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Identification and Management of Deaf and Mute Child Here is a brief outline of managing deaf and mute children meant for General Practitioners. Details of various tests described are beyond the purpose of this article and can be found elsewhere. Hearing loss is an impairment of hearing. The term "deaf" should be applied to those individuals whose hearing impairment is so severe that they are unable to benefit from any type of amplification. - WHO1980 The "deaf" are those in whom sense of hearing is nonfunctional for ordinary purposes of life (>90 db in better ear or total loss of hearing in both ears). - Ministry of Social Welfare, Government of India. Deaf children also fail to develop speech and are termed as Deaf-Mute. Aetiology PRENATAL CAUSES GENETIC DEFECTS With Conductive Type of Hearing Loss- Down's, Crouzon's, Treacher-Collins Syndromes. With Sensorineural Type of Hearing Loss- Aplasias ( Michel's, Mondini's, Schiebe's, Alexander's) and Syndromes (Pendred, Usher, Waardenberg, Alport,Klippel-Feil). MATERNAL INFECTIONS DURING PREGNANCY- TORCHES Viruses DRUGS TAKEN DURING PREGNANCY- Streptomycin, Gentamicin, Amikacin, Chloroquin, Quinine. RADIATION EXPOSURE IN 1ST TRIMESTER OF PREGNANCY. NUTRITIONAL DEFICIENCIES. THYROID DISORDERS. PERINATALCAUSES HYPOXIA DURING BIRTH. BIRTH INJURIES. PREMATURITY(BIRTH WEIGHT LESS THAN 1500 GRAMS). NEONATAL JAUNDICE (BILIRUBIN MORE THAN 20mg%). NEONATAL MENINGITIS. OTOTOXIC DRUGS. ACQUIRED CONDUCTIVE TYPE OF LOSS- Otitis Media, Trauma. SENSORINEURAL TYPE OF LOSS-Labyrinthitis, Meningitis, Ototoxic drugs, Noise Trauma, Measles, Mumps. SUSPICION A Child should be suspected to be deaf if: Sleeps unperturbed in loud noise. Fails to startle to loud sound. Does not turn head on calling. Fails to develop speech and language in a normal way. Children who are at greater risk for deafness. Having a family history of deafness. Suffered from congenital infections. Born with Craniofacial abnormalities/Syndromes. Birth weight less than 1500 grams. Hyperbilirubinemia with bilirubin levels more than 20mg%. Administered with ototoxic medicines. Suffered bacterial meningitis Treated with prolonged mechanical ventilation for more than 10 days. APGAR score of 0-4 at 1 minutes or 0 to 6 at 5 minutes. Identification of a deaf child is done by: NEONATAL SCREENING TESTS (TOAE,BERA,ARC,Distraction Tests). Incidence of significant congenital or perinatal hearing loss is reported to be 0.9 to 2 per thousand live births. 7 to 9 % of live borne babies are at risk for hearing loss. These tests are needed for early detection & early intervention. 50 -70% hearing impaired population identified on the basis of neonatal screening. CLINICAL EVALUATION BY HISTORY Asking and recording Antenatal, Perinatal, Postnatal events. Recording developmental milestones Extracting family history of significant events and hearing loss in family. Recording speech and hearing milestones. BY EXAMINATION NOTICE CERTAIN SYNDROMIC TRAITS Skin-tags, Cafe-au- lait spots, cleft palate, goitre, micrognathia, polydactyly, neck pits, whiteforlock, mongloid slant, parrot beak nose. In Ears- low set ears, anotia, microtia, stenosis of EAC, wax, foreign body, OME, congenital cholesteatoma. In Eyes- heterochromia iridis, blue sclera, retinitis pigmentosa. ASSESSMENT OF HEARING HAS TO BE DONE BY SUBJECTIVE TESTS BEHAVIORAL OBSERVATION AUDIOMETRY DISTRACTION TESTS- for ages 6 to 24 months. VISUAL REINFORCEMENT AUDIOMETRY. PLAY AUDIOMETRY PURE TONE AUDIOMETRY OBJECTIVE TESTS EVOKED OTOACOUSTIC EMISSIONS IMPEDENCE AUDIOMETRY STAPEDIAL REFLEXES BERA ASSR (Auditory Steady State