1. Tarek Ghannoum , M.D.
Audiology Unit , ENT Department
Kasr Alainy Hospitals- Cairo University

2. Hearing loss :

3. Hearing loss:
*Any degree of impairment of the ability
to apprehend sound.
*Being partly or totally unable to hear
sound.

4. CHILD:
*A person between birth and full growth.
Infant:
*A person not more than 12 months old.

5. Prevalence of Hearing Loss:
* Prevalence estimates vary across studies.
*Estimated that 1 to 3 per 1000 infants will
have permanent sensorineural hearing
loss.
-1/1000 from well baby nursery.
-10/1000 from the NICU.
* Rate increases to 6/1000by school age.

6. Children with hearing problems
may have difficulties in:
*Language and/or speech development.
* Listening and understanding in noisy
environments.
*Paying attention and participation in noise
(class).
*Hearing differences between sounds in words.

7. Hearing loss:
Impaired all brain functions:
*Speech and language development.
*Cognitive functions and intellectual
abilities
*Social activities.

8. Hearing mechanism

9. Neurological Issues:
We hear with the brain—the ears
are just a way in.
Children can’t listen like adults
1. The higher auditory brain centers
are not fully developed (15 years).
2. Children cannot perform
sophisticated automatic auditory
cognitive closure.

10. So
Infants and children need:
Quieter environment (S/N ratio)
Louder signals than adult

11. Hearing loss is not about the ears, it’s
about the brain.
Any-time the word hearing is used, think
about “auditory brain development”
Acoustic accessibility of intelligible speech
is essential for brain growth (CAP).
Hearing is the first order event for the
development of spoken communication and
literacy skills.

12. Summary of Neuroplasticity
Greatest in the first year of life.
The younger the infant, the greater the
neuroplasticity.
Rapid brain growth requires prompt
intervention, including amplification and
habilitation programs.
In the absence of sound, the brain re-
organizes itself to receive input from other
senses, primary vision- cross modal
reorganization. This reduces auditory neural
capacity

13. Goals for hearing screening:
All infants must access hearing
screening no later than 1 month of age.
All confirmed cases should receive
early intervention not later than 6
months of age.

14. Reminder
A pass on newborn hearing screening
does not guarantee typical hearing
forever.
High risk babies should undergo
retesting every 6-12 months.
Any child with delayed language
development should be retested.
Average age for identification of
hearing loss is after 3 years of age.

15. High risk babies:
Prenatal Perinatal
Consanguinity Pre-eclampsia
Similar condition Low birth weight
Viral infection Birth trauma
Ototoxic drugs Hyperbilirubinemea
Cyanosis
Congenital anomaly

16. High risk babies (cont.)
Post natal
NICU

17. Normal chart of language development:
Cry (at birth)
Pseudocry (2-3 weeks)
Babling (3-4 months)
Lalling (6 months)
Echolalling (9 months)
One word ( one year)
Two words (2 years)
Three words (3 years)
Full language maturation (School age)

18. Degrees of hearing loss

19. AUDIOGRAM

20. AUDIOGRAM
0-15 dB Normal.
15-25 dB Minimal hearing loss.
26-40 dB Mild hearing loss.
41-55 dB Moderate hearing loss.
56-70 dB Moderately severe hearing loss.
71-90 dB Severe hearing loss.
>90 dB Profound hearing loss.

21. Speech banana

22. Audiological evaluation:
Objective audiometry:
Otoacoustic emission:
ABR/ SSEP

23. ABR & SSEP

24. Subjective audiometry:
Play audiometry
PTA
Speech audiometry

25. Circumaural environment

26. Hearing Technology Options
Hearing aids:
Ear level
Bone conduction.
BAHA.
Cochlear implant:
FM system.

27. Hearing Technology Options
Hearing aids:
Ear level
Bone conduction.
BAHA.
Cochlear implant:
FM system.

28. Hearing Technology Options
Hearing aids:
Ear level
Bone conduction.
BAHA.
Cochlear implant:
FM system.

29. Hearing Technology Options
Hearing aids:
Ear level
Bone conduction.
BAHA.
Cochlear implant:
FM system.

30. Hearing Technology Options
Hearing aids:
Ear level
Bone conduction.
BAHA.
Cochlear implant:
FM system.

31. Benefits of hearing aids fitting
1-Improve discrimination.
2-Improve communication
3-Prevent sensory degradation.
4- Alleviation of tinnitus
5- Alerting device.