Detection of Hearing Loss in Children

Ichsan Juliansyah Juanda

Supervisor:dr.Sally Mahdiani, M.kes, Sp.T.H.T.K.L

BackgroundCritical period of hearing and talking development begins within the first 6 months of life and continued until 2 years

Children with severe bilateral deafness only 49% of their parents who suspect the possibility of hearing loss, whereas in children with mild to moderate hearing loss or unilateral only 29%

The incidence of hearing loss in newborns in the United States ranged between 1-3 of 1,000 live births

Data Sense of Hearing according to a health survey in 7 provinces in 1994-1996 obtained 0.1% of the population was congenital hearing loss

Incidence and pattern of hearing impairment in children with≤ 800 g birthweight in British Columbia, Canada AR Synnes, S Anson, J Baum, L Usher - Acta Paediatrica, 2012 - Wiley Online Library

Anatomy & PhysiologyOExternal earOMiddle Ear: - Tympanic Membrane

- OssiclesOInner ear: - cochlea

- Vestibular

Hearing Proses

The development of auditory and Talk

O Research shows that cochlear achieve normal function as an adult after 20 weeks' gestation

O Normal child development can be observed by Milestone

Developmental Milestone

Developmental Milestone - WHO

Hearing Problem

definition •Partial or total inability to listen to the sound in one or both ears•Hearing loss can be divided into partial deafness (hearing impaired) and total deafness.

clasiffication •Conductive Hearing Loss•Sensory Neural Hearing Loss•Mix Type Hearing Loss

Early intervention and language development in children who are deaf and hard of hearing MP Moeller - Pediatrics, 2000 - Am Acad Pediatrics

Degree of Hearing LossDegree of hearing loss Hearing loss range (dB HL)

Normal -10 to 15

Slight 16 to 25

Mild 26 to 40

Moderate 41 to 55

Moderate severe 56 to 70

Severe 71 to 90

Profound >90

Hearing assessment in infants and children: recommendations beyond neonatal screeningM Cunningham, EO Cox - Pediatrics, 2003 - Am Acad Pediatrics

The degree of hearing loss and its impact on children

Hearing assessment in infants and children: recommendations beyond neonatal screeningM Cunningham, EO Cox - Pediatrics, 2003 - Am Acad Pediatrics

Hearing Loss in ChildrenOEtiology

Systematic review of the etiology of bilateral sensorineural hearing loss in children S Morzaria, BD Westerberg, FK Kozak - International journal of pediatric, 2004 - Elsevier

Examination of Hearing in Infants and Children

O Behavioral Observation Audiometry (BOA)

O Audiometri bermain (play audiometry)

O TimpanometrYO OtoAcoustic Emission (OAE)O Brainstem Evoked Response

Audiometry (BERA)

Hearing assessment in infants and children: recommendations beyond neonatal screening M Cunningham, EO Cox - Pediatrics, 2003 - Am Acad Pediatrics

Behavioral Observation Audiometry (BOA)

Examination carried out on a fairly quiet room (noisy environment is not more than 60 dB), ideally in a soundproof room

Behavioral Reflex AudiometryThe response can be observed among others: blinking (autopalpebral reflex), dilate the eyes (eye widening), wrinkled face (grimacing), stop feeding (cessation reflex), increased heart rate, reflexes Moro

Behavioral Response AudiometryIn normal infants around the age of 5-6 months, acoustic stimulation will produce a distinctive response pattern in the form of turn or move his head towards the sound source outside the field of view

BOA

Responses of infants and young children to behavior observation audiometry (BOA) G Thompson, BA Weber - Journal of Speech and Hearing Disorders, 1974 - ASHA

Play Audiometry O This examination requires children to respond to

the sound stimulus through play activities, such as dropping the beam when the sound is heard through earphones

The new age of play audiometry: prospective validation testing of an iPad-based play audiometer J Yeung, H Javidnia, S Heley… - J Otolaryngol Head 2013 - biomedcentral.com

Pure tone audiometryO Examination performed using

audiometer and the results is audiogram

O Examination can be performed in children aged 4 years or more cooperative

O Examination of air conduction perform in soundproof room through headphones at a frequency of 125, 250, 500, 1000, 2000, 4000, and 8000 Hz

