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

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

Early detection

• When

• How

BOA versus tuning fork versus audiometer

OAE

BERA/ABR

• Type of deafness

• Treatable deafness

• Preventable deafness

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.

“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

Auditory & Visual channels are responsible for more than 95% of information

acquisition. They need to be functioning optimally for the development of child’s speech, language & communication skills

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

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Audiological diagnosis

OAE/IMPEDENCE/PTA BERA/ABR

Early Detection

• Work with Pediatricians and Obstetrician

Screening in NICU

Oto acoustic emission testing

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

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

Treatable causes of deafness

Intervention

• Auditory Brain Development

• Acoustic accessibility of intelligible speech-Hearing aids ,Cochlear implants, FM systems

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

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

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?

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Govaerts, et al, Otology & Neurotology 2002, Svirsky MA, Robbins AM, Kirk KI, Pisoni DB, Miyamoto RT. Psychological Research 2000;11:153-158.

Cochlear Implant Surgery

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Surgery

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SWITCH ON

Parent role in AVT

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Mapping

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Silence to speech

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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”

Group therapy

What are we aiming for?

• “We are developing the brain ..not just hearing”

• “Develop language skills not just speech”

EDUCATION

• TAILORMADE

• MAINSTREAM V/S INTEGRATEDV/S SPECIAL SCHOOLS

• ROLE OF SPECIAL EDUCATOR FOR THE DEAF

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

Are you listening?

EDUCATE DECISION MAKERS

“The impersonal hand of government can never replace the helping hand of a neighbor”

Hubert H Humphrey

Empower Parents of the hearing impaired Involve the hearing impaired community in decision making

Public Awareness

We can together make it possible –institutions, professionals working for the hearing impaired along with the parent groups

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