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THE CHILD IS NOT RESPONDING TO SOUNDS Dr. Dennis Kin-kwok AU AuD Audiologist Hearing and Dizziness Laboratory Hong Kong Sanatorium & Hospital

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

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Page 1: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

THE CHILD IS NOT

RESPONDING TO

SOUNDS

Dr. Dennis Kin-kwok AU AuD

Audiologist Hearing and Dizziness Laboratory

Hong Kong Sanatorium & Hospital

Page 2: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

HEARING LOSS IS AN

INVISIBLE HANDICAP

Page 3: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

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

Page 4: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

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

Page 5: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

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)

Page 6: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

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

Page 7: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Types of Hearing Loss

Conductive Sensorineural

Mixed

Page 8: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Types of Hearing Loss

• Conductive

• Sensorineural

• Mixed

• Functional

Page 9: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Audiogram

• Measurement of

hearing level against

different frequencies

Page 10: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Scale of Hearing Loss

Page 11: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

HEARING ASSESSMENTS

Page 12: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Impedance Audiometry

• Middle-ear Test

Tympanogram

• Ear canal volume

• Middle-ear pressure

• Amplitude

Page 13: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Tympanogram

Type A

• Type A

Type C

• Type C

Significant –ve middle-ear pressure

ME pressure > 100 daPa

Normal middle-ear pressure &

compliance

Page 14: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Tympanogram

Type B

• Type B

Type B

Middle-ear fluid Perforated eardrum

Page 15: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

BEHAVIOURAL TESTS

Page 16: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Distraction Test

• 3 weeks to 18 months

• Elicit head-turn response

• Test the better ear only

• MCHC for hearing test

Page 17: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Distraction Test

Page 18: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Distraction Test

• /mum/mum/mum/ 250 Hz

• chime bar 500 Hz

• chime 1K Hz

• /sh/ 2K Hz

• /s/ 4K Hz

• high-frequency rattle 6-8 KHz

Page 19: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Auropalpebral Reflex (Eye Blink Reflex)

Page 20: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Visual Reinforcement Audiometry (VRA)

• 16 to 30 months

• Reinforcement of

child's response by

attractive visual

stimulus

• Test the better ear

only

Page 21: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Play Audiometry

• 2 1/2 years old and

above

• More interesting

• Test each individual ear

• Ability to wait

Page 22: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

OBJECTIVE TESTS

Page 23: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

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

Page 24: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

OAEs

Transient OAEs Distortion Products

Page 25: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Auditory Brainstem Response (ABR)

• A far field recording of synchronized electric

response from auditory pathway in

response to fast acoustic stimulus

• Diagnostic test

Page 26: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Sedation

• Sedation (choral hydrate) 30 mg/kg

• Natural sleep

Page 27: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Hearing Thresholds

• Look at the presence or absence of Wave V

Page 28: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Hearing Thresholds

• Look at the presence or absence of Wave V

Page 29: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

AURAL REHABILITATION

Page 30: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Hearing Aids

BTE mBTE ITE ITC CIC

Page 31: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Hearing Aids CROS Hearing Aid Tactile Hearing Aid

Hearing Aid with Remote Control Eyeglass Hearing Aid

Page 32: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Speech Audiogram

Page 33: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

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

Page 34: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Sound Localization

• Interaural time

difference

• Interaural level

difference

Page 35: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

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

Page 36: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Cochlear Implant

Page 37: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Cochlear Implant – How it works?

Page 38: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Cochlear Implant Nucleus Advanced Bionic Med El

Page 39: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Selection Criteria for Children (I)

• Bilateral severe to profound deafness

• As soon as possible > 6 months

• No radiological contraindications

• No medical contraindications

Page 40: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

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

Page 41: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Multidisciplinary Team Approach

• Audiologists

• ENT doctors

• Speech pathologists

• Social workers

• Teachers of the deaf

• Linguist

• Administrators

Page 42: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Mapping of Speech Processor

• Measure threshold

level (T)

• Measure comfortable

level (C)

• Determine if any

electrode stimulation

causes, pain,

dizziness, irritation,

inconsistent percept

Page 43: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Microtic / Atresic Ears

Page 44: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Bone Anchored Hearing Aid (BAHA)

• Made up of three

parts

• Fixture

• Abutment

• Sound Processor

Page 45: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Bone Anchored Hearing Aid (BAHA)

• Sounds are picked up by the speech processor

• Sounds are transmitted through bone conduction to

cochlear/s

Page 46: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Indications

• Single Sided Deafness

• Chronic otitis media

• Congenital atresia

Patients suffering from conductive, mixed or unilateral hearing loss due to

Page 47: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

BAHA

Page 48: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Vibrant Bonebridge

Page 49: HKMA Structured CME Programme with HKS&H Session 11 The Child is not Responding to Sounds

Vibrant Bonebridge – How it works?