The landmarks towards hearing

1. The landmarks towards hearing Paul J Govaerts, MD, MS, PhD K Daemers, G De Ceulaer, M Yperman, C De Beukelaer the eargroup Antwerp-Deurne (Belgium)

2. Flanders 60% of population approx 60.000 newborns Antwerp 1993 pilot study European concerted actions (Grandori) 1995 Well Baby Organization BELGIUM

3. Flanders UNHS 2003 Flanders approx 60.000 newborns since 1999: universal screening (ALGO) coverage: 94-96% 5.7 %0 retested >> 2 %0 referred >> 0.9 %0 of population with bilateral loss

4. Congenital SNHLthe landmarks towards hearing … • 1 month: screening • + referral • + expert counseling • + setting out the time line

5. Congenital SNHLthe landmarks towards hearing … • 1 month: screening • + referral • + expert counseling • + setting out the time line • 3 months: diagnostic work-up

6. Congenital SNHLDiagnostic work-up • Confirmation of hearing loss • Excluding other pathologies (syndromes) • Looking for the etiology

7. Congenital SNHLDiagnostic work-up • Confirmation of hearing loss • ABR under anaesthesia • After paracenthesis • With air and bone conduction • Excluding other pathologies (syndromes) • Looking for the etiology

8. Congenital SNHLDiagnostic work-up • Confirmation of hearing loss • ABR under anaesthesia • After paracenthesis • With air and bone conduction • Excluding other pathologies (syndromes) • Clinical examination • Ophtalmologic examination • Ultrasound kidneys, urine • ECG • Chromosomal analysis • Looking for the etiology

9. Congenital SNHLDiagnostic work-up • Confirmation of hearing loss • ABR under anaesthesia • After paracenthesis • With air and bone conduction • Excluding other pathologies (syndromes) • Clinical examination • Ophtalmologic examination • Ultrasound kidneys, urine • ECG • Chromosomal analysis • Looking for the etiology

10. Blood exam ! MRI / CT scan ! Congenital SNHLdiagnostic work-up • 10 years ago: only diagnosis is 15% • Now: diagnosis in 75%

11. Congenital SNHLthe landmarks towards hearing … • 1 month: screening • + referral • + expert counseling • + setting out the time line • 3 months: diagnostic work-up

12. Congenital SNHLthe landmarks towards hearing … • 1 month: screening • + referral • + expert counseling • + setting out the time line • 3 months: diagnostic work-up • 3-6 months: hearing aid fitting + rehab

13. Audiometry ?? Congenital SNHLthe landmarks towards hearing … • 1 month: screening • + referral • + expert counseling • + setting out the time line • 3 months: diagnostic work-up • 3-6 months: hearing aid fitting + rehab • 9-12 months: evaluate hearing aids Cochlear function - amplification (detection) - discrimination HA evaluation CI candidacy selection CI evaluation + programming

14. *.wav files

15. Boy 11 months Connexin-26 deafness Hearing aids from age 3 months A§E

16. Boy 11 months Connexin-26 deafness Hearing aids from age 3 months A§E

17. CI @ 16 mos A§E

18. Congenital SNHLthe landmarks towards hearing … • 1 month: screening • + referral • + expert counseling • + setting out the time line • 3 months: diagnostic work-up • 3-6 months: hearing aid fitting + rehab • 9-12 months: evaluate hearing aids Cochlear implant before 18 months Continu Hearing aids http:/www.eargroup.net

19. 10 17 6 22 Age at implantationCAP: follow-up 2 years telephone language discrimination response to spoken language 9 9

20. Age at implantationbabbling

21. Receptive language development (Reynell) Courtesy of Leo De Raeve, KIDS, Hasselt, Belgium)

22. Expressive language development (Reynell) Courtesy of Leo De Raeve, KIDS, Hasselt, Belgium)

23. Age at implantationmainstream integration

24. http://eargroup.net Info@eargroup.net Conclusionthe road towards hearing… • 1 month: screening • 3 months: diagnostic work-up • < 6 months: hearing aid fitting + rehab • < 12 months: evaluate hearing aids • < 18 months: hearing restoration