Ebook Pediatric otolaryngology: Part 2
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Ebook Pediatric otolaryngology: Part 2
The Hearing Impaired Child14 Nonsurgical Management of the Child with Hearing LossPriya Singh and Josephine MarriageIll14.1IntroductionPermanent child Ebook Pediatric otolaryngology: Part 2dhood hearing impairment (PCHI) from early life occurs in approximately 1 per 1.000 live births in most populations. In approximately 50% of these cases, the hearing loss may be due to some factors around the birth, including prematurity, illness, or congenital infection. In the other half of the ca Ebook Pediatric otolaryngology: Part 2ses, the hearing loss is related to genetic factors, though not necessarily with experience of deafness in other family members, especially in autosomEbook Pediatric otolaryngology: Part 2
al recessive conditions.1 Newborn hearing screening programs (NHSPs) have been implemented in many European countries to identify these cases early anThe Hearing Impaired Child14 Nonsurgical Management of the Child with Hearing LossPriya Singh and Josephine MarriageIll14.1IntroductionPermanent child Ebook Pediatric otolaryngology: Part 2th hearing aids is to achieve optimum development of the auditory system during critical periods of early neural plasticity.2 The aim is that speech, language, and academic outcomes for the majority of hearing-impaired (HI) children should be on a par with their peers with normal hearing by the time Ebook Pediatric otolaryngology: Part 2 of school entry. This is not yet being fulfilled in most countries, but the academic and communication achievements have greatly improved for recentEbook Pediatric otolaryngology: Part 2
generations of HI children.3In addition to the infants with hearing loss at or around birth, children may acquire debilitating hearing loss during chiThe Hearing Impaired Child14 Nonsurgical Management of the Child with Hearing LossPriya Singh and Josephine MarriageIll14.1IntroductionPermanent child Ebook Pediatric otolaryngology: Part 2dia with effusion |0V1E|: see Chapter 8). which may impact on talking and on learning development, and those with acute or recurrent ear infections (see Chapter 7). Another group of children acquire hearing loss over the years of childhood such that the prevalence of permanent loss of greater than 4 Ebook Pediatric otolaryngology: Part 20dB in at least one ear by teenage years is approximately 1.6 per 1.000. This compares with 1.1 per 1.000 at birth.4 The commonest causes of late onseEbook Pediatric otolaryngology: Part 2
t hearing loss include bacterial meningitis, congenital cytomegalovirus (CMV) infections, acquired infections (mumps, measles), ototoxic medication, aThe Hearing Impaired Child14 Nonsurgical Management of the Child with Hearing LossPriya Singh and Josephine MarriageIll14.1IntroductionPermanent child Ebook Pediatric otolaryngology: Part 2ity to deterioration in cochlear hearing levels over time. This may be hearing loss in isolation or as part of a genetic syndrome. Example of genetic syndromes with progressive hearing loss include Alport's syndrome with renal abnormalities. Usher's syndrome with loss of vision, andDown's syndrome ( Ebook Pediatric otolaryngology: Part 2trisomy 21) associated with early conductive hearing loss and abnormal aging.The onset of a hearing loss may be first indication of a wider genetic coEbook Pediatric otolaryngology: Part 2
ndition: therefore, careful and thorough investigation of each case is important.14.2What Is the Impact of Hearing Loss for Children?The period from bThe Hearing Impaired Child14 Nonsurgical Management of the Child with Hearing LossPriya Singh and Josephine MarriageIll14.1IntroductionPermanent child Ebook Pediatric otolaryngology: Part 2to have age-appropriate language by school entry.8Speech is acquired through hearing and its more active counterpart of listening. There is no part of the child's day in which it is not important for the child to be able to hear sounds in the environment. The neural processes for binaural hearing, l Ebook Pediatric otolaryngology: Part 2ocalization skills, listening in noise, and applying auditory attention are laid down in the early years of life. Even a fluctuating conductive hearinEbook Pediatric otolaryngology: Part 2
g loss from middle ear effusion can delay or obstruct these processes for later auditory learning potential.9 A typical vocabulary size at school entrThe Hearing Impaired Child14 Nonsurgical Management of the Child with Hearing LossPriya Singh and Josephine MarriageIll14.1IntroductionPermanent child Ebook Pediatric otolaryngology: Part 2s have not been taught but have been acquired through overhearing and tangential learning. Language level and hearing ability predict later acquired literacy skills as the school curriculum is mainly delivered through audition.11 The scores by children in standardized attainment scores used in Brita Ebook Pediatric otolaryngology: Part 2in for schools are influenced by the noise levels in the classroom, even when controlled for socioeconomic group.12 This demonstrates the importance oEbook Pediatric otolaryngology: Part 2
