Detection and Confirmation of Hearing Loss in Children

child population

• sensorineural hearing loss as birth defect

  • 3/1000 kids

  • additional 6/1000 acquire by school age

• prelingual hearing loss

  • birth to 3 y.o of age critical speech and language development

newborn hearing screening

UNHS

• pass/refer screening protocol

  • false-negative pass screening, but has hearing loss

  • refer for complete audiological exam

    • false-postive fail screening, but pass exam

research supporting UNHS

• when hearing loss identified by 6 months or age or younger, the prognosis for good language, speech etc. improves greatly

• language similar to the child’s nonverbal cognitive development

• low to average language development

pass vs. fail

• passes: monitor hearing and language milestones

• fail:

  • audiological assessment

  • consideration of risk factors

  • otolaryngological exam

risk factors

• family history

• low birth weight

• low Apgar scores

• in utero infection

• ototoxic medications

• ventilator use for more than five days

• carniofacial anomoalies

• syndrome

• meningitis

• hyperbilirubinemia

hearing test

• method dependent on child’s age

• follow-up testing two to four times per year

• audiologist counsels parents about test results

  • provide opportunity to ask questions

  • establish follow-up schedule

auditory brainstem response (ABR)

• most comprehensive test for identifying infants

  • birth through five months of age

• electrophysiological

  • elicit brainwave activity

• performed on sleeping child

• measured in terms of latency

• wave correlates to 1500 to 4000

otoacoustic emissions (OAE)

• screen for newborns other than audiologist

• pass/refer

• tests 2000, 3000, 4000, and 5000Hz

• record OAEs for hearing better than 30 to 4 dB

visual reinforcement audiometry (VRA)

child from 6 -18 m.o tested in sound booth via an audiometer

• child is conditioned to look towards a lit box of moving toy, taking advantage of a child’s natural tendency to look towards sound and to seek positive reinforcement

• able to obtain individual ear info

• based on operant-conditioned response

conditioned play audiometry (CPA)

audiologist presents sound via an audiometer to a child who is in a sound booth

• two or more years of age

• “wait and listen” behavior

• use familiar toys

• can also use for speech testings

onset

• prenatal: occurs before birth

• perinatal: occurs at birth

• postnatal: occurs after birth

non-genetic causes

• intrauterine infection

• rh-factor complications

• pre-maturity

• maternal diabetes

• parental radiation

• toxemia

• anoxia

• syphilis

genetic causes

• half congenital hearing loss

• modes

  • autosomal dominant

  • autosomal recessive

  • x-linked

• syndromic vs. non-syndromic

• configuration of audiogram

• bilateral vs. unilateral

• progression of hearing loss

• affect on vestibular system

mixed conductive hearing losses

• mixed

  • both SNHL and conductive

• conductive

  • anomaly of outer and/or middle ear

  • most commonly caused by otitis media

  • also caused by cholesteatoma

  • questions about impact on academic performance

other disabilities

• cognitive delays vision impairment

• learning disabilities

• attention deficit disorder

• autism

counseling

• a family centered approach

• family system theory: family consists of interdependent individuals, none of whom can be understood in isolation from the family system

  • parents

  • siblings

  • extended family

stages of grief

• shock and disbelief

• guilt

• bargaining

• anger

• depression or detachment

• acceptance