Assessment of Hearing Loss

1. Assessment of Hearing Loss SH2030: Secondary Level Training Module.4

2. Objectives • To familiarise the trainees with the normal hearing and language milestones. • To sensitize them to how they can suspect hearing loss in a child or an adult. • To inform them regarding further testing modalities. SH2030: Secondary Level Training Module.4

3. Suspicion • If there has been a problem during pregnancy or birth, such as: • Maternal Rubella • Use of Ototoxic drugs • Difficult labour-Birth Asphyxia • Low birth weight • Jaundice • Prolonged stay in NICU • If there is a Family history of Deafness • If the child has/had history of discharge from the ear • In case of malformation of the head & neck. In case of any such risk factor…. SUSPECT HEARING LOSS: REFER for Hearing Test SH2030: Secondary Level Training Module.4

4. Hearing & Language Development • All children start listening and responding to sounds gradually after birth. • Gradually, they start babbling and then speaking. • Lets see how this development goes on… SH2030: Secondary Level Training Module.4

5. 0-3 month child • Responds to loud sounds, such as bangs etc. • S/he may blink or close the eyes or open them. May wake up from sleep if loud sound is produced nearby. SH2030: Secondary Level Training Module.4

6. 3-6 months • Is able to recognise the mother’s voice and turns his head towards her voice. • Starts showing interest in new sounds. • Turns towards the source of a sound. SH2030: Secondary Level Training Module.4

7. 6-9 months • Starts making babbling sounds by this age. • Shows interest in squeaky toys. SH2030: Secondary Level Training Module.4

8. 9-12 months • The child will start responding to his/her name. • S/he will understand small words such as ‘come’, ‘bye’ etc. SH2030: Secondary Level Training Module.4

9. 12-18 months • Starts imitating small words like mama, papa… • Tries to imitate words that he/she hears SH2030: Secondary Level Training Module.4

10. 18-24 months • Responds to instructions like: ‘Touch your nose