Chapter 13: Pediatric Hearing Loss Justice Communication Sciences and Disorders: An Introduction...

Chapter 13:

Pediatric Hearing Loss

JusticeCommunication Sciences and Disorders: An Introduction

Copyright ©2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Focus Questions

• What is pediatric hearing loss?

• How is pediatric hearing loss classified?

• What are the defining characteristics of prevalent types of pediatric hearing loss?

• How is pediatric hearing loss identified?

• How is pediatric hearing loss treated?

• What is an auditory processing disorder, and how is it identified and treated?

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Introduction• Importance of hearing: recognize familiar

voices, differentiate among wide range of sounds

• Detection, categorization, and comprehension of sounds

• Complex auditory system, so can result in many types of hearing problems

• Specialists can help children learn to listen and speak through the use of assistive technology or specialized teaching methods that foster learning

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Case Study #1: Mesha• 12-month old with profound sensorineural

hearing loss– her father and other family members are also deaf

and immersed in the Deaf community

• Mesha’s parents do not want her to be conflicted between a hearing a deaf world, so parents believe she should have a strong identity as a “Deaf person”

• Mesha is producing a few words right now in sign and actively communicates with her family

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Case Study #1 Questions

• If you were an interventionist working with Mesha and her parents, would you endorse their decision? Why or why not?

• What challenges face children who are raised in the Deaf versus hearing community?

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Case Study #2: Jack• 30-month old child

• 18 months old: Jack’s mom had concerns about language and upon pediatrician’s inspection, noticed severe bilateral otitis media

• Went through medical intervention (antibiotics), but at two years, Jack’s mom went to consult an SLP

• Jack was diagnosed with moderately-severe mixed hearing loss

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• In your opinion, what is Jack’s prognosis for achieving normal speech and language milestones in the next few years?

• Why wasn’t Jack’s hearing evaluated as soon as his mother noted a delay in his communication skills?

• How might Jack’s future be different if his sensorineural loss had been identified earlier? How much difference do you think the delay in identification will make?

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Case Study #3: Lilly• 12-year old girl with congenital profound

sensorineural hearing loss and a syndrome with affects the electrical system of her heart

• Pediatrician refused to approve a referral for a hearing evaluation until 2 years of age; at age 3, Lilly was diagnosed with hearing loss

• Parents decided that they wanted Lilly to use an auditory-verbal approach, be home-schooled, and have cochlear implants

• Now, Lilly is well-adjusted, articulate, reads and writes above grade level, and wants to advocate for other children with hearing loss

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• What role can parents of children with hearing loss play in advocating for the needs of individuals with hearing loss?

• What factors likely contributed to Lilly’s positive outcomes?

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I. What is Pediatric Hearing Loss?• a condition in which a child or adolescent

is unable to detect or distinguish the range of sounds at the level normally possible by the human ear

• Hearing loss: results from damage to the outer, middle, or inner ear, or the auditory nerve

• Auditory processing disorder: hearing loss resulting from damage to the processing centers of the brain

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Varieties of Hearing Loss• Location of damage (outer, middle, inner,

auditory nerve)• Whether it affects one or both ears

– Unilateral or bilateral

• Extent of impact on communication• Chronicity

– Short-term, fluctuating, permanent or progressive

• Timing– Congenital, prelingual, acquired, postlingual

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Hearing Loss and Communication• Hearing loss varies in the extent to which it

affects speech, language, and communication

• Affects ability to develop relationships, succeed academically, and be involved with extracurricular activities

• Can result in delayed receptive and expressive speech and language development, can affect any domain of language

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Early Identification• Family needs to respond early,

proactively, and responsively

• Newborn hearing screenings increase likelihood of early identification

• Parental decisions: communication mode, communication “orientation” (Deaf vs. deaf)

• Best age for identification and initiation of intervention: prior to six months

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Terminology• Hearing impairment, hearing disorder,

deafness, hard-of-hearing• Prefer the term hearing loss:

