Role of institutions in early detection and intervention for early mainstreaming of hearing impaired

1. Role of institutions in
early detection and
intervention for early
mainstreaming of
hearing impaired
Dr Sheelu Srinivas,
Consultant ENT and Cochlear Implant Surgeon
Dr Sheelu’s ENT and Deafness Habilitation Center, Bangalore
WWW.ENTBANGALORE.IN

2. Is it a distant dream or is it for
some privileged ones ?

3. Early detection
• When
• How
BOA versus tuning fork
versus audiometer
OAE
BERA/ABR
• Type of deafness
• Treatable deafness
• Preventable deafness

4. Development Timing
• Week 3 - otic placode, otic vesicle
• Week 5 - cochlear part of otic vesicle elongates
(humans 2.5 turns)
• Week 9 - Mesenchyme surrounding membranous
labrynth (otic capsule) chondrifies
• Week 12-16 - Capsule adjacent to membranous
labrynth undegoes vacuolization to form a cavity
(perilymphatic space) around membranous
labrynth and fills with perilymph
• Week 16-24 - Centres of ossification appear in
remaining cartilage of otic capsule form petrous
portion of temporal bone. Continues to ossify to
form mastoid process of temporal bone.
• 3rd Trimester - Vibration acoustically of
maternal abdominal wall induces startle respone
in fetus.

5. “How Early ?”
• At birth….Newborn Hearing Screening
• Where is the baby at birth or infancy?-home, pediatrician
• Preschool /Anganwadi up to 5 years
• Till 8 years
• After 8 years Cerebral plasticity
• We do not ignore them after 8 years-its just the
mainstreaming becomes difficult

6. Auditory&Visualchannelsareresponsibleformorethan95%ofinformation
acquisition.Theyneedtobefunctioningoptimallyforthedevelopmentof
child’sspeech,language&communication skills

7. What is a cochlear implant?
• An electronic device that provides a sense of sound to
individuals who are profoundly deaf or severely hard-of-
hearing.
• Cochlear implants process sounds from the environment and
directly stimulate the auditory nerve, bypassing damaged
portions of the inner ear
www.entbangalore.in

8. www.entbangalore.in

9. Audiological diagnosis
OAE/IMPEDENCE/PTA BERA/ABR

10. Early Detection
• Work with Pediatricians and Obstetrician

11. Screening in NICU

12. Oto acoustic emission testing

13. Audiometry
• Behavior Observation Audiometry: Eye blink, Eye widening,
Increased sucking, Decreased sucking, Increased breathing
rate, Searching for sound, turn to left speaker, turn to right
speaker, smile, startle, cessation of crying, other
__________for babies up to 12-18 months
• VRA-Visual Response Audiometry-Excellent tool
• Pure Tone Audiometry is the gold standard

14. Early Hearing
Detection and Intervention
Rule of 1-3-6
EHDI process including
• screening before 1 month of age,
• diagnostic evaluation before 3 months of age,
• fitting of amplification within 1 month of diagnosis,
• enrollment in an appropriate early intervention program as
soon as possible after diagnosis, but no later than 6 months
of age

15. Treatable causes of deafness

16. Intervention
• Auditory Brain Development
• Acoustic accessibility of intelligible speech-Hearing aids
,Cochlear implants, FM systems

17. What is the difference between
Cochlear Implant & Hearing Aid?
• HA simply amplify
sounds.CI on the other
hand transforms speech
sounds into electrical
energy used to stimulate
the surviving auditory
nerve fibers in the inner
ear.
• CI have internal &
external parts & a
surgical process is
needed to place internal
processor components

20. 2 groups
Pre lingual
• Lost hearing before
acquisition of speech
• Implant before 3 years
• CEREBRAL PLASTICITY
Post lingual
• Lost hearing after
acquisition of speech
• Implant as soon as
possible

21. 0---1---2---3---4---5---6---7---8---9 Age in Years
Optimal for
Implant
Suitable for
Implant
Outcomes variable
Critical Period
for Language
Acquisition
What is the best age for a patient to
receive a Cochlear implant system?
www.entbangalore.in
Govaerts, et al, Otology & Neurotology 2002, Svirsky MA, Robbins AM, Kirk KI, Pisoni DB, Miyamoto RT.
Psychological Research 2000;11:153-158.

22. Cochlear Implant Surgery
www.entbangalore.in

23. Surgery
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24. SWITCH ON

25. Parent role in AVT
www.entbangalore.in

26. Mapping
www.entbangalore.in

27. Silence to speech
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28. Intervention
• Auditory Verbal Therapy
• Auditory oral approach
• Various other: sign language, cued speech
“Technological and medical devices only give children access to
hearing. Whether they learn to use this hearing depends on the
therapy they receive”

29. Group therapy

30. What are we aiming for?
• “We are developing
the brain ..not just
hearing”
• “Develop language
skills not just speech”

32. EDUCATION
• TAILORMADE
• MAINSTREAM V/S INTEGRATEDV/S SPECIAL SCHOOLS
• ROLE OF SPECIAL EDUCATOR FOR THE DEAF

33. What can institutions do to make a
difference in the larger population?
• Large country with so many organizations
• We have to come under one platform and work together
• Form a protocol-
lets say hearing screening
BOA/VRA/SCREENING AUDIOMETRY Versus OAE/BERA
COST EFFECTIVE

35. Are you listening?

36. EDUCATE DECISION MAKERS
“The impersonal hand of government can never replace the
helping hand of a neighbor”
Hubert H Humphrey

38. EmpowerParentsofthehearingimpaired
Involve thehearingimpairedcommunityindecision
making

39. Public Awareness

40. We can together make it possible–
institutions,professionalsworkingfor the
hearing impairedalong withthe parent
groups

41. www.entbangalore.in
https://www.facebook.com/Deafnesssolutions
Email:sheelusent@gmail.com