1. Hearing Loss In The Child With Downs Syndrome

2. Frequency 3000-5000 a year are born with Downs syndrome 75-89% of children with Downs have associated hearing Loss !! 66-89% have a hearing loss greater than 15-20dBHL in at least 1 ear 75% found to have at least a mild hearing problem

3. Progress in Speech & Language performance is linked to factors which include – hearing status, speech, Non Verbal cognitive skills, and daily experience

4. Children with downs experience slower development of language relative to other cognitive skills 1/3 of these children have recurring problems with hearing throughout childhood which if not addressed lead to greater speech and language delay 1/3 of these children have recurring problems with hearing throughout childhood which if not addressed lead to greater speech and language delay

5. Physical features affecting listening Although the skull of a child with Downs grows to nearly the same side as the average adult, it has more of the shape of a newborn.

6. Leads to…… OME (middle ear fluid) Retraction (the eardrum getting sucked in) Cholesteatoma A type of skin cyst located in the middle ear and skull bone Eustachian tube dysfunction (the tube that runs from your middle ear to the back of the mouth) & cartilage anomalies Promotes stillness of fluid in the ear and infection travelling up to the ear from the mouth

7. Otitis Media with Effusion The angle in which the Eustachian tube sits in the child with Downs

8. Other structural differences that can lead to hearing difficulties EAM stenosis – (narrowing of the ear canal) Wax build up - impacted Small nasopharynx (back of the nose & throat) Impaired swallow Production of more mucus which can then becomes infected due to a lowered immune system Changes in the pinna

9. SO WHAT IS THE OUTCOME? OME = MILD – MODERATE HEARING LOSS worse in the low frequencies Congenital SNHL in the high frequencies – bony deposits along the cochlear & Acquired/presbycusis (high frequency hearing loss) in the older years 35-40.

10. Medical Problems that can occur 40 –45% congenital heart disease Intestinal changes Thyroid dysfunctions Skeletal problems Sleep apnoea - 50% Obesity in adolescence & older Immunologic concerns Leukaemia Alzheimer's Seizure difficulties Skin disorders

11. Other possible symptoms Average IQ is 30-40 but some children have mild-moderate difficulties -Marcell 98 A narrowed ear canal can make looking at the eardrum difficult OME = pain, ↓ Attention, Distractibility, Feeling of fullness, bunged up LEAKY EAR Inconsistent performance Low muscle tone

12. Management Myringotomy is a surgical procedure in which a small incision is created in the eardrum to relieve pressure caused by build-up of fluid or to drain pus from the middle ear. Tympanostomy tubes/PE tubes This tube is inserted into the eardrum in order to keep the middle ear aerated for a prolonged period of time to prevent re-accumulation of fluid, as without the insertion of a tube, the incision would heal spontaneously in two to three weeks Grommets a very small tube that is inserted into your child's ear through a small cut in their eardrum. A grommet will drain away fluid in the middle ear and help to maintain the air pressure in the middle ear cavity. Antibiotics Hearing aids Surgical repair or of perforation

13. AgeRecommended hearing evaluations birth to 2 months 2 to 12 months 1 to 12 years 12 to 18 years over 18 years Refer for auditory brainstem response (ABR) test or other objective assessment of hearing to assess hearing by 6 months of age, if not performed at birth. Provide brainstem response test (ABR) or other objective assessment of hearing by 6 months of age if not performed previously or if previous results are suspicious. Evaluation by ENT specialist for recurrent otitis media. Yearly auditory testing for children 1-3 years old and every two years for children 3-13 years old. Hearing evaluations every other year. Continue auditory testing every two years.

14. So What does a Speech Therapist do? Observe Advise Monitor Refer to any other relevant professionals Support Remind MDT working Assess

15. Focus on the holistic Approach Strategies that fit into everyday life Fun Highlighting great activities that are done anyway