– Focuses solely on the present physical condition

– Carries no connotation regarding impairment, disability, or handicap

• True deafness (inability to hear at all) is extremely rare

• Deaf vs. deaf (community orientation)

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Prevalence and Incidence• Early Hearing Detection and Intervention

(EDHI) program: 5 to 6 out of every 1000 infants born with hearing loss

• Eight percent of school-age children have “educationally significant” hearing loss– Includes cases of acquired hearing loss due

to middle ear infections (35% children experience ongoing middle ear infections throughout childhood)

– Also includes cases of congenital hearing loss due to pre-, peri-, or post-natal genetic influences, injuries or illnesses

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II. How is Pediatric Hearing Loss Classified?

• Classified by either etiology, manifestation and impact, or severity

A. ETIOLOGY

• For characterizing the cause of the hearing loss:

a. Genetic or environmental cause

b. Age of onset

c. Type of loss

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a. Genetic or Environmental Causes

• Genetic:– Transmitted from parents to offspring

• autosomal dominant• autosomal recessive

• Environmental:– Exposure to noise (e.g., ventilator system in

NICU)– Sudden exposure to noise or sudden change

in air pressure (barotrauma)

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b. Age of Onset

• Developmental: present at birth– Common causes: genetic disorders, Rh

incompatibility, infection or disease, trauma, anoxia, ototoxic drugs, prematurity

• Acquired: occurs sometime after birth– Common causes: trauma, ototoxic drugs,

middle ear infections, infection, noise, systemic illness, barotrauma

• Prelingual vs. postlingual

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c. Type of Loss

• Identifies the auditory structures that are affected

• Conductive loss: damage to the outer or middle ear

• Sensorineural loss: damage to the cochlea or auditory nerve

• Mixed loss: simultaneous damage to the conductive and sensorineural mechanisms

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B. Manifestation and Impact

• Classification based on the aspects of audition that are impacted

• Loss of hearing acuity: loss of precision of hearing at different levels of loudness

• Decrease in language comprehension (occurs with sensorineural loss)– more difficult to manage

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C. Severity• Classification based on severity using

decibel system (dB)

• Hearing loss is represented by identifying the threshold of hearing: where a person just begins to hear– Normal hearing: -10 to 15 dB– Mild hearing loss: 26 to 40 dB– Moderate hearing loss: 41 to 55 dB– Severe hearing loss: 71 to 90 dB– Profound hearing loss: 91 dB or higher

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III. Prevalent Types of Pediatric Hearing Loss

• Conductive Hearing Loss

• Sensorineural Hearing Loss

• Mixed Hearing Loss

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Conductive Hearing Loss• Attenuation or reduction of the sounds

heard in the environment

• However, exaggerates sound of one’s voice and chewing, because of bone conduction

• Slight to moderate loss in one or both ears, typically not severe

• Medical or surgical intervention is usually successful, so loss is usually temporary

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Causes and Risk Factors• Most common cause: middle ear infections

(otitis media)– Angle and shortness of Eustachian tube in

children allows organisms to enter easily– Allergens (e.g., cigarette smoke) make more

susceptible– Interactions with other children spread

infections (e.g., child-care centers)

• Other causes: ear wax (cerumen) blockage, foreign objects, congenital malformations

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Sensorineural Hearing Loss

• Most common type of hearing loss – slight to profound loss of hearing in one or both ears

• Decrease in loudness, also decrease in speech perception and ability to distinguish speech from background noise

• Some also experience reduced tolerance for loud noises or ringing in the ears (tinnitus)

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Causes and Risk Factors

• Usually is present at birth as a congenital hearing loss

• Half of the causes are unknown, the other half are caused by genetics and heredity, infection, otitis media, prematurity, pregnancy complications, trauma

• Risk factors: influenced by maternal health, birth process, hereditary factors, exposure to medications, and disease

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Mixed Hearing Loss

• Both permanent reduction of sound (sensorineural) and additional temporary loss of hearing (conductive)

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IV. How is Pediatric Hearing Loss Identified?

