Download Identification and Management of Deaf and Mute Child

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.