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Hear and now: Chinese Health in NZ Michelle Wong ENT Surgeon, ADHB

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Population statistics 2013 Census: 4.24 Million Kiwis 170,667 Chinese Life Expectancy born today (non-Maori): Males 80 years Females 84 years Life Expectancy of 65 year-old (non-Maori): Males 84 years Females 86.5 years

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Population by Age 2013

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Chinese Population by age 2013

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Chinese HEARING Health in NZ Population of baby boomers and elderly on the increase Newborn Hearing Screen Increasing Migrant population from China Bilingual: hearing and tonal languages

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UNHS around the World United Kingdom Screening 600,000/yr by March 2005 United States Screening > 3.5 million babies per year. Australia Screening >100,000 babies per year

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In New Zealand 135- 170 children / year ( 3/1000 births) with PCHI Identification ( 2003): Average age 3-4 years Maori 80% by 80 months age ( 6.7 years) Others 80% by 60 months age ( 5 years)

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Evidence for the importance of early identification of hearing loss Critical period= first 6 months of life

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Vocabulary Range at 3 years of age: Normal hearing 700+ words

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Vocabulary Range at 3 years of age: Identified at birth 350 words

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Vocabulary Range at 3 years of age: Identified at 6 months 200 words

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Vocabulary Range at 3 years of age: Identified at 2 years Begin pre-school with less than 50 words in their vocabulary.

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Mean language quotient by age of identification From:Yoshinago-Itano et al (1998) Even when picked up in the first 12mths they don t do significantly better. It is not until intervention begins in the first 6mths there is a significant improvement.

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HIEDI 2001 Hearing Impairment, Early Detection and Intervention formed in NZ 2006 government announces national funding for Newborn Screening program NZ 1 July 2007 rolled out over 3 years 20 DHBs Self governance

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UNHSEIP- aims: 1. Babies to be screened by 1 month age 2. Audiology assessment completed by 3 months age 3. Initiation of appropriate medical and audiological services and Early Intervention education services, by 6 months of age

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How do you screen for a babys hearing?

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Infant diagnostic test battery Tympanometry Otoacoustic Emissions (OAEs) Auditory Brainstem Response ( ABR)

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(Distortion Product) Otoacoustic emissions ( DPOAE)

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Pass Result Otoacoustic Emissions (OAE s) Fluid behind the eardrum. Debris in the ear canal. Outer Hair Cells OAE testing probe placed in the ear canal Click stimulus Within the cochlear Outer hair cells contract in response to the sound. The emission from the Outer Hair Cell travels out the ear & is picked up by the probe. Fluid & debris can block the stimulus getting in AND block the response coming out = Higher Refer rates.

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DPOAE s The most prominent emission is 2F1- F2 If F1=1000Hz.and F2=1200Hz., then 2F1-F2=2(1000)-1200=800Hz.)

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(Automated) Auditory Brainstem Response, AABR

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Auditory Brainstem Response (ABR) AABR screening tests the response of the hearing nerve & brainstem. AABR tests beyond both the Inner & Outer hair cells. Automated Auditory Brainstem Response (AABR) If built up enough fluid & debris can still increase the refer rate because it blocks the sound getting into the ear. BUT This doesn t occur as much as with OAE because the recording is not being made back through the ear canal.

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Automated Auditory Brainstem Response (AABR) 35dB PASS result AABR Template built into the screener (statistical rather than an actual waveform)

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AABR What happens with a restless baby? 35dB Refer result The sensors pick up the muscle movement, which are much larger than the ABR response. This distorts the waveform & it can t match up to the template/black box algorithm.

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1. Exclusion criteria Age range: 6mths old has a more mature brain & faster response, which the template is NOT designed for. < 34 weeks gestation A baby

Some numbers of interest 1990: 6 million totally deaf people 1 2008: 21 million people with hearing loss 2 2000: WHO estimated prevalence of hearing loss 3 Childhood onset: 0.12% (hearing threshold in better ear is 61-80 dB HL) Childhood onset: 0.1% (hearing threshold in better ear Is >81 dB HL) Adult onset: 1.3% (hearing threshold in better ear is 61-80 dB HL) Adult onset: 0.3% (hearing threshold in better ear is >81 dB HL) ~24.5 million people with a severe to profound hearing loss in China

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Tonal languages ~ 88 languages in the world have complex tone system (more than 3 tones) shown in red dots

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Six lexical-tones of / w i /, Cantonese Tone 1 (smart) Tone 4 (surround) Tone 2 (appoint) Tone 3 (feed) Tone 5 (huge) Tone 6 (stomach) Time Fundamental Frequency (F0)

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Six lexical-tones of / w i /, Cantonese Tone 1 (smart) Tone 4 (surround) Tone 2 (appoint) Tone 3 (feed) Tone 5 (huge) Tone 6 (stomach) Time Fundamental Frequency (F0)

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/ma/ mother hemp horse to scold L H F R 4 lexicial tones /ma/, Mandarin

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Outcomes with CI Two large scale outcomes studies in China still ongoing The preliminary data from the studies indicate that the performance of Mandarin-speaking CI children is comparable to that of US children with CIs. Although the results of studies on CI outcomes of Mandarin-speaking children showed variable outcomes, it is evident that the majority of children benefited from CI intervention.

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Investigation of cortical and subcortical plasticity following short-term unilateral auditory deprivation in normal hearing adults 11 adults ( 21-50 years), normal hearing Left custom-fitted silicone plug for 7 days ( equivalent to a mild high freq hearing loss) fMRI 3.0T was performed just after plug inserted and 7 days later; stimulus was a noise burst to evoke cortical activity

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Hearing loss in the elderly

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