Pure Tone Audiometer V Vencovský, F Rund - 20th Annual Conference Proceeding's Technical …, 2012 - humusoft.cz

TimpanometryO This examination is needed to assess the

condition of the middle earO Through a tone probe (plug the ear canal) that is

mounted on the ear canal can be seen the amount of pressure in the ear canal based on sound energy is reflected back (to the outside) by the eardrum

O In adults or infants aged 7 months to use the probe tone frequency of 226 Hz

O In infants under 6 months of use of high frequency probe tone (668, 678, or 1000 Hz)

Otoacoustic Emission (OAE) O OAE is a cochlear

electrophysiological response to acoustic stimuli, such as sound of clicks or tone bursts. The response emitted outwards through the middle ear, so it can be recorded by a mini microphone who is also in the probe in the ear canal

O There are two types, namely OAE Spontaneous OAE (SPOAE) and Evoked OA

Brainstem Evoked Response Audiometry

O Another term of this examination is Auditory Brainstem Response (ABR)

O Examination carried out by using surface electrodes attached to the scalp or forehead and mastoid processes or ear lobule

O The principle of ABR examination is to assess changes in electrical potential in the brain after administration of sensory stimuli in the form of sound

Early Detection of Hearing Loss in Children

Infants and children who have a high risk of hearing loss by the Joint Committee on Infant Hearing (2000):For 0-28 days:O Condition or disease that requires treatment

NICU (Neonatal ICU) for 48 hours or moreO State or stigmata associated with a

particular syndrome that are known to have a relationship with sensorineural or conductive deafness

O A family history of sensorineural hearing loss are permanent since childhood

O Craniofacial anomalies including morphological abnormalities of the pinna or ear canal

O Intrauterine infections such as toxoplasmosis, rubella, cytomegalo virus, herpes, syphilis.

For infants 29 days-2 years:O Suspicion of parents or caregivers about hearing

loss, speech delay, language, and or developmental delays

O Family history of hearing loss is permanent since childhood

O State or stigmata associated with a particular syndrome that are known to have a relationship with sensorineural deafness, conductive, or malfunctioning of the tube Eusthachius

O Postnatal infections that cause sensorineural hearing loss including bacterial meningitis

O Intrauterine infections such as toxoplasmosis, rubella, cytomegalo virus, herpes, syphilis

O The existence of certain risk factors in the neonatal period, especially hyperbilirubinemia requiring exchange transfusion, pulmonary hypertension who require ventilator and other conditions that require corporeal membrane oxygenation (ECMO)

O Certain syndromes associated with progressive hearing loss such as Usher syndrome, neurofibromatosis, osteoporosis

O The existence of degenerative disorders such as Hunter syndrome, and neuropathy disorders sensomotorik example Friederich's ataxia, Charrot-Marie Tooth Syndrome

O Head injuryO Otitis media with recurrent or persistent middle ear effusion at

least 3 months

O Efforts to early detection of hearing loss in infants assigned through the program Newborn Hearing Screening (NHS). Currently the gold standard in infant hearing screening examination is the examination of Otoacoustic Emission (OAE) and Automated ABR (AABR)

Newborn Hearing Screening Programme

Universal Newborn Hearing Screening (UNHS)Targeted Newborn Hearing Screening

Newborn Hearing Screening Programme F Bonney - 2012 - oxfordradcliffe.nhs.uk

Newborn Hearing Screening

Hearing HabilitasiO After we know a child suffering

deafness, hearing habilitation efforts should be made as early as possible, because the critical age the process of speaking and listening is about 2-3 years.

O When there is a moderate degree of sensorineural deafness or severe, it must be fitted hearing aids or cochlear implants

Conclusion

O Hearing loss in infancy, will cause disruption of speech, language, cognitive, social, and emotional.

O Identification of hearing loss in children early by means of observation of the child's reaction to sound or auditory function tests with simple methods and equipment, it should be understood by all professions in the health sector faces many babies and children

The gold standard in infant hearing screening examination is the examination of Otoacoustic Emission (OAE) and Automated ABR (AABR)Screening programs should be prioritized in infants and children at high risk for hearing lossAssessment of auditory function in children requires understanding, training and clinical experience is quite extensive

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