f being able to overhear speech by different talkers as a foundation skill for literacy, academic. and social achievement. One of the recent themes beThe Hearing Impaired Child14 Nonsurgical Management of the Child with Hearing LossPriya Singh and Josephine MarriageIll14.1IntroductionPermanent child Ebook Pediatric otolaryngology: Part 2ns, even if their language skills are age-appropriate on assessment.13 The178Nonsurgical Management of me VIIIIU Willi ricuiiuy LU3>evidence is clear: the impact of hearing loss in early life, even for short periods, is wide-ranging and has long-term effects on achievement and life choices.Tips and Ebook Pediatric otolaryngology: Part 2TricksAvoid simplified phrases such as “speech is coming on weir unless there are specific measures from Standardized evaluations such as language scoEbook Pediatric otolaryngology: Part 2
res. Comments may be quoted out of context and be overinterpreted as meaning “no intervention is required.’ The medical doctor’s statements carry veryThe Hearing Impaired Child14 Nonsurgical Management of the Child with Hearing LossPriya Singh and Josephine MarriageIll14.1IntroductionPermanent child Ebook Pediatric otolaryngology: Part 2ers are concerned about hearing, this is a red flag. The child needs full and accurate assessment of hearing in each ear. A fuller communication assessment is needed if hearing is found to be normal. The converse is not true: parents, teachers, and carers may not always be aware that a child has poo Ebook Pediatric otolaryngology: Part 2r hearing. If there is any doubt, refer for early assessment.14.3.1 Objective Hearing Assessment in the Early Months of Life14.3Diagnosis of AcquiredEbook Pediatric otolaryngology: Part 2
Hearing LossAs the focus of screening for hearing loss is now on identifying children with bilateral permanent hearing loss at birth (with concurrent The Hearing Impaired Child14 Nonsurgical Management of the Child with Hearing LossPriya Singh and Josephine MarriageIll14.1IntroductionPermanent child Ebook Pediatric otolaryngology: Part 2me may have had no period of illness. for example, those with later onset genetic deafness or chronic noninfective middle ear effusion. The screening of hearing at school entry is no longer standard practice in most countries. A wide-ranging yet methodical system of surveillance is necessary, usuall Ebook Pediatric otolaryngology: Part 2y through primary practitioners and family doctors leading on to ear. nose, and throat (ENT)/audiology and pediatric referrals.Hearing deficits may beEbook Pediatric otolaryngology: Part 2
noticed by parents and carers. When a parent expresses concern about their child’s hearing, there is almost always a hearing or communication impairmThe Hearing Impaired Child14 Nonsurgical Management of the Child with Hearing LossPriya Singh and Josephine MarriageIll14.1IntroductionPermanent child Ebook Pediatric otolaryngology: Part 2ly express concerns about their child's hearing, this is a red flag for there being a problem. It may not be hearing-sometimes it is a more generalized communication difficulty—but it is always important to arrange hearing assessment if parents or carers are questioning hearing.Screening TestsOtoaco Ebook Pediatric otolaryngology: Part 2ustic emission (OAE) testing is a noninvasive and simple method for recording reflected sound generated by the normal activity of the outer hair cellsEbook Pediatric otolaryngology: Part 2
in the cochlea (refer to Chapter 13 for more on screening tests). The OAE is typically absent for hearing loss of 25 to 30 dB HL or above or when theThe Hearing Impaired Child14 Nonsurgical Management of the Child with Hearing LossPriya Singh and Josephine MarriageIll14.1IntroductionPermanent child Ebook Pediatric otolaryngology: Part 2the cochlea and therefore this test is not sensitive to cases with normal cochlear function but with an auditory neuropathy (refer to Chapter 13. Chapter 14.4.3. and ► Fig. 14.7) in which the transmission of neural information is compromised.Objective Assessment of Hearing Loss Auditory Brainstem Re Ebook Pediatric otolaryngology: Part 2sponse or Brainstem Evoked Response AudiometryThe techniques used for hearing assessment depend upon the age and developmental status of the child. InEbook Pediatric otolaryngology: Part 2
the first few months of life, up to approximately 4 months of age. auditory brainstem response (ABR) testing is used. This is typically needed for neThe Hearing Impaired Child14 Nonsurgical Management of the Child with Hearing LossPriya Singh and Josephine MarriageIll14.1IntroductionPermanent child Ebook Pediatric otolaryngology: Part 2 mastoid of the baby’s head. These record the electroencephalogram (EEG) activity that is time-locked to the presentation of short acoustic signals, either clicks or tone bursts, to the ear. Use of averaging and filtering of the EEG allows the auditory neural potentials from the14179The Hearing Impa Ebook Pediatric otolaryngology: Part 2ired ChildFig. 14.1 Newborn undergoing auditory brainstem response.brainstem pathways to be extracted and analyzed in response to acoustic signals ofEbook Pediatric otolaryngology: Part 2
different intensities and frequencies. ABR therefore reflects early hearing levels for detection and transduction of sound signals within the cochleaGọi ngay
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