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  • 2. OVERVIEW  Deafness  Types of hearing impairment  Causes of hearing impairment and deafness  Evaluation of deafness  Interventions and Treatments for Hearing Loss  Protective measure for deafness
  • 4. • Hearing impairment that is so severe that the child is impaired in processing linguistic information through hearing, with or without amplification, that adversely affects a child's educational performance. National Dissemination Center for Children with Disabilities
  • 5. Facts about hearing impairments and deafness  278 million - moderate to profound bilateral hearing loss. (WHO 2005)  80% of deaf and hearing impaired - low and middle income countries.  Chronic middle ear infection is the leading cause of mild to moderate hearing impairment in children. World Health organization
  • 6.  50% of deafness and hearing impairment is avoidable through prevention, early diagnosis and management  Current annual production of hearing aids is estimated to meet less than 10% of global need.  Hearing impairment impacts development in ◦ Speech ◦ Language ◦ Education ◦ Social integration
  • 8. 1. A conductive hearing impairment: Hearing impairment caused by interference with sound or vibratory energy in the external canal, middle ear, or ossicles. 2. A sensorineural hearing impairment: One resulting from dysfunction in the inner ear, especially the cochlea where sound vibrations are converted into neural signals, or in any part of the brain that subsequently processes these signals.
  • 10. CAUSES -Infancy - Later in Life
  • 11. Infancy Causes • Heredity & genetics (most common cause) - Cleft Palate - Cytomegalovirus, Herpes Simplex virus - Down syndrome - Hyperbilirubinemia - Syphilis, Toxoplasmosis - Treacher-Collins syndrome, Usher syndrome, Waardenburg syndrome • Meningitis • OtitisMedia • Noise Harvard Medical School Center for Hereditary Deafness
  • 12. Later in Life • Noise: – Major contributor to hearing loss in teenagers and adults – Can be prevented Males are more likely to acquire noise-induced hearing loss as they engage in activities such as • City or freeway traffic 70 dB • Hair dryer/alarm clock 80 dB • Mowing the lawn- 90 dB • Riding a motorcycle – 90 dB • Race car/dance club- 110 dB • Firecracker 140 dB • Levels 85 and up are considered unsafe
  • 13. • Other causes  Acoustic Neurinoma.  Sudden deafness hearing is lost w/o warning  CAPD- Central Auditory Processing Disorder  AIED- Autoimmune Inner Ear Disease  Mondini Syndrome- incomplete cochlea  Auditory Neuropathy- nerves cannot process sound  Presbycusis- Age related hearing loss.  Ototoxicity  Glue Ear : untreated ear infection causing hearing loss
  • 15. Detailed history - Age, time, symptoms -History of using ototoxic drug, family history of deafness, history of noise exposure Examination : - Aural - General Examination of auditory function
  • 16. Symptoms of hearing loss • Symptoms that can accompany hearing impairment due to ear infections include fever, ear pain, fullness in the ear, chills and a discharge for the ear. • Symptoms that can occur with hearing impairment due to: Meniere’s disease or labyrinthitis include tinnitus, vertigo, dizziness, nausea and vomiting.
  • 17. • Symptoms that can accompany hearing impairment due to barotrauma include ear pressure, ear pain, tinnitus and dizziness. • Symptoms that can occur with hearing impairment due to ruptured eardrum include ear pain and ear discharge. • Symptoms that can occur with hearing impairment due to earwax blockage include plugged ear and tinnitus.
  • 18. Examination of Auditory function The stages for examination are: 1 Clinical assessment of the degree of deafness. 2 Tunning fork tests. 3 Audiometry. 4 Otoacoustic emissions 5 Auditory brainstem response
  • 19. Clinical assessment of the degree of deafness. Whispered speech test. -The GP will whisper a combination of numbers and letters behind the patient and check if he can hear anything by asking the patient to repeat the combination. - If unilateral deafness is suspected the good ear should be masked and the deaf ear tested. BMJ. 2003 October 25; 327(7421): 967
  • 20. Tuning fork Test. There are two types of tuning fork: 1 RINNE’S Test. 2 WEBER’S Test.
  • 21. 1 RINNE’S TEST .
  • 22. INTERPRETATION OF RINNE’S TEST o Air Conduction > Bone Conduction = Normal or SNHL o Bone Conduction > Air Conduction = Conductive HL or dead ear
  • 23. 2 WEBER’S TEST.
