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Similar to 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. THE CHILD IS NOT RESPONDING TO SOUNDS Dr. Dennis Kin-kwok AU AuD Audiologist Hearing and Dizziness Laboratory Hong Kong Sanatorium & Hospital
- 2. HEARING LOSS IS AN INVISIBLE HANDICAP
- 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. 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. 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. 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. Types of Hearing Loss Sensorineural Conductive Mixed
- 8. Types of Hearing Loss • Conductive • Sensorineural • Mixed • Functional
- 9. Audiogram • Measurement of hearing level against different frequencies
- 10. Scale of Hearing Loss
- 12. Impedance Audiometry • Middle-ear Test Tympanogram • Ear canal volume • Middle-ear pressure • Amplitude
- 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. Tympanogram Type B Type B • Type B Perforated eardrum Middle-ear fluid
- 16. Distraction Test • 3 weeks to 18 months • Elicit head-turn response • Test the better ear only • MCHC for hearing test
- 17. Distraction Test
- 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. Auropalpebral Reflex (Eye Blink Reflex)
- 20. Visual Reinforcement Audiometry (VRA) • 16 to 30 months • Reinforcement of child's response by attractive visual stimulus • Test the better ear only
- 21. Play Audiometry • 2 1/2 years old and above • More interesting • Test each individual ear • Ability to wait
- 22. OBJECTIVE TESTS
- 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
- 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. Sedation • Sedation (choral hydrate) 30 mg/kg • Natural sleep
- 27. Hearing Thresholds • Look at the presence or absence of Wave V
- 28. Hearing Thresholds • Look at the presence or absence of Wave V
- 31. Hearing Aids CROS Hearing Aid Eyeglass Hearing Aid Tactile Hearing Aid Hearing Aid with Remote Control
- 32. Speech Audiogram
- 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. Sound Localization • Interaural time difference • Interaural level difference
- 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. Cochlear Implant
- 37. Cochlear Implant – How it works?
- 39. Selection Criteria for Children (I) • Bilateral severe to profound deafness • As soon as possible > 6 months • No radiological contraindications • No medical contraindications
- 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. Multidisciplinary Team Approach • Audiologists • ENT doctors • Speech pathologists • Social workers • Teachers of the deaf • Linguist • Administrators
- 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. Microtic / Atresic Ears
- 44. Bone Anchored Hearing Aid (BAHA) • Made up of three parts • Fixture • Abutment • Sound Processor
- 45. Bone Anchored Hearing Aid (BAHA) • Sounds are picked up by the speech processor • Sounds are transmitted through bone conduction to cochlear/s
- 46. Indications Patients suffering from conductive, mixed or unilateral hearing loss due to • • • Single Sided Deafness Chronic otitis media Congenital atresia
- 47. BAHA
- 49. Vibrant Bonebridge – How it works?