Hearing is the important for the development of speech and verbal communication. Impairment of hearing may be congenital or acquired. It may be temporary or permanent, organic or inorganic, central or peripheral in origin. Hearing defect can be mild, moderate, severe or profound. It is the most common handicapped conditions in children. It is found about 9 to 15 % among Indian school children.

1. Hearing Disorder
By
Mr. Ravi Rai Dangi
Assistant Professor
Fellowship in Neonatal Nursing
MSc. Child Health Nursing

2. Hearing Impairment
 Hearing is the important for the development of speech and
verbal communication. Impairment of hearing may be
congenital or acquired.
 It may be temporary or permanent, organic or inorganic,
central or peripheral in origin. Hearing defect can be mild,
moderate, severe or profound. It is the most common
handicapped conditions in children. It is found about 9 to
15 % among Indian school children.

3. Etiology
Genetic
 Familial deafness
 Chromosomal abnormalities
 Congenital cranio facial anomalies

4. Intra Uterine Infection
Rubella
CMV

5. Teratogenic Exposure During Pregnancy
Radiation
Streptomycin

6. Postnatal Infection
Meningitis
Recurrent and support otitis media
Encephalitis
Mumps
Measles

7.  Mechanical obstruction of external auditory canal by wax
and foreign body.
 Brain damage, CP, MR. LBW, Severe respiratory distress,
birth asphyxia, toxic neonatal hyperbilirubinemia

8. Oto Toxic Drug Therapy

9. Injury
 Direct injury of ear, head
Nutritional
 Malnutrition
 Vitamin “B” complex deficiency

10. Classification
In a quite environment the healthy baby can hear 0 to 25db
range sound.
 Slight hearing impairment – 15 to 24 db
 Mild hearing impairment – 25 to 39db
 Moderate hearing impairment – 40 to 64db
 Severe hearing impairment – 65to 94 db
 Profound hearing impairment – 95 or more db

11. Types
Conductive hearing deficit
 It is dysfunction of sound transmission or
conduction of sound wave through the external ear
and middle ear.
 Any process interfering with sound transmission
through ear canal, ear drum or ossicles may result
in conductive hearing loss. It is common type of
hearing defect. It is common type of hearing
defect.

12.  The most common cause of conductive deafness is otitis
media with effusion.
 Other causes are impacted wax, foreign body, tympanic
perforation, cholesteatoma, otosclerosis etc. Several
congenital syndromes may also be associated with
conductive hearing deficit.

13. Sensorineural Hearing Defect
 This condition is caused by damage or lesion of the
cochlea (organ of corti), auditory nerve or central
auditory pathway.
 It is usually an acquired problem due to meningitis,
CNS infection, birth asphyxia, neonatal
hyperbilirubinemia, ototoxic drug effect and loud
noise.

14.  This condition may be congenital due to genetic or non-
genetic causes. Genetic causes are associated with Alport’s
syndrome, Jervell’s syndrome etc.
 Non genetic causes are LBW baby, prematurity, neonatal
sepsis.
 These problem damage to auditory nerve and hair cells, the
cochlea thus prevent transmission of sound impulses to the
brain for interaction resulting in sensorium hearing deficit.

16. Mixed type
 It includes both type of hearing defect
 Central hearing defect – it indicates auditory deficit
originating along central auditory nervous system
from the proximal VIIIth cranial nerve to cortex due to
convulsive disorder, tumors, demyelinating disease
etc.
 Peripheral hearing defect – it indicates dysfunction
in the sound transmission through the external or
middle ear as also its conversion into neutral activity
at the inner ear and the VIIIth cranial nerve. It may be
conductive, sensorineural or mixed type.

17. Diagnostic evaluation
Physical examination
Tuning Fork Tests
A tuning fork evaluation may also reveal
whether hearing loss is caused by damage to the
vibrating parts of your middle ear (including
your eardrum), damage to sensors or nerves of
your inner ear, or damage to both.

18. Audiometer Tests
 The audiologist presents a range of sounds of various
tones and asks you to indicate each time you hear the
sound.
 Each tone is repeated at faint levels to find out when
you can barely hear. The audiologist will also present
various words to determine your hearing ability.

19.  Tympanometry may be performed to detect mobility of
the tympanic membrane.
 Labyrinthine Test
It will be performed to detect vestibular function in
older children and adolescence. It is simple, inexpensive
and accurate diagnostic test indicating presence or
absence of labyrinthine response.
 Auditory Brainstem Response Test should be performed
to detect hearing impairment for all neonates with risk
factor for hearing loss.

20. Management
 Early detection and prompt treatment of ear disease by
medical and surgical intervention are important aspect of
management.
 Treatment of infection by antibiotic therapy removal of
cerumen or toxic agent and management the specific
cause should be done effectively.
 Surgical intervention may be required specially in the
conductive problems as myringotomy, tympanoplasty,
stapedectomy and insertion of the graft or prosthesis and
cochlear implant etc.

21.  Supportive and rehabilitative management are provided
with hearing aids, speech therapy, lip reading, sign
language deaf education.
 Cochlear implants are indicated in profound sensorium
deafness, which is unresponsiveness to 3 to 6-month
trail with powerful hearing aids.

22.  Necessary instruction to be given about maintenance and
care of hearing aids with precautions.

23.  Improvement of communication ability of the child
should be emphasized by visual cues, sign language.
 Parental involvement and counseling are the important
aspect of management
 Prevention of injury and accidents with environment
modification, referrals for rehabilitation and emotional
support for facilitation of ventilation of feeling are also
important.