1. Assessment of Hearing Loss 1SH2030: Secondary Level Training Module.4

2. Objectives To familiarise the trainees with the normal hearing and language milestones. To sensitize them to how they can suspect hearing loss in a child or an adult. To inform them regarding further testing modalities. 2SH2030: Secondary Level Training Module.4

3. Suspicion If there has been a problem during pregnancy or birth, such as: –Maternal Rubella –Use of Ototoxic drugs –Difficult labour-Birth Asphyxia –Low birth weight –Jaundice –Prolonged stay in NICU If there is a Family history of Deafness If the child has/had history of discharge from the ear In case of malformation of the head & neck. In case of any such risk factor…. SUSPECT HEARING LOSS: REFER for Hearing Test 3SH2030: Secondary Level Training Module.4

4. Hearing & Language Development All children start listening and responding to sounds gradually after birth. Gradually, they start babbling and then speaking. Lets see how this development goes on… 4SH2030: Secondary Level Training Module.4

5. 0-3 month child Responds to loud sounds, such as bangs etc. S/he may blink or close the eyes or open them. May wake up from sleep if loud sound is produced nearby. 5SH2030: Secondary Level Training Module.4

6. 3-6 months Is able to recognise the mother’s voice and turns his head towards her voice. Starts showing interest in new sounds. Turns towards the source of a sound. 6SH2030: Secondary Level Training Module.4

7. 6-9 months Starts making babbling sounds by this age. Shows interest in squeaky toys. 7SH2030: Secondary Level Training Module.4

8. 9-12 months The child will start responding to his/her name. S/he will understand small words such as ‘come’, ‘bye’ etc. 8SH2030: Secondary Level Training Module.4

9. 12-18 months Starts imitating small words like mama, papa… Tries to imitate words that he/she hears 9SH2030: Secondary Level Training Module.4

10. 18-24 months Responds to instructions like: ‘Touch your nose’, ‘Show your tummy’ etc. Will start speaking small 2-3 word sentences 10SH2030: Secondary Level Training Module.4

11. In case any of the milestones is not achieved…. SUSPECT HEARING LOSS: REFER for Hearing Test 11SH2030: Secondary Level Training Module.4

12. Ways to diagnose Hearing Loss 12SH2030: Secondary Level Training Module.4

13. 13 What is the modality for testing? Hearing in an infant or young child can be tested by: Use of Noisemaker (only for clinical screening) Otoacoustic Emissions (screening test) Auditory Brainstem response (diagnostic test)

14. SH2030: Secondary Level Training Module.414 Noisemaker In a quiet room 2 persons are required Mother/Parent holds the baby Stand in front of the baby with a toy to distract him/her 1 person standing behind the child with the noisemaker, shakes the rattle to make a noise. Observe the baby: Does he try to look for the source of sound

15. SH2030: Secondary Level Training Module.415 A: Observer B: Parent with child C: Assistant with Noisemaker A B C Use of Noise maker

16. SH2030: Secondary Level Training Module.416 Diagnosis Once there is suspicion, Diagnosis can be made by: –OAE testing –BERA test Refer the child to the District hospital for detailed assessment.

17. SH2030: Secondary Level Training Module.417 In an older child: ASK, if the child has…. discharge from the ear recurrent pain in the ear Difficulty in hearing improper development of speech Difficulty in understanding & following commands Poor performance in school

18. SH2030: Secondary Level Training Module.418 Suspect hearing loss if.. Child –Cannot follow simple instructions –Gives wrong answers to questions –Does not respond to your call –Cannot sing/dance in time to music –Cannot identify different sounds

19. SH2030: Secondary Level Training Module.419 Testing older Children and Adults Clinical testing: Voice tests: excellent clinical indicator Tuning Fork Tests Pure Tone Audiometry

20. SH2030: Secondary Level Training Module.420 Voice Tests (Child) Ask the child to repeat the words that you say. OR Ask him/her (child) to do simple actions eg: Touch your nose, Pat your head etc OR Point to the object as you say the name eg Chair, pen etc If response is unsatisfactory: Refer for Hearing assessment

21. SH2030: Secondary Level Training Module.421 Sit about 1 meter from the child with one ear facing you. Other ear should be blocked. Cover your lips while speaking (to prevent lipreading) First speak in whisper: Correct response=normal hearing Incorrect response: Repeat in conversational voice Correct response=slight H. loss Incorrect response: Repeat in loud voice Correct response=moderate H. loss Incorrect response: Repeat by shouting in the ear Correct response= Severe H. loss Incorrect response: Deafness Voice Tests

22. Voice tests (Adults & Older children) Ask patient to block off one ear. Sit facing test ear at a distance of 1meter from the ear Cover your lips while speaking (to prevent lipreading) 22SH2030: Secondary Level Training Module.4

23. 23 Voice tests (Adults & Older children) give stimulus in the form of spoken words, such as Bicycle, Post-office, Aeroplane etc Ask patient to repeat back the spoken words Start with whispered voice & progress to shouted voice, if required. Repeat with the other ear.

24. SH2030: Secondary Level Training Module.424 First speak in whisper: Correct response=normal hearing Incorrect response: Repeat in conversational voice Correct response=slight H. loss Incorrect response: Repeat in loud voice Correct response=moderate H. loss Incorrect response: Repeat by shouting in the ear Correct response= Severe H. loss Incorrect response: Deafness Voice tests (Adults & Older children)

25. SH2030: Secondary Level Training Module.425 Pure Tone Audiometry Standard technique for older children & adults. Gives us detailed frequency specific information about the hearing of the child. Requires cooperation from the child.

26. SH2030: Secondary Level Training Module.426 In Adults Suspect hearing loss (Presbyacusis), if they are : isolating themselves socially Speaking too loudly Speaking too much (so as to not have to listen to others) Speaking too little Raising the volume of the TV Have difficulty in understanding what is being said over the phone Refer for Audiometry

27. SH2030: Secondary Level Training Module.427 Suspect Noise Induced hearing loss If the person: Has been working/living in noisy environment Has noisy pastimes (eg walkman, I-Pods) Complains of tinnitus Complains of difficulty in hearing bells etc. Complains of difficulty in understanding speech/difficulty in hearing. Refer for Audiometry

28. SH2030: Secondary Level Training Module.428 Counselling The patient as well as the Parent needs advice & support in order to rehabilitate the deaf child. Encourage the child and the family Ensure that they start rehabilitative therapy Encourage them to try to put the child in a regular school. Warn the parents against overprotecting the child

29. SH2030: Secondary Level Training Module.429 Whenever there is a suspicion of Hearing Loss: REFER Thank You