Download Chapter 13: Pediatric Hearing Loss

Chapter 13:
Pediatric Hearing Loss
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.1
Focus Questions
• What is pediatric hearing loss?
• How is pediatric hearing loss classified?
• What are the defining characteristics of
prevalent types of pediatric hearing loss?
• How is pediatric hearing loss identified?
• How is pediatric hearing loss treated?
• What is an auditory processing disorder,
and how is it identified and treated?
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.2
Introduction
• Importance of hearing: recognize familiar
voices, differentiate among wide range of
sounds
• Detection, categorization, and
comprehension of sounds
• Complex auditory system, so can result in
many types of hearing problems
• Specialists can help children learn to listen
and speak through the use of assistive
technology or specialized teaching
methods that foster learning
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.3
Case Study #1: Mesha
• 12-month old with profound sensorineural
hearing loss
– her father and other family members are also deaf
and immersed in the Deaf community
• Mesha’s parents do not want her to be conflicted
between a hearing a deaf world, so parents
believe she should have a strong identity as a
“Deaf person”
• Mesha is producing a few words right now in
sign and actively communicates with her family
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.4
Case Study #1 Questions
• If you were an interventionist working with
Mesha and her parents, would you
endorse their decision? Why or why not?
• What challenges face children who are
raised in the Deaf versus hearing
community?
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.5
Case Study #2: Jack
• 30-month old child
• 18 months old: Jack’s mom had concerns
about language and upon pediatrician’s
inspection, noticed severe bilateral otitis
media
• Went through medical intervention
(antibiotics), but at two years, Jack’s mom
went to consult an SLP
• Jack was diagnosed with moderatelysevere mixed hearing loss
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.6
Case Study #2 Questions
• In your opinion, what is Jack’s prognosis
for achieving normal speech and language
milestones in the next few years?
• Why wasn’t Jack’s hearing evaluated as
soon as his mother noted a delay in his
communication skills?
• How might Jack’s future be different if his
sensorineural loss had been identified
earlier? How much difference do you think
the delay in identification will make?
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.7
Case Study #3: Lilly
• 12-year old girl with congenital profound
sensorineural hearing loss and a syndrome with
affects the electrical system of her heart
• Pediatrician refused to approve a referral for a
hearing evaluation until 2 years of age; at age 3,
Lilly was diagnosed with hearing loss
• Parents decided that they wanted Lilly to use an
auditory-verbal approach, be home-schooled, and
have cochlear implants
• Now, Lilly is well-adjusted, articulate, reads and
writes above grade level, and wants to advocate
for other children with hearing loss
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.8
Case Study #3 Questions
• What role can parents of children with
hearing loss play in advocating for the
needs of individuals with hearing loss?
• What factors likely contributed to Lilly’s
positive outcomes?
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.9
I. What is Pediatric Hearing Loss?
• a condition in which a child or adolescent
is unable to detect or distinguish the range
of sounds at the level normally possible by
the human ear
• Hearing loss: results from damage to the
outer, middle, or inner ear, or the auditory
nerve
• Auditory processing disorder: hearing loss
resulting from damage to the processing
centers of the brain
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.10
Varieties of Hearing Loss
• Location of damage (outer, middle, inner,
auditory nerve)
• Whether it affects one or both ears
– Unilateral or bilateral
• Extent of impact on communication
• Chronicity
– Short-term, fluctuating, permanent or progressive
• Timing
– Congenital, prelingual, acquired, postlingual
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.11
Hearing Loss and Communication
• Hearing loss varies in the extent to which it
affects speech, language, and
communication
• Affects ability to develop relationships,
succeed academically, and be involved
with extracurricular activities
• Can result in delayed receptive and
expressive speech and language
development, can affect any domain of
language
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.12
Early Identification
• Family needs to respond early, proactively,
and responsively
• Newborn hearing screenings increase
likelihood of early identification
• Parental decisions: communication mode,
communication “orientation” (Deaf vs.
