HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

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HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

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HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

  1. 1. THE CHILD IS NOT RESPONDING TO SOUNDS Dr. Dennis Kin-kwok AU AuD Audiologist Hearing and Dizziness Laboratory Hong Kong Sanatorium & Hospital
  2. 2. HEARING LOSS IS AN INVISIBLE HANDICAP
  3. 3. Warning Signals Hearing Defects (I) • Risks Factors • Suspicion on mother's part • Not responding to nearby or everyday sounds by 6-8 weeks • Not showing ordinary interest in people and for play things by 3-4 months
  4. 4. Warning Signals Hearing Defects (II) • Not using frequent, tuneful, repetitive babble to self and others by 10 months • Not speaking single words by 21 months • Not putting 2 or 3 words together in sentences by 27 months • Not using fully intelligible speech by 4 years
  5. 5. High Risk Factors (I) • Family history of deafness • Congenital deformities, esp. ENT • Ante-natal viral infections (rubella, cytomegalo virus) • Peri-natal and post-natal infections (bacterial meningitis, syphilis)
  6. 6. High Risk Factors (II) • Low birth weight < 1500 gm • Hyperbilirubinaemia (serum bilirubin > 18 mg percent or exchange transfusion) • Severe cerebral hypoxia (Apgar score at 5 min < than 5 • Aminoglycosides given for serious neonatal infections
  7. 7. Types of Hearing Loss Sensorineural Conductive Mixed
  8. 8. Types of Hearing Loss • Conductive • Sensorineural • Mixed • Functional
  9. 9. Audiogram • Measurement of hearing level against different frequencies
  10. 10. Scale of Hearing Loss
  11. 11. HEARING ASSESSMENTS
  12. 12. Impedance Audiometry • Middle-ear Test Tympanogram • Ear canal volume • Middle-ear pressure • Amplitude
  13. 13. Tympanogram Type A • Type A Normal middle-ear pressure & compliance Type C • Type C Significant –ve middle-ear pressure ME pressure > 100 daPa
  14. 14. Tympanogram Type B Type B • Type B Perforated eardrum Middle-ear fluid
  15. 15. BEHAVIOURAL TESTS
  16. 16. Distraction Test • 3 weeks to 18 months • Elicit head-turn response • Test the better ear only • MCHC for hearing test
  17. 17. Distraction Test
  18. 18. Distraction Test • /mum/mum/mum/ • chime bar • chime • /sh/ • /s/ • high-frequency rattle 250 Hz 500 Hz 1K Hz 2K Hz 4K Hz 6-8 KHz
  19. 19. Auropalpebral Reflex (Eye Blink Reflex)
  20. 20. Visual Reinforcement Audiometry (VRA) • 16 to 30 months • Reinforcement of child's response by attractive visual stimulus • Test the better ear only
  21. 21. Play Audiometry • 2 1/2 years old and above • More interesting • Test each individual ear • Ability to wait
  22. 22. OBJECTIVE TESTS
  23. 23. Otoacoustic Emissions (OAEs) • Sounds generated from normal outer hair cells • Response to acoustic stimulation • Absent when hearing loss >30-40dB • Testing time in 1-2 minutes • MCHC for hearing test
  24. 24. OAEs Transient OAEs Distortion Products
  25. 25. Auditory Brainstem Response (ABR) • A far field recording of synchronized electric response from auditory pathway in response to fast acoustic stimulus • Diagnostic test
  26. 26. Sedation • Sedation (choral hydrate) 30 mg/kg • Natural sleep
  27. 27. Hearing Thresholds • Look at the presence or absence of Wave V
  28. 28. Hearing Thresholds • Look at the presence or absence of Wave V
  29. 29. AURAL REHABILITATION
  30. 30. Hearing Aids BTE mBTE ITE ITC CIC
  31. 31. Hearing Aids CROS Hearing Aid Eyeglass Hearing Aid Tactile Hearing Aid Hearing Aid with Remote Control
  32. 32. Speech Audiogram
  33. 33. Advantages of Binaural Hearing / Binaural Hearing Aids • Binaural summation > 3-5 dB • Better speech discrimination in noise • Sterophonic effect • Feeling of balanced hearing • Better sound localization
  34. 34. Sound Localization • Interaural time difference • Interaural level difference
  35. 35. Preferential Seating in Classroom • Good ear facing the teacher • Good view of teacher’s face • Sit in the front of classroom • Seated away from source of environmental noise
  36. 36. Cochlear Implant
  37. 37. Cochlear Implant – How it works?
  38. 38. Cochlear Implant Nucleus Advanced Bionic Med El
  39. 39. Selection Criteria for Children (I) • Bilateral severe to profound deafness • As soon as possible > 6 months • No radiological contraindications • No medical contraindications
  40. 40. Selection Criteria for Children (II) • Little or no benefit from hearing aids • Educational program with a strong auditory/oral component • Appropriate family expectations and support
  41. 41. Multidisciplinary Team Approach • Audiologists • ENT doctors • Speech pathologists • Social workers • Teachers of the deaf • Linguist • Administrators
  42. 42. Mapping of Speech Processor • Measure threshold level (T) • Measure comfortable level (C) • Determine if any electrode stimulation causes, pain, dizziness, irritation, inconsistent percept
  43. 43. Microtic / Atresic Ears
  44. 44. Bone Anchored Hearing Aid (BAHA) • Made up of three parts • Fixture • Abutment • Sound Processor
  45. 45. Bone Anchored Hearing Aid (BAHA) • Sounds are picked up by the speech processor • Sounds are transmitted through bone conduction to cochlear/s
  46. 46. Indications Patients suffering from conductive, mixed or unilateral hearing loss due to • • • Single Sided Deafness Chronic otitis media Congenital atresia
  47. 47. BAHA
  48. 48. Vibrant Bonebridge
  49. 49. Vibrant Bonebridge – How it works?

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