Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Evolution of mammalian auditory ossicles wikipedia , lookup
Auditory system wikipedia , lookup
Auditory processing disorder wikipedia , lookup
Telecommunications relay service wikipedia , lookup
Hearing aid wikipedia , lookup
Hearing loss wikipedia , lookup
Noise-induced hearing loss wikipedia , lookup
Sensorineural hearing loss wikipedia , lookup
Audiology and hearing health professionals in developed and developing countries wikipedia , lookup
Stimmheilzentrum Bad Rappenau Hörgeräte und Cochlea Implantate: Indikationen/Entwicklungen Annerose Keilmann Stimmheilzentrum Bad Rappenau 5th Phonak European Pediatric Conference Berlin Current Developments and New Directions in Pediatric Audiology Berlin, June 16th - 18th 2016 1962 • Beckmann wrote in his teaching book that children with inborn deafness should be supplied with hearing aids at age 2 • for that time age 2 was extremly early – no regular health check for children (in Germany using the yellow booklet) – no newborn hearing screening – no ABR – no otacoustic emissions 3. Mai 1995 Indications to CI 1984 1990 1998 today age adults From age 2 on From 18 months on <12M onset Postlingual Degree of hearing loss Complete deafness Resudual hearing Severe HL (adults) Residual hearing (children) Severe hearing loss (adults/children) bilateral bilateral bilateral uni- or bilateral 0% 0% <40% Speech audiometry 4 Postlingual Postlingual adults adults & & Pre/Postlingual Pre/Postlingual children children Postlingual adults & Pre/Postlingual children Indication to CI • There is a deficit looking at hearing and/or understanding • Fitting with hearing aids is not sufficient or is presumably not sufficient • but: hearing aids can be tried without risk, cochlea implant surgery is risky I there a hearing loss (HL)? The child does not want to hear (at least The child cannot hear: in the moment), • playing with high concentration • testing the limit • difficult behaviour • conductive HL • sensorineural HL • central auditory processing disorder • functional = psychogenic HL Possible mistakes and differential diagnosis: • • • • •9 insuffcient instruction missing comprehension of the task missing cooperation cognitive problems autism, other psychic disease I there a hearing loss (HL)? The child does not want to hear (at least The child cannot hear: in the moment), • playing with high concentration • testing the limit • difficult behaviour • conductive HL • sensorineural HL • central auditory processing disorder • functional = psychogenic HL We must take care about the development • newborns are unable to do speech audiometry…. • adults with hearing loss (with insuffcient supply) loose nonverbal intelligence Different reasons for impaired hearing and understanding • wrong hearing aid or right hearing aid with bad programming • changing middle ear leads to inconstant hearing • circumstances for hearing are bad, in rooms with reverberation, without wireless transmission systems • early loss of concentration, it is too hard to listen • insufficient learning conditions in the past • central auditory processing disorder The guidelines aren't an algorithm that gives a clear simple solution for every case. Instead: work with an interdisciplinary team work step for step – without loosing too much time Fitting of hearing aids • modern technology • reasonable preselection on the basis of expert knowledge for comparing fitting • sufficient learning conditions • training of hearing • additional technology Hearing in different conditions • acoustically favourable and less favourable rooms • with and without Hearing Assistive Devices/Hearing Assistive Techniques • concentration loss during the day? • social withdrawal? Hearing anamnesis • fitting too late • deficit recuperable? • receptive and productive speech and language development • articulation deficit? • nonverbal intelligence • development of identity as deaf or hearing person? • coping Expectations of the parents/ the patient • Can a regular wearing be expected? • Will the patient be able and willing to train the hearing? • Will the costs be covered? • Will the patient attend the control appointments? Cochlear implant • is time consuming • medical risks – vertigo, balance disorders – facial paresis /dyseugesia – problems with wound healing • problems with imaging What would happen without cochlear implant? • progressive hearing loss • insufficient training with the hearing aids (financial reasons?) • development of identity Delayed maturation of the auditory pathways • Could it be that the hearing loss will disappear? • Immature auditory pathway, serous otitis media with effusion • Relevant conductive component? • In children with a severe hearing loss a delayed maturation is not probable. Auditory neuropathy or functional hearing loss • contradicting results in subjective audiometry • changing hearing levels • otoacoustic emissions present do not exclude that an cochlear implant is indicated What is my summary? Work with an interdisciplinary team work step for step – without loosing too much time Thank you for your kind attention!