Impact and challenges of hearing loss following meningitis

1. Impact and challenges of hearing loss following meningitis Vicki Kirwin After Meningitis Conference, London November 2009

2. Meningitis and hearing loss • Biggest cause of acquired sensorineural hearing impairment in children (~6% all PCHI) • Majority of children are deafened before their 3rd birthday • Bilateral or unilateral • Any level from mild to profound hearing loss • Hearing loss normally occurs early in the course of the illness • Hearing loss often not immediately stable

3. Meningitis causes hearing loss… • Most commonly as result of infection spreading into the cochlea • Sometimes due to inflammation of the auditory nerve • Can also affect the vestibular organ • Ossification

4. Protocol for early referral - newborn babies Newborn babies who have had bacterial meningitis are excluded from the newborn hearing screen and ref’d for full audiological assessment • 1/10 following meningitis • 1/100 NICU/SCBU babies • 1/1000 for well babies

5. Protocol for early referral - older infants and children "Immediate referral to Audiology for age-appropriate assessment If these conditions occur at any point in infancy or childhood after the screen then, on recovery, immediate referral should be made to Audiology for an age-appropriate audiological assessment within 4 weeks of discharge from hospital” Guidelines for surveillance and audiological monitoring of infants & children following the newborn hearing screen (NHSP Clinical Group, 2009) http://hearing.screening.nhs.uk/cms.php?folder=88

6. 125 250 500 1000 2000 4000 8000 z v f th p s h g ch sh l a j mdb o r n ng e i u AUDIOGRAM OF FAMILIAR SOUNDS FREQUENCY IN CYCLES PER SECOND (HZ) 0 10 20 30 40 50 HEARING LEVEL (dB HL) 60 70 80 90 100 110 120

7. Impact of hearing loss • Pre-lingually deafened • Post-lingually deafened • Degree of deafness

8. Impact of hearing loss • Home • Education • Social

9. Impact of hearing loss pre-lingually deafened • Language acquisition and use • Speech and communication • Incidental hearing for learning • Child’s behaviour may have changed • Attention span may be shorter • Temper tantrums • More clingy • Siblings may react to the focus of attention on the deaf child

10. Impact of hearing loss post-lingually deafened • Maintaining speech and language skills • Emotional impact of illness • Emotional impact and acceptance of hearing loss • Support needed to find new ways of communicating • Incidental hearing for learning & gossip!

11. Impact of hearing loss post-lingually deafened • Different experiences to peers • Unwanted/higher levels adult direction/attention • Professional intervention - ToD, SLT, support assistants, social worker, Ed. Psychologist, audiologist, GP, consultant, etc • Higher risk mental health problems

12. Management of the hearing loss - hearing aids Sound enters the microphone, is processed and amplified and exits via the receiver. The amplified sound enters the ear via the tubing and ear mould.

13. Management of the hearing loss - cochlear implants A surgically implanted electronic device which stimulates the hearing nerves in the cochlea directly.

14. Cochlear implants cont. Sound enters the microphone. The sound is transformed into electrical signals and transfers across the skin from the receiver to the internal electrodes. The electronic signals are ‘de-coded’ by the brain and ‘heard’.

15. Management of the hearing loss - other support • voice to text software for computers • subtitles on television, DVDs, cinemas and theatres • note takers and communication support workers in school • text phones that give access to phone calls • lip-reading • sign language

16. NDCS support • Founded by parents for parents in 1944 • The UK’s largest national charity supporting all deaf children and their families • Supports all families regardless of deafness, amplification, communication methodology and educational placement.

17. NDCS objectives • Offer clear, balanced information and support to families • Advocate for deaf children, young people and their families • Providing opportunities for young deaf people to develop social skills, confidence and independence • Work with professionals and policy makers to ensure high quality services are available for all • Campaign and lobby on issues affecting the lives of deaf children, young people and their families

18. NDCS services • Freephone helpline 0808 800 8880 • Free membership to families and professionals • Family officers • Legal casework team • Regional directors team • Offices in London, Birmingham, Belfast, Cardiff and Glasgow • Membership magazine & email updates • Free publications • A purpose built listening bus • An equipment loan scheme • Grants to help parents on low incomes buy computers • Local DCS’s • Events for families and young deaf people including arts, sports, outdoor activities and family weekends

21. Further references & resources • Balance and balance disorders factsheet, NDCS, 2008. www.ndcs.org.uk • Fortnum HM & Davis AC (1993). Hearing impairment in children after bacterial meningitis: incidence and resource implications. Brit J Audiol 27, 43-52 • Fortnum HM, Summerfield AQ, Marshall DH, Davis AC, Bamford JM (2001). Prevalence of permanent childhood hearing impairment in the United Kingdom and implications for universal neonatal hearing screening: questionnaire based ascertainment study. Brit Med J 323(7312), 536-40 • Guidelines for surveillance and audiological monitoring of infants & children following the newborn hearing screen, NHSP, July 2009 http://hearing.screening.nhs.uk/cms.php?folder=88 • Meningitis and childhood deafness, NDCS/The Meningitis Trust, 2009 www.ndcs.org.uk • Meningitis & Hearing Loss (Deafness Research UK, 2005) http://www.deafnessresearch.org.uk/Factsheets+3565.twl • http://www.nhs.uk/Conditions/Meningitis/Pages/Introduction.aspx

22. vicki.kirwin@ndcs.org.uk www.ndcs.org.uk