Early hearing testing in children
Infants with undiagnosed hearing problems may struggle to learn to speak and communicate,perform well in school, or develop socially and emotionally. However, if identified, early action can reduce and even reverse these harmful effects. All infants should be evaluated for hearing impairment, preferably before being discharged from the hospital. Between birth and the start of school, the proportion of children with hearing loss doubles, from about 3 in 1000 to 6 in 1000. For more kids to benefit from early detection and intervention, hearing screening during the formative language-learning years is essential.
Infants with hearing loss benefit from timely and adequate diagnostic and therapeutic treatments when their needs are met. This leads to improved listening, speaking, and language development. As soon as a baby is born, ideally the newborn screening is finished.The next stage is diagnostic audiology if an infant does not pass the newborn screening. So that any potential hearing loss can be identified before the child turns three months old, the initial diagnostic tests must be finished as quickly as feasible. If a newborn is found to have a hearing impairment, hearing aids should be fitted (if necessary) and the child should be enrolled in an early intervention programme well before the age of six months.
1 to 2 babies in every 1,000 are born with permanent hearing loss in 1 or both ears.
This increases to about 1 in every 100 babies who have spent more than 48 hours in intensive
care. Most of these babies are born into families with no history of permanent hearing loss.
Permanent hearing loss can significantly affect babies; development.
Finding out early can give these babies a better chance of developing language, speech and
communication skills.
It will also help them make the most of relationships with their family or careers from an early
age.
An audiologist for children does the diagnostic examination. A paediatric audiologist is a specialist with a master's degree in Audiology, the technical know-how, and the desire to deal with young children. In order to ascertain whether a hearing loss exists and, if so, the type(affected auditory system), degree (amount of hearing loss present), and configuration
(affected frequencies or pitches) of the loss. the audiologist conducts a number of tests, which are detailed below.
When is the newborn hearing test done?
Before you are allowed to leave the hospital after giving birth, you can be offered a newborn hearing test for your child. Otherwise, it will be carried out within the first few weeks by an Audiologist. Although it can be done as late as 3 months of age, the test is best performed in the first 4 to 5 weeks.
Risk indicators associated with permanent congenital, delayed-onset, or progressive hearing loss in childhood
1. Family history* of permanent childhood hearing loss
2. Premature birth, low birth weight, and anoxia are all symptoms of the baby not getting enough oxygen
3. Neonatal intensive care of 5 days, or any of the following regardless of length of stay: ECMO,* assisted ventilation, exposure to ototoxic medications (gentamycin and tobramycin) or loop diuretics (furosemide/lasix), and hyperbilirubinemia (jaundice) requiring exchange transfusion.
4. In-utero infections, such as CMV,*, herpes, rubella,syphilis,and toxoplasmosis.
5. Craniofacial anomalies, including those involving the pinna, ear canal, ear tags, ear pits, and temporal bone anomalies.
6. Physical findings, such as white forelock, associated with a syndrome known to include a sensorineural or permanent conductive hearing loss.
7. Syndromes associated with hearing loss or progressive or late-onset hearing loss,*such as neurofibromatosis, osteopetrosis, and Usher syndrome). Other frequently identified syndromes include Waardenburg, Alport, Pendred, and Jervell and Lange-Nielson.
8. Neurodegenerative disorders,* such as Hunter syndrome, or sensory motor neuropathies, such as Friedreich ataxia and Charcot-Marie-Tooth syndrome
9. Culture-positive postnatal infections associated with sensorineural hearing loss,*including confirmed bacterial and viral (especially herpes viruses and varicella) meningitis.
10. Head trauma, especially basal skull/temporal bone fracture* requiring hospitalization.
Auditory Brainstem Response (ABR)
ABR testing is an electrophysiological assessment that gives the audiologist knowledge of the health of the auditory nerve and/or inner ear. Since it can accurately and reliably predict hearing loss in newborns who are too young to react to behavioural testing, it is the most important technique in the initial test battery. Clicks, Tone bursts, and Bone Conduction tests should all be a part of ABR. The ABR measurement enables the audiologist to equip an infant with a hearing aid when necessary and offers details on the degree, kind, and configuration of a hearing loss.
Otoacoustic Emissions (OAE) screening
OAEs are low-intensity, quantifiable sounds that are produced by a cochlea that is healthy in addition to receiving sound. When an infant or toddler has a sensorineural hearing loss of 30dBHL or more, OAEs are not present. It's crucial to be aware that measuring the OAE can be hampered by middle ear fluid or the negative middle ear pressure that results from otitis media. OAE technology can only accurately evaluate cochlear functioning when the middle ear is clean. When OAE results are compared against ABR data, which are normally normal,the disorder known as "auditory neuropathy/dys-synchrony" is identified (typically
abnormal).
Tympanometry
Tympanometry involves changing the air pressure in the ear canal to assess the middle ears health, the eardrums mobility (tympanic membrane), and the conduction of the middle ear bones. Tympanometry can be imprecise when performed on extremely young infants because of their small, sensitive ear canals. Tympanometry for infants 0 to 6 months of age is therefore frequently performed with specialist equipment that produces a high frequency probe tone.
Behavioral Audiometry
Hearing data can be plotted more precisely as a child gets older and becomes able to communicate their hearing results behaviorally. The audiologist determines during audiometric testing the lowest intensity level (threshold) at which a child is able to detect sound at various frequencies. Using this data, an audiogram—a visual representation of the hearing loss—is produced. Normal classifications for hearing loss include mild, moderate,moderately severe, severe, and profound.
Behavioral Audiometry
Hearing data can be plotted more precisely as a child gets older and becomes able to communicate their hearing results behaviorally. The audiologist determines during audiometric testing the lowest intensity level (threshold) at which a child is able to detect sound at various frequencies. Using this data, an audiogram—a visual representation of the hearing loss—is produced. Normal classifications for hearing loss include mild, moderate, moderately severe, severe, and profound.
In addition to the tests previously mentioned, visual reinforcement audiometry (VRA) is advised for infants aged 6 to 36 months. The infant or toddler is positioned on a caregivers lap in a soundproof booth during a VRA assessment. When a sound is heard, the youngster is taught to turn toward a toy (one that lights up and/or moves). At all common clinical frequencies (250, 500, 1000, 2000, 4000, 8000 Hz) or at low, mid, and high frequencies, individual ear air conduction and bone conduction thresholds can be assessed. A complete audiogram can be acquired when this testing is used. A toddler can be trained for conditioned play audiometry once they are about 2 years old (CPA). In this test, the audiologist instructs the youngster to throw a ball into a bucket or do anything else amusing whenever a tone is heard. A complete individual ear audiogram by both air and bone conduction is typically the outcome of CPA.