deaf)
• Best age for identification and initiation of
intervention: prior to six months
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.13
Terminology
• Hearing impairment, hearing disorder,
deafness, hard-of-hearing
• Prefer the term hearing loss:
– Focuses solely on the present physical
condition
– Carries no connotation regarding impairment,
disability, or handicap
• True deafness (inability to hear at all) is
extremely rare
• Deaf vs. deaf (community orientation)
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.14
Prevalence and Incidence
• Early Hearing Detection and Intervention
(EDHI) program: 5 to 6 out of every 1000
infants born with hearing loss
• Eight percent of school-age children have
“educationally significant” hearing loss
– Includes cases of acquired hearing loss due
to middle ear infections (35% children
experience ongoing middle ear infections
throughout childhood)
– Also includes cases of congenital hearing loss
due to pre-, peri-, or post-natal genetic
influences, injuries or illnesses
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.15
•
II. How is Pediatric Hearing
Loss Classified?
Classified by either etiology,
manifestation and impact, or severity
A. ETIOLOGY
• For characterizing the cause of the
hearing loss:
a. Genetic or environmental cause
b. Age of onset
c. Type of loss
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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13.16
a. Genetic or Environmental
Causes
• Genetic:
– Transmitted from parents to offspring
• autosomal dominant
• autosomal recessive
• Environmental:
– Exposure to noise (e.g., ventilator system in
NICU)
– Sudden exposure to noise or sudden change
in air pressure (barotrauma)
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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13.17
b. Age of Onset
• Developmental: present at birth
– Common causes: genetic disorders, Rh
incompatibility, infection or disease, trauma,
anoxia, ototoxic drugs, prematurity
• Acquired: occurs sometime after birth
– Common causes: trauma, ototoxic drugs,
middle ear infections, infection, noise,
systemic illness, barotrauma
• Prelingual vs. postlingual
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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13.18
c. Type of Loss
• Identifies the auditory structures that are
affected
• Conductive loss: damage to the outer or
middle ear
• Sensorineural loss: damage to the cochlea
or auditory nerve
• Mixed loss: simultaneous damage to the
conductive and sensorineural mechanisms
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.19
B. Manifestation and Impact
• Classification based on the aspects of
audition that are impacted
• Loss of hearing acuity: loss of precision of
hearing at different levels of loudness
• Decrease in language comprehension
(occurs with sensorineural loss)
– more difficult to manage
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.20
C. Severity
• Classification based on severity using
decibel system (dB)
• Hearing loss is represented by identifying
the threshold of hearing: where a person
just begins to hear
– Normal hearing: -10 to 15 dB
– Mild hearing loss: 26 to 40 dB
– Moderate hearing loss: 41 to 55 dB
– Severe hearing loss: 71 to 90 dB
– Profound hearing loss: 91 dB or higher
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.21
III. Prevalent Types of Pediatric
Hearing Loss
• Conductive Hearing Loss
• Sensorineural Hearing Loss
• Mixed Hearing Loss
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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13.22
Conductive Hearing Loss
• Attenuation or reduction of the sounds
heard in the environment
• However, exaggerates sound of one’s
voice and chewing, because of bone
conduction
• Slight to moderate loss in one or both
ears, typically not severe
• Medical or surgical intervention is usually
successful, so loss is usually temporary
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.23
Causes and Risk Factors
• Most common cause: middle ear infections
(otitis media)
– Angle and shortness of Eustachian tube in
children allows organisms to enter easily
– Allergens (e.g., cigarette smoke) make more
susceptible
– Interactions with other children spread
infections (e.g., child-care centers)
• Other causes: ear wax (cerumen)
blockage, foreign objects, congenital
malformations
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.24
Sensorineural Hearing Loss
• Most common type of hearing loss – slight
to profound loss of hearing in one or both
ears
• Decrease in loudness, also decrease in
speech perception and ability to
distinguish speech from background noise
• Some also experience reduced tolerance
for loud noises or ringing in the ears
(tinnitus)
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.25
Causes and Risk Factors
• Usually is present at birth as a congenital
hearing loss
• Half of the causes are unknown, the other
half are caused by genetics and heredity,
infection, otitis media, prematurity,
pregnancy complications, trauma
• Risk factors: influenced by maternal
health, birth process, hereditary factors,
exposure to medications, and disease
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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13.26
Mixed Hearing Loss
• Both permanent reduction of sound
(sensorineural) and additional temporary
loss of hearing (conductive)
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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13.27
IV. How is Pediatric Hearing
Loss Identified?
