Download Conductive hearing loss - British Society of Audiology

04/07/2014
Are there any differences of speech and
language development in children with
sensorineural hearing loss vs.
conductive hearing loss?
Annette Limberger
[email protected]
4th July 2014
British Society of Audiology, Birmingham
Contents
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Types of hearing loss
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Conductive hearing loss
Sensorineural hearing loss
Combined hearing loss
Central auditory processing disorders
Therapy of hearing loss
 Surgery
 Assistive listening devices
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Speech and language development
 …. and conductive HL
 …. and sensorineural HL
●
Conclusion
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British Society of Audiology, Birmingham
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Types of hearing loss
Inner ear
Outer ear
Middle ear
WebMD, LLC, 2014
4th July 2014
British Society of Audiology, Birmingham
Conductive hearing loss
● Common causes for a conductive hearing
loss
 Outer ear
• Impacted cerumen
• Otitis externa
 Tympanic membrane
• Tympanic membrane perforation
• Tympanic membrane retraction
Source: en.wikipedia.org
 Middle ear
• Acute otitis media
• Serous otitis media (OME)
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Conductive hearing loss
●
Poor Eustachian tube function (adenoids)
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Allergies (serous otitis media)
●
Absence or malformation of the outer ear, ear
canal or middle ear
Source: https://www.luks.ch/uploads/media/Atresie.pdf
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British Society of Audiology, Birmingham
Sensorineural hearing loss
●
Congenital hearing loss
 Genetic
• Non-syndromic, syndromic
 Lack of development (aplasia) of the cochlea
 Congenital rubella syndrome
 Human Cytomegalovirus (HCMV)
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Sensorineural hearing loss
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Acquired hearing loss
 Inflammatory
•
•
•
•
•
Meningitis
Mumps (epidemic parotitis)
Measles
Virus infection
Syphilis
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British Society of Audiology, Birmingham
Sensorineural hearing loss
●
Ototoxic drugs
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Aminoglycosides (most common, e.g. tobramycin)
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Loop diuretics (e.g. furosemide)
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Antimetabolites (e.g. methotrexate)
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Salicylates (e.g. aspirin)
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Physical trauma
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Noise-induced
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Presbycusis
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Sensorineural hearing loss
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Sudden sensorineural hearing loss (SSHL)
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Idiopathic
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Vascular ischemia of the cochlea
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Perilymph fistula
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Autoimmune
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Acoustic neuroma
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Meningeoma
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Menière`s disease
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British Society of Audiology, Birmingham
Other types of hearing loss
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Combined hearing loss
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Auditory neuropathy spectrum disorders
●
Central auditory processing disorders (CAPD)
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British Society of Audiology, Birmingham
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Therapeutic options
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For conductive hearing loss
 Antibiotic therapy in case of bacterial infection,
like acute otitis media or external otitis
 Surgical procedures
•
•
•
•
•
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Tympanostomy with or without insertion of tubes
Myringoplasty or
Tympanoplasty
Otoplasty in case of malformations or atresia
de.wikipedia.org
Adenoidectomy
British Society of Audiology, Birmingham
Tympanostomy tubes in children
●
Rosenfeld RM et al., 2013: Clinical practice
giudeline: Tympanostomy tubes in children
 Topical antibiotic eardrops, without oral antibiotics, for
children with uncomplicated acute tympanstomy tube
otorrhea
 Ventilation tubes only in OME histories of more than 3
months
 Appropriate hearing tests prior to surgery
 Bilateral tubes for bilateral OME
 Re-evaluation at 3- to -6 month intervals
 Early insertion for at-risk children for speech and/or
language problems
ent-info.nhs.uk
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Therapeutic options
●
For conductive hearing loss
 Bone-anchored hearing systems
(Farnoosh et al. 2014)
 Active implantable devices like e.g.
the bonebridge, now available for
children from age 5
www.oticonmedical.de
www.medel.com
4th July 2014
British Society of Audiology, Birmingham
Therapeutic options
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For sensorineural hearing loss
 Hearing aids
• With new technologies, e.g. frequency-lowering
 Cochlear implants
• Also with new technologies, e.g. directional microphones and
reduction of background noise
www.welches-hoergeraet.de
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Speech and language development
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Very different approaches in many studies
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Many studies with older children, like 8 or 9 years
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Influence of reading and writing skills?