Response) CERA (Cortical Evoked Response Audiometry). OTHER TESTS TO BE DONE TORCH screen Thyroid Funcion Tests FTA URINALYSIS TEMPORAL BONE CT SCAN TREATMENT/ REHABILIATION PLAN Rehabiliation is a process designed to maximize a patient's physical, mental, social,and vocational potential. Following help in rehabilitating the deaf child. DRUGS AND SURGERY: Outer and middle ear problems are amenable to these interventions. HEARING AIDS BONE ANCHORED HEARING AIDS(BAHA) COCHLEAR IMPLANT VIBRO TACTILE AIDS ASSISTIVE LEARNING DEVICES COMMUNICATION AID SYSTEM FM HEARING AID INFRARED HEARING AID GROUP HEARING AID LOOP SYSTEM TELECOMMUNICATION DEVICES VISUAL INFORMATION-TEXT PHONE, SUBTITLED TV/VIDEOS,TEXT TV ANNOUNCEMENTS ALERTING AND WARNING SYSTEM DOOR BELLS,ALARM CLOCK,VISUAL STIMULI,VIBRATOR STIMULI,LIVE DOG. COMMUNICATION TRAINING AURALISM (LIP READING) CUED SPEECH M P B K D L MANUALISM(SIGNING SYSTEM) BRITISH AND AMERICAN SIGN LANUAGES SIGNED ENGLISH,PAGET GORMAN ,MAKETON FINGER SPELLING TOTAL COMMUNICATION EDUCATIONAL PROGRAMMES: Parents are the child's first & natural teachers. Correspondence course for parents(Shravan Vani Sudhar Kendra, AIIMS, Ansari Nagar.) Integrated or segregated Pre-School Primary & Secondary & Higher Secondary Education. National Open School , SAIED (AYHNIHH) for continued education & drop-outs. College education- Regular and IGNOU. Some centers are: GOVT. LADY NOYCE SECONDARY SCHOOL FOR THE DEAF. FIROZSHAH KOTLA DELHI GATE NEW DELHI 110002 PRE-PRIMARY, PRIMARY, SECONDARY GOVT. N.P.SCHOOL FOR THE DEAF. B-BLOCK, PWD BARRACKS KALKAJI, NEAR GURUDWARA NEW DELHI 110019 PRE-PRIMARY, PRIMARY GOVT. NURSERY PRIMARY SCHOOL FOR THE DEAF. SEVA KUTIR KINGSWAY CAMP WEST DELHI NEW DELHI PRE-PRIMARY, PRIMARY LANGUAGE, SPEECH & HEARING SCHOOL FOR THE DEAF. BASTI VIKAS KENDRA, J.J.CAMP, MADHUVIHAR, PHASE-I, I.P.EXT. PATPARGANG DELHI - 110092 PRE-PRIMARY ASHA SPECIAL SCHOOL. RZD-58, STREET NO.4 MAHAVIR ENCLAVE, PALAM NEW DELHI 110045 PRE-PRIMARY, PRIMARY GOVT NP SCHOOL FOR THE DEAF. SHAHDRA DELHI GATE, FEROZSHAH KOTLA NEW DELHI 110001 PRE-PRIMARY, PRIMARY VOCATIONAL REHABILITATION: There are 50 special employment exchanges for physically handicapped 17 vocational rehabiliation centres. Vocational training schools & centres teach - Tailoring,stitching,crafts,candle making,computers, - Soft toys,file cover making,binding,flower decoration,catering,painting,welding,typing. Some of them are: Prabha Institute Of Fine Arts, Paharganj. School for Handicap, Madhubhan Chowk, Rohini. Delhi Association forDeaf, Kamla Market. Asha Awwa School for Handicapped, Delhi Cantt. SCHEMES & FACILITIES FOR DEAF-MUTE. SCHEME FOR ASSISTANCE TO DISABLED PERSONS FOR PURCHASE/FITTING OF AIDS/APPLIANCES (ADIP) DISABILITY ACT,1995 STATE GOVT.SCHEMES Reservation in Grade C & D Jobs 3%. Reservation in ITI,IIT for PHD 3%. Scholarship stipened,hostel & reading allowance. Disability pension 200/mnth. Unemployment allowance. Conveyence allowance,bus concession. Assistance for purchase of aids/appliances. ALI YAVAR JUNG NATIONAL INSTITUTE FOR THE HEARING HANDICAPPED An autonomous organization under the Ministry of Social Justice & Empowerment,Government of India,New Delhi. Apex Institute in the Country dealing with hearing disabilities. NRC at kasturba niketen,lajpat nagar phase2,DELHI. Evaluation & diagnosis of hearing, speech & language impairment. Helps in selection & fitting of hearing aids & moulds. Provides Psychotherapy & Behavioural therapy. Provides Speech & Language therpy. Runs Educational & Certified training programmes Provides Vocational Training Runs Disability line Provides Certification of hearing disability.