Chapter 1 Lecture 2 5/2/2015 Hearing disorders in children/ Hala AlOmari1

 Three classes or levels of need for audiological healthcare can be considered 1. Population- at this level the actions needed to reduce the need for intervention 2. Sub-population of children in each age cohort. For example, children on at risk register, or who have failed primary screen 3. Individual/ family the considerations of need at this class is difficult. Hearing disorders in children/ Hala AlOmari2

 The aim here is to reach the whole birth cohort living in a certain district for example immunisation  Education to promote good auditory health or normal auditory and communicative development.  The combination of surveillance and screening at critical times Hearing disorders in children/ Hala AlOmari3

 There could be several sub-populations of children at each age cohort.  The need here may be a very prompt and efficient auditory assessment of the child.  Advice why the assessment is necessary and explanation of the results of each assessment needed.  For the sub-population whose hearing is impaired one of the major provisions will be hearing aid. Hearing disorders in children/ Hala AlOmari4

 What are the needs?  What place or priority should they have in a properly constructed audiological health service configured to give maximum benefit to society?  One of the major needs for an adult with an acquired hearing impairment is to be able to hear and communicate with other people. providing a service to meet that need is by supplying an appropriate rehabilitative package Hearing disorders in children/ Hala AlOmari5

 If we are to consider a child’s need, is it appropriate to use the adult service provision?  The need of the child will depend on - The age of confirmation of the hearing impairment - The severity of the hearing impairment - The need of a very young child is very different than that of an adult. Hearing disorders in children/ Hala AlOmari6

 The hearing impaired child needs help to develop the skills necessary to learn to communicate with other people.  The society has to purchase a service that aims at the population level to eliminate the causes of deafness in children via appropriate vaccinations, education and preventive programmes.  At a sub-population level the aim is to identify the hearing impaired child as early and as efficiently as possible  At an individual level to provide appropriate forms or rehabilitation for the child and its family at different stages of development. Hearing disorders in children/ Hala AlOmari7

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 e.g. What proportion of 3 yr olds have a hearing loss?  What % age of 3 yr olds have a profound hearing loss  What % age of 3 yr olds have moderate permanent hearing loss  What % age of 3 yr olds have a moderate hearing loss  What % age of 3 yr olds have glue ear Hearing disorders in children/ Hala AlOmari9

 type of impairment ◦ conductive/SNHL  age at onset ◦ Congenital/late onset/acquired  aetiology ◦ genetic/ meningitis  degree of impairment ◦ mild/moderate/severe/profound Hearing disorders in children/ Hala AlOmari10

 Average of 0.25, 0.5, 1, 2 & 4 kHz ◦ mild <40 dB HL ◦ moderate 41 –70 dB HL ◦ severe 71 – 95 dB HL ◦ profound >95 dB HL Hearing disorders in children/ Hala AlOmari11

 Population base e.g. geographical, clinic based  Assigning children to categories ◦ Young/difficult to assess ◦ Audiological certainty ◦ Conductive overlay Hearing disorders in children/ Hala AlOmari12

Hearing disorders in children/ Hala AlOmari13

 Significant hearing loss occurs in 1 to 2 per 1000 newborns  2 per 1000 young children  Nearly all children develop transient hearing loss related to middle ear infections during the period from birth to 11 years of age * based on a study by Fortnum and Davis (1997) carried out in UK-Trent region for children born in the period between ( ) Hearing disorders in children/ Hala AlOmari14

◦ Squint 3-7 per 1000 ◦ Hypothyroidism 0.2 per thousand ◦ Congenital heart disease (CHD) 5.5 per 1000 ◦ Phenylketonuria (PKU) per ◦ Down syndrome 1 per 600 * ketonuria Hearing disorders in children/ Hala AlOmari15

genetic 40% prenatal (e.g., TORCH) 4% perinatal (e.g., NICU) 7% postnatal (e.g., meningitis) 6% Craniofacial abnormality CFA 1% missing 41% TORCH Toxoplasmosis Other (e.g., syphilis) Rubella (German measles) Cytomegalovirus (CMV) Herpes

 40 % of children with PCHI have additional disability –cognitive deficit13.9% –visual10% –systematic disorder13% –cerebral dysfunction11.3% –neuromotor7.6% –named syndrome13.6%  Permanent Childhood Hearing Impairment (PCHI) – usually defined as better ear hearing level of 40 dB or more, includes sensorineural and permanent conductive loss, at present tend to exclude mild and unilateral loss Hearing disorders in children/ Hala AlOmari17