screens for newborns with features that are known to be associated with an increased risk of hearing loss o ICU >48h o Positive family history of hearing impairment o Craniofacial abnormalities

what are universal screenings for infants

• Usually performed 2-3 days after birth
• Objective audiometry tests o OAE + BERA

describe otoacoustic emissions test

• Asses function of the cochlea
• Cannot determine hearing threshole
• If OAEs are present, it assumes that peripheral hearing is normal o Presence of OAEs doesn’t excluse hearing disorder

describe brainstem evoked response audiometry

• Asses the function of cochlea
• Can determine eharing threshold
• Acoustic stimulation is given and auditory evoked potentials are measured
• If no Aps are elicited= newborn has severe hearing loss

what is the treatment

• Education + rehabilitation
• Hearing aids o Used in moderate to severe hearing loss o Typically 2 behind the ear hearing aids o Can be used for infants
• Cochlear implants o Severe hearing loss o Using if cochlear damage and responsive auditory nerve stimulation