• Identification: often begins with routine
screening, (e.g., newborn screening)
• Ongoing monitoring: understanding
hearing loss changes over time and to
measure effects of intervention
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.28
The Assessment Process
•
•
•
•
Referral
Screening
Comprehensive Audiological Evaluation
Hearing Aid Evaluation
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.29
Referral
• EDHI programs are present in most states,
with the goal to detect hearing loss while
the infant is still in hospital after birth
• Toddlers and preschoolers are referred if:
– show developmental delay
– have hereditary disposition for hearing loss
– develop disease or disorder that affects the
auditory mechanism
• All children are evaluated routinely in
kindergarten, and 1st-3rd grades, and 7th
and 11th grades
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.30
Screening
• Infant Screening:
– Completed at birth in the hospital
– Typically uses otoacoustic emissions or
evoked auditory potentials as test measures
• Conventional Hearing Screening:
– Require the child to respond when a soft tone
is presented and heard (behavioral testing)
– Children who fail are either re-screened in two
weeks or referred for a comprehensive
examination
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.31
Comprehensive Audiological
Evaluation
• Assesses the type and degree of hearing
loss, speech discrimination, and auditory
perception
• Case history
• Interview and observation
• Otoscopic examination
• Audiometry
• Objective measures
– Immitance, otoacoustic emissions (OAEs),
evoked auditory potentials (EAPs)
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.32
Hearing Aid Evaluation
• If family decides on this option, requires
fitting and monitoring use of hearing aids
• Probe microphone measurement:
computerized method of measuring
hearing aid function in a child’s ear
• Electroacoustic evaluation: electronic
verification of sound properties of hearing
aid (gain, output, frequency response)
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.33
Importance of Accurate Diagnosis
• Because there is typically no outward
signs of hearing loss, it is hard to identify
and consequently treat
• Failure to identify hearing loss continues
the harmful effect on the child
• However, mistaking other conditions for
hearing loss can have negative
consequences as well
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.34
V. How is Pediatric Hearing
Loss Treated?
• Communication Choices
• Amplification and Listening Devices
• Aural Habilitation
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.35
Communication Choices
• Parents need to choose whether to
embrace the Deaf community or the
mainstream oral community, or to consider
a combination
– 49% of children use both speech and sign
• 44% use speech only
– 6% use sign only
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.36
Amplification and Listening
Devices
• Hearing Aids: children usually have behind-the-ear
hearing aids (BTEs)
– improved greatly in recent years due to technological
advances
• Assistive Listening Devices: improve a person’s
ability to hear in difficult listening situations (e.g.,
FM system, soundfield system)
• Cochlear Implants: provides direct electrical
stimulation to the auditory nerve, for children with
severe to profound sensorineural loss
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.37
Aural Habilitation
• Individualized intervention to achieve fluent
communication in manual and/or oral
modality
• Involves activities such as tactile training,
auditory training, speech reading and visual
cues, and education and counseling
• Three principles:
– Ensure an appropriate listening environment
– Maximize audition
– Support the continuum of listening
development
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.38
Intervention Principles: Infants,
Toddlers, and Preschoolers
1.
2.
3.
4.
5.
Early Intervention
Parental Involvement
Naturalistic Environments
Social Interaction
Functional Outcomes
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.39
Intervention Principles:
School-Age Children
1. Effective Means of Communication
2. Self-Advocacy
3. Literacy
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.40
VI. Auditory Processing Disorder
• Neurological problem that adversely
affects an individual’s processing or
interpretation of auditory messages
• Not typically accompanied by a loss of
hearing acuity
• Cause is often unknown, but sometimes
associated with other disorders, like
dyslexia, ADD, and autism
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
13.41
Assessment and Intervention
• Currently no “gold standard” for
identification, but behavioral assessment,
so not recommended for children under 7
• Common symptoms cluster into four
areas: behavioral, literacy, linguistic, and
organizational
• Treatment approaches:
– Environmental modification
– Remediation activities
– Compensatory strategies
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.