●
Examination of children with delayed speech and
language development or without
4th July 2014
British Society of Audiology, Birmingham
OME affects the language development
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Expressive language delay in children with early otitis media
(e.g. Abraham SS et al., 1996, Lehmann MD et al., 1979, Teele,
DW et al., 1984, Schoenweiler R et al., 1998, Van Cauwenberge
P et al., 1985, Wallace IF et al., 1988, Haapala S et al., 2014,
Uclés P, et al., 2012, Gouma P et al. 2011)
 Otitis-positive group significant fewer initial consonant phones and
produced them less accurately
 otitis-positive group acquired significantly fewer consonants with back
place of articulation
 Effects on intelligence, attention and activity, manual skills and social
behaviour
 Expressive language delay already at the age of one year
 Aberrant preattentive discrimination of sound patterns
 Right chronic OM impairs phonetic and phonological coding of sounds
 Patients with OME had more anxiety/depression related disorders
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… in contrast
●
There are no significant differences to a normal
hearing population without history of recurrent
OME (Timms L, et al. 2014, Browning, GG et al.,
2010, Zumach A et al., 2010, Baxter JD et al.,
1979, Grievenik EH et al., 1993, Harsten G et al.,
1993, Lous J et al., 1988, Roberts JE et al., 1991,
Zielhuis GA et al., 1989)
 No differences in speech development between groups
 Negative consequences of early-life OM will be resolved
at the age of 7
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British Society of Audiology, Birmingham
Nittrouer S., Burton L.T.
J Comm Disorders, 2005
Percentages of items correct for the same-different intial-consonant-the-same task.
The dashed line shows the upper limit of chance performance
4th July 2014
British Society of Audiology, Birmingham
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Nittrouer S., Burton L.T.
J Comm Disorders, 2005
Percentages of items correct for the three-choice initial-consonant-the-same task.
The dashed line shows the upper limit of chance performance.
4th July 2014
British Society of Audiology, Birmingham
4th July 2014
British Society of Audiology, Birmingham
Schoenweiler et al. (1998): Int J Ped ORL
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Schoenweiler et al. (1998): Int J Ped ORL
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British Society of Audiology, Birmingham
Differences conductive vs. sensorineural HL
Schoenweiler et al. (1998): Int J Ped ORL
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Conductive hearing loss and auditory
perception disorders
● Zargi and Boltezar (1992)
made an investigation in
children in Slovenia
 Follow-up over 2 years (children
aged 0 – 2 years)
 Control 2 years later
 The children, who had recurrent
(more than 3 times) OME in their
first two years of life had a higher
incidence of some auditory
processing disorders like sound
discrimination and sequential
memory
4th July 2014
British Society of Audiology, Birmingham
Summary on language development and
conductive HL
● Children with conductive HL have problems in the
acquisition of language skills
● The earlier the impairment, the greater the
influence on the language development
 ‘mild’ hearing loss does not mean ‘mild’ language
impairment (Furukawa)
●
Conductive HL affects nearly all levels of language
development (e.g. extent of vocabulary,
grammatical structure, phonetic synthesis,
auditory discrimination)
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British Society of Audiology, Birmingham
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Summary on language development and
conductive HL
● The differences between children are much higher
than in sensorineural HL this may be due to
(according to Hall & Hill, 1986):
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The age at which the disorder occurs
The duration of the episodes
The severity of hearing loss
Intrinsic qualities of the child
The child’s environment
British Society of Audiology, Birmingham
Comparison SNHL and SLI
Briscoe et al. (2001): J Child Psychol Psychiat
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British Society of Audiology, Birmingham
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Briscoe et al. (2001): J Child Psychol Psychiat
Hearing thresholds in relation to phonological impairment status in SNHL group.
Error bars show standard error.
4th July 2014
British Society of Audiology, Birmingham
4th July 2014
British Society of Audiology, Birmingham
Briscoe et al. (2001): J Child Psychol Psychiat
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Summary on sensorineural HL
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Sensorineural HL leads to a delay the speech and
language development
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It’s dependent on the degree of the HL
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More phonological problems than in children with
conductive HL
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The problems are less severe than expected
maybe because of the educational programs
4th July 2014
British Society of Audiology, Birmingham
Conclusions I
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It is mandatory to check the
hearing more often than only in
the newborn period and (in
Germany) at the age of 4
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In children who have already a
delayed speech and language
development it is always
necessary to check the hearing
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British Society of Audiology, Birmingham
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Conclusions II
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Special attention and follow-up
for children with recurrent ear
infection
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Children with conductive hearing
loss have better chances to
catch up with their language
development
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One of the main influences is the
socio-economic status, therefore
early intervention like nursery,
kindergarten ect. is useful
4th July 2014
British Society of Audiology, Birmingham
Case report
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9 year old boy
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Difficulties in school (3rd
degree), especially reading
and writing
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British Society of Audiology, Birmingham
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Case report
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On examination:
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Normal peripheral hearing
Speech in quiet 100 % monosyllables
Speech in noise SNR for SRT: 5 dB
Massive limited auditory memory (2 items sequentially)
Significantly low phoneme discrimination
4th July 2014
British Society of Audiology, Birmingham
Case report
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Mother reported of nearly two year period of
recurrent conductive hearing loss due to OME,
which was not treated by the paedatrician
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Insufficient hearing testing
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Overextended mother with two other exhausting
children with special needs, one of them preterm
baby at the 25th week of pregnancy
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Case report
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First private lessons and auditory training
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Then referral to a special school for children with
hearing handicaps, also auditory processing
disorders
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Now: one of the best in his class
4th July 2014
British Society of Audiology, Birmingham
Although careful assessment of
these children is essential, it is
still far from universal (Hall and
Hill 1986)
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