Philippine Normal University National Center for Teacher Education Taft Ave, Manila

Hearing Impairment:
*Classification *Etiology

Submitted by: Irene F. Mendoza III-16 BSE History

Submitted to: Prof. Zhanina U. Custodio

Classification of Hearing Impairment

The affected part of the ear is one basis for classifying hearing impairment. A conductive hearing loss occurs in the outer and middle ear thereby blocking the passage of the acoustic energy. The blockage may be cause by abnormal growths or complications of the outer or middle ear. Impacted cerumen results from the excessive buildup of earwax in the auditory canal. Diseases of the middle ear can leave fliud or debris. Malformation, incomplete development, or abnormal growth and improper movement of the ossicular chains can cause conductive hearing loss. If the inner ear is intact, conductive hearing impairment can be corrected through surgical or medical treatment. A hearing aid is usually prescribed. A sensorinemeual hearing impairment occurs in the inner ear. The sensitive mechanisms and the auditory nerve may be damaged. When the cochlea is impaired, the neural energy delivered to the brain is distorted or not delivered at all. Audition does not take place and speech is not heard. Sensorineural hearing losses may be congenital or adventitious because of illness or traumatic incidents. Only a very small percentage of sensorineural deafness canbe reversed by medical intervention. A mixed hearing impairment results from a combination of both conductive and sensorineural hearing losses. Any dysfuntion in the central auditory nervous system between the brain stem and the auditory cortex in the brain results in a central hearing disorder. Another basis for classifying hearing impairment is its being unilateralor present in one ear only, or bilateral or present in both ears. As mentioned earlier, deafness may be congenital or adventitious. The degree od severity of hearing impairment may be slight, mild, moderate, severe, profound. Sound is measured in decibels (dB) or units that describe its intensity, that is, its loudness or softness. Zero dB represents the softest or faintest sound a person with normal hearing can hear. Zero dB is also called zero-hearing threshold (HTL) or audiometric zero. Larger dB numbers represent louder sound. A whisperfive feet away registers about 10 dB, conversational speech 10 to 20 feet aways registers about about 65 dB, while a motorcycle or tricycle registers louder at about 85 dB. A ten to sixteen wheeler truck registers from about 100 to 125 dB and causes pain to the ears. The following table shows the intensity of sound as heard by persons who have hearing impairments. The severity of degree of the hearing loss corresponds to losses in decibels that result to learning difficulties. Severity Of Hearing Loss And Resulting Impairments Degree of hearing Decibel loss Resulting Impairments loss 0-20 dB Normal

Slight Mild

27-40 dB 42-55 dB

Moderate

56-70 dB

Severe

71-90 dB

Profound

91- and above

Faints sounds and distant conversations are difficult to hear. With a hearing aid, the student can attend regular school. As much as 50 percent of classroom conversations are missed. Limited vocabularyand speech difficulties may result. Loud conservations can be heard. Defective speech, language difficultiesand limited vocabulary result. Hearing is limited to aradius of one foot, enough to discriminate loud sounds. Defectice speech and language and severe difficulty in hearing consonant sounds may result. Sounds and tones cannot be perceived. Visions becomes the primary sense of communication. Speech and language are likely to deteriotrate.

Incidence and Prevalence

In the Philippines, the consevative estimate is that 2% of the population has hearing impairment and the number may increase if children below school age and persons who lose hearing sensitivity due to old age are included. In the United states at least 1 in every 22 newly born infants has some degree of hearing impairment. At least 3 in 1000 infants have a severe or profound hearing impairment. In its latest report, the U.S. Department of education claimed that children with hearig impairment constitute 1.3% of pupils provided with special education servives and 11% of the total age population.

Etiology Of Hearing Impairment

Hearing impairments are attributed to genetic and heredity factors, infections, environmental and other traumatic factors. Some hearing impairments have unknown causes. Genetic and hereditary types of deafness occur in one of one thousand live births. Causea are hereditary and chromosomal abnormalities.

Infections such as maternal rubella, cytomegalovirus hepatitis B virus, syphilis, mumps and otitis media may occur during pregnancy or after birth. Advetitious hearing loss can be attributed to enviromental factors such as excessive and constant exposure to very loud noises. Drugs and medication that can turn toxic when administered to the mother or to the child at inappropriate times and circumtances. Traumatic factors can cause hearing impairment at birth. Low birth weight, difficult and prolonged labor can traumatize the hearing mechanism and can cause hearing loss and permanent damage to the ear. Skull fractures due to accidents, as well as pressure changes may damage the ear. The more specific causes of conductive hearing loss are otitis media (middle ear infection), excessive earwax (impacted cerumen) and otosclerosis ( a spongy boney growth around the stirrup hich impedes its movement). Sensorineural hearing loss results from damage to the cochlea or the auditory nerve. Other causes are viral diseases, Rh incompatibility, hereditary factors, exposure to noise, aging and ototoxic medications. Common Disorders Assocatiated With Hearing Loss Atresia Absence of the external ear canal. Usually unilateral or found in the both ears Often seen in the conjuction with such syndromes as Cruzons, Treacher Collins, Pierre Robin Usually congenital, but can be acquired (fungal infection, squamous cell carcinoma) Results in conductive hearing loss Acoustic neuroma Benign, slow-growing tumor Associated with NF-2, chromosome 22, autosomal dominant Found in the internal auditory canal Prevalence 1:100000 75% have slowly progressive sensorineural hearing loss Other symptoms include poor speech understanding on the affected side, facial numbness,unsteadiness Fistula Hole in or rupture of the oval or round window in the inner ear May leak perilymph (clear fluid) into the middle ear. Caused by head injuries, diving, barotraumas, violent sneezing, etc. Results in fluctuating and/or sudden sensorineural hearing loss

Can be a complication of cholesteatoma Dizziness can also be a symtom

Autoimmune disease Associated with a variety of immune disorders such as hiv/aids May be accompanied by chronic ottis media, nasal crusting, cough, iritis,etc.. Sensorineural hearing loss occurs in 20% Ototocity Can be caused by awide variety of strong antibiotics such as amino glycosides gentamicin, kanamycin and others as well as chemotherapeutic agents such as cisplatin or loop diuretics. Can be result from exposure to various chemical agents in the environment Characterized by a progressive high-frequency sensorineural hearing loss following such exposure Cytomegalovirus (CMV) Most common congenital viral infection causing hearing loss today, occuringin 1:1000live births Contracted during pregnancy, during or after birth Can result in sensorineural hearing loss as well as CNS, cardiac, optic,and growth abnormalities Symtoms may be apparent at birth, with onset at aboout 18 months Progresses rapidly during first year Meningitis Neonatal infection, can be viral or bacterial Most common cause of acquired sensorineural hearing loss Hearing loss can range from mild to profound, may be progressive Symptoms may include headache, neck stiffness, photophobia, and suppurative otitis media Down syndrome Congenital chromosomal abnormality (trisomy 21) 30% of these children have sensorineural hearing loss Most have poor Euchachian tube function, resulting in chronic middle ear disease with associated conductive fluctuant hearing loss Choleasteatoma May be acquired or congenital

A benign growth of slow-growing skin tissue in the middle ear Usually caused by recurring otitis medis and negative middle ear pressure Associated hearing loss is usually conductive, but may be sensorineural depending on the location of the growth Cruzons syndrome Congenital abnormality of the external and middle ear Inherited autosomal dominant disorder Frog-face apperance One-third of these children have bilateral conductive hearing loss Pinnas may be low set and rotated with atresia Often have middle ear defomities Waardenburg syndrome Autosomal hereditary dominant disorder 20% have white forelock. 99% have increased distance between the eyes, 45% have irises of the different colors Depigmetation of the skin and the eyebrows that meet over the bridge of the nose area is a common feature of this syndrome 50% have mild to severe sensorineural hearing loss. Which can be unilateral or bilateral that is progressive. Usher syndrome Autosomal recessive disorder Occurs in 6-12% of congrnitally deaf children and 3 in 100000 of the general population Involves retinitis pigmentosa and progressive moderate to severe sensorinural hearing loss Can vary greatly in age of onset, severity, and progression Treacher collins syndrome Autosomal dominant congenital abnormality of the external and middle ear Facial anomalies such as depressed cheekbones,malformed pinna, receding chin large fishlike mouth and dental abnormalities Poorly developed middle ear space with ossicles frequently absent or deformed Can be associated with conductive or sensorineural hearing loss Pendreds syndrome Congenital abnormality of the inner ear Recessive endoctrine, metabolic disorder occuring in 1 of 100,000 newborns Associated with profound sensorineural hearing loss which may develop during the first 10 years of life

Also associated with thyroid defect, resulting in a goiter during the second or third decade of life. 40% have vestibular problems Often seen with a Mondini-like cochlear abnormality Lyme disease Acquire disorder Caused by tick-borne spirochete Leading cause of facial paralysis in children Symptoms include rash, headache, hearing loss, stiff neck, artharalysis and fatigue Hearing loss usually improves with the antibiotic therapy Turner syndrome Aberration of sex chromosomes, X chromosome is absent Associated with abormalities of the external and middle ear including low set ears, auricle, defect, middle ear abnormalities and a Mondini-cochlea Can result in the conductive or sensorineural hearing loss Pierre Robin Syndrome Autosomal dominant inheritance Congenital abnormality of the external and middle ear Cleft palate and glossoptosis Low set cupped ears, facial nerve abnormalities Conductive hearing loss