  • 24. INTERPRETATION OF WEBER’S TEST  In conductive deafness the sound is heard loudest in the affected ear.  In sensorineural deafness the sound is heard louder in the un affected ear.
  • 25. 3 AUDIOMETRY.  Pure tone audiometry (PTA). - Is the key hearing test used to identify hearing threshold levels of an individual - The lower the threshold the better hearing. - AC threshold are obtained with headphones and measure outer , middle, inner ear and the auditory nerve function. - BC threshold are obtained with bone conduction oscillators which effectively bypass outer and middle ear function BRITISH SOCIETY OF AUDIOLOGY
  • 27. AUDIOGRAM  0 dB - 20 dB ....... normal hearing  20 dB - 40 dB ..... mild hearing loss  40 dB - 55 dB ..... moderate hearing loss  55 dB - 70 dB ..... moderately severe hearing loss  70 dB - 90 dB ..... severe hearing loss  >90 dB................. profound hearing loss
  • 28. AUDIOGRAM – CONDUCTIVE HL - Bone conduction threshold in normal rang . - Air conduction threshold outside of normal limits. - Gap between AC and BC threshold > 10 db ( air bone gap ).
  • 29. AUDIOGRAM - SNHL -Both air and bone conduction threshold below normal . -Gap between AC and BC less 10 db ( no air bone gap).
  • 30. 4 OTOACOUSTIC EMISSIONS This is used to measure the cochlear function by recording signals produced by the hair cells. 5 AUDITORY BRAINSTEM RESPONSE . • This measures the activity of the cochlea, auditory nerve and brain when a sound is heard.
  • 32. o Initial treatment- Surgery (Otomicrosurgery) and medications o Assistive technology  Hearing aids  Cochlear implants o Communication and language options o Family support systems  Professional staff CENTER FOR DISEASE CONTROL AND PREVENTION
  • 33. Initial treatment -Treatment for reversible hearing loss depends on its cause. It is often treated successfully. Hearing loss caused by:  Ototoxic medicines (such as aspirin or ibuprofen) often improves after you stop taking the medicine. An ear infection, such as a middle ear infection, often clears up on its own, but you may need antibiotics. An injury to the ear or head you may need surgery. Otosclerosis, acoustic neuroma, or Ménière's disease may require medicine or surgery.
  • 34. An autoimmune problem may be treated with corticosteroid medicines, generally prednisone. Earwax or foreign body is treated by removing the wax. Do not use a cotton swab or a sharp object to try to remove the wax. This may push the wax even deeper into the ear or may cause injury.
  • 35. Management of otitis media with effusion
  • 37. ASSISTIVE TECHNOLOGY HEARING AID CIC ITC ITE BTE Completely In the canal Inside the ear Behind the ear in canal
  • 38. Bone anchored hearing aid (BAHA)
  • 39. COCHLEAR IMPLANT  Is a surgically implanted electronic device that provides a sense of sound to a person who is profoundly deaf or severely hard of hearing  For children and adults who derive no benefit from the use of properly fitted hearing aids
  • 41. Communication Three ways of communicating for the deaf or hard of hearing 1.) Oral/aural communication through spoken English, speech reading, residual hearing, and sound amplification 2.) American Sign Language (ASL) a visual/gestural language or fingers spelling used for spelling words and proper names that have no known sign 3.) Simultaneous communication uses sign language finger spelling and speech, (manually coded English and pidgin sign language) www.csus.edu
  • 42. Educational Implications • Social Interaction – Consider the child’s needs and how their placement can affect their social-emotional development – Teach students how to ask questions, take turns and listen – Incorporate small group activities • Dyad cooperative exercises are best for equal interaction to take place – Foster home-school collaboration www.csus.edu
  • 44.  Prevention of congenital deafness  Genetic counseling and prenatal diagnosis  Pregnant women are prohibited to use ototoxic drugs  To avoid viral infection when pregnant  Prevention of viral and bacterial infection  Measles  Varicella  Parotitis  Epidemic meningitis  Rhinitis  Otitis media
  • 45.  To keep favourable mental status and avoid over-tired  To avoid exposure to noise for long time  To lower level of sound source  To decrease exposure time  To use ear protector  To protect from ototoxic deafness  To understand family history and susceptivity  To control suitable dosage and course of treatment Protective measure for deafness