• Identification: often begins with routine screening, (e.g., newborn screening)

• Ongoing monitoring: understanding hearing loss changes over time and to measure effects of intervention

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The Assessment Process

• Referral

• Screening

• Comprehensive Audiological Evaluation

• Hearing Aid Evaluation

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Referral• EDHI programs are present in most states,

with the goal to detect hearing loss while the infant is still in hospital after birth

• Toddlers and preschoolers are referred if:– show developmental delay– have hereditary disposition for hearing loss– develop disease or disorder that affects the

auditory mechanism

• All children are evaluated routinely in kindergarten, and 1st-3rd grades, and 7th and 11th grades

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Screening• Infant Screening:

– Completed at birth in the hospital– Typically uses otoacoustic emissions or

evoked auditory potentials as test measures

• Conventional Hearing Screening:– Require the child to respond when a soft tone

is presented and heard (behavioral testing)– Children who fail are either re-screened in two

weeks or referred for a comprehensive examination

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Comprehensive Audiological Evaluation

• Assesses the type and degree of hearing loss, speech discrimination, and auditory perception

• Case history• Interview and observation• Otoscopic examination• Audiometry• Objective measures

– Immitance, otoacoustic emissions (OAEs), evoked auditory potentials (EAPs)

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Hearing Aid Evaluation• If family decides on this option, requires

fitting and monitoring use of hearing aids

• Probe microphone measurement: computerized method of measuring hearing aid function in a child’s ear

• Electroacoustic evaluation: electronic verification of sound properties of hearing aid (gain, output, frequency response)

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Importance of Accurate Diagnosis

• Because there is typically no outward signs of hearing loss, it is hard to identify and consequently treat

• Failure to identify hearing loss continues the harmful effect on the child

• However, mistaking other conditions for hearing loss can have negative consequences as well

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V. How is Pediatric Hearing Loss Treated?

• Communication Choices

• Amplification and Listening Devices

• Aural Habilitation

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Communication Choices

• Parents need to choose whether to embrace the Deaf community or the mainstream oral community, or to consider a combination– 49% of children use both speech and sign

• 44% use speech only– 6% use sign only

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Amplification and Listening Devices

• Hearing Aids: children usually have behind-the-ear hearing aids (BTEs)– improved greatly in recent years due to technological

advances

• Assistive Listening Devices: improve a person’s ability to hear in difficult listening situations (e.g., FM system, soundfield system)

• Cochlear Implants: provides direct electrical stimulation to the auditory nerve, for children with severe to profound sensorineural loss

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Aural Habilitation• Individualized intervention to achieve fluent

communication in manual and/or oral modality

• Involves activities such as tactile training, auditory training, speech reading and visual cues, and education and counseling

• Three principles:– Ensure an appropriate listening environment– Maximize audition– Support the continuum of listening

development

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Intervention Principles: Infants, Toddlers, and Preschoolers

1. Early Intervention

2. Parental Involvement

3. Naturalistic Environments

4. Social Interaction

5. Functional Outcomes

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Intervention Principles: School-Age Children

1. Effective Means of Communication

2. Self-Advocacy

3. Literacy

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VI. Auditory Processing Disorder• Neurological problem that adversely

affects an individual’s processing or interpretation of auditory messages

• Not typically accompanied by a loss of hearing acuity

• Cause is often unknown, but sometimes associated with other disorders, like dyslexia, ADD, and autism

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Assessment and Intervention• Currently no “gold standard” for

identification, but behavioral assessment, so not recommended for children under 7

• Common symptoms cluster into four areas: behavioral, literacy, linguistic, and organizational

• Treatment approaches:– Environmental modification– Remediation activities– Compensatory strategies

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Chapter 13: Pediatric Hearing Loss Justice Communication Sciences and Disorders: An Introduction...

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