HEARING LOSS IN THE COMMUNITY:

FOCUS ON CHILDREN

Dr. Jeyanthi Kulasegarah

FRCS (Ireland), MD, MRCS
July 2020
Do you know the difference between
visual and hearing impairment?

Both are sensory impairments

This is an example
of visual impairment
If you show hearing loss in a
visual way
Can you see the difference?
Introduction
• Definition
• Epidemiology
• A-Z of hearing loss in children
Definition
WHO Definition Audiogram
• Disabling hearing loss
refers to hearing loss
greater than 40dB in
the better hearing ear
in adults and a hearing
loss greater than 30dB
in the better hearing
ear in children.
Epidemiology

• WHO figures:
• Around 466 million people worldwide have disabling
hearing loss, and 34 million of these are children.

• It is estimated that by 2050 over 900 million people will

have disabling hearing loss.

• 1.1 billion young people (aged between 12–35 years)

are at risk of hearing loss due to exposure to noise in
recreational settings
34 million children
 KEEP YOUR KIDS HEARING SAFE!

“12.5% of kids between the ages of 6 and 19 suffer from hearing loss as a result of
using earphones turned to a high volume.”  
 
Noise Levels

Stereo headset listening

for 2 hours
A – Z OF HEARING LOSS
IN CHILDREN
Aural Rehabilitation
• Once hearing loss is identified and confirmed,
babies and children require intensive training in
learning to listen using hearing devices
• Parents should be counseled regarding
importance of hearing devices
• Guided by the audiologists and speech and
language therapist
Brain Plasticity
• The brain is able to re-organize its neural
pathways whenever new information or memory
is received = neuroplasticity
• The auditory cortex (temporal) is the part of the
brain that is responsible for hearing and speech
• The period from birth to 4 years is the critical
window for auditory development and language
learning.
• Importance of early intervention
Causes of Hearing Loss
• Hearing loss can be divided into:
• Timing (Congenital vs. Acquired or Prelingual vs.
Postlingual)
• Location
• Conductive hearing loss (Outer and middle ear
pathology)
• Sensorineural hearing loss (Inner, auditory nerve)
• Mixed hearing loss
Developmental Checklist
Early Detection and Intervention
• Critical for the development of speech, language
and communication skills in children with hearing
loss
• The earlier the detection of hearing loss, the
earlier the intervention process can start for the
child.
• Importance of Neonatal Hearing Screening
Program
• As clinicians, we need to check that this test was
done for babies
Family Support
• Each parent will react and respond differently to
the diagnosis and it is really important that they
are supported in this challenging journey.
• Family support helps to deal with the situation
better
• Family-centred approach
Genetics
Genetics
Hearing Devices
• Non-surgical devices
• BTE (Behind-the-ear)
• Soft/hard band
• Adhere
• Surgical devices
• Cochlear implant
• BAHA (Bone Anchored Hearing Aid)
• Bonebdrige
• Vibrant soundbridge (VSB)
Hearing Aid
Cochlear Implant
Bone Conduction Hearing Aid
Bone Conduction Hearing Implant
Bonebridge
Impact of Hearing Loss
• Especially in children:
• Delayed language development
• Poor academic performance
• Feelings of loneliness, isolation, and even frustration
• Unaddressed hearing loss = US750billion per
year (RM3.224bil)
Jaundice
• High levels of bilirubin  crosses blood brain
barrier  brain damage
• Treatment of jaundice is important
• Babies need to be monitored closely
Listening
• 4 stages:
• Detection
• Discrimination
• Identification
• Comprehension
Mainstream School
• Early diagnosis and early intervention, it is
possible for a hearing-impaired child to be
enrolled into a mainstream school
• School for the deaf
• Home schooling
 Newborn Hearing Screening
Otoacoustic Emission
(OAE)
• In Malaysia, major public
and some private hospitals
implement universal
newborn hearing screening
using an automated
diagnostic device.
• Pass or Refer
• If refer, will need ABR
(Auditory Brainstem
Response)
Otitis Media
Otitis Media with Effusion
(OME)
• Common
• ET immaturity
• Risk factors:
• Day care
• Passive smoking
• Down’s syndrome
• Cleft palate
• Craniofacial anomalies
Parent Groups
• In Malaysia, limited support groups
• HEAR ME https://www.hearme.my
• Pusat Majudiri ‘Y’ (PMY) for the Deaf
https://www.ymcakl.com
/page/199/Pusat-Majudiri-'Y'-For-The-Deaf-(PMY)
/
Questions

• Referral to ENT/Audiologists/SLT
Resource Material

• Internet
• Ministry of Health Website
• American Speech and Hearing Association
• Hearing devices websites
• Professional advice
Symptoms & Signs
• Babies and toddler cant communicate verbally
• Importance of developmental milestones
Tests
• Objective test:
• OAE (Otoacoustic Emission) Sound waves emitted by
outer hair cells
• ABR (Auditory Brainstem Response)
• Subjective test:
• Sound field testing (6 months to 2 years)
• Visual reinforcement audiometry (8months – 3 years)
• Play audiometry (2 – 5 years)
• Pure tone audiometry (>5 years)
Unilateral Hearing Loss
• Also known as single sided deafness
• Can be easily missed
• Importance of newborn hearing screening to
identify these children
Vestibular
• Don’t forget the
hearing and vestibular
system are inter-
related.
• There may be some
element of imbalance
among children with
hearing loss
Work with Professionals
• MDT approach
• ENT
• Audiologists
• Speech and language therapy
• Behavioural therapist/psychologist
• Teachers of the deaf
• Paediatrician
X to Myths
1. Myth: Only old people have hearing loss as it is a sign of
aging.
Fact: Hearing loss can happen to any age group, either from
birth or acquired.
2. Myth: All deaf children use sign language.
Fact: With early diagnosis and intervention, a hearing-
impaired child should be able to use spoken language.
3. Myth: Deaf children can’t enjoy music.
Fact: With the help of hearing devices, children with
hearing loss can appreciate music like anyone else.
4. Myth: Hearing aids will make everything sound loud.
Fact: Hearing aids are indeed amplifiers, but current digital
technology ensures that only the appropriate amount of
amplification suited to the hearing levels is given.
You can help!
ZZzzz……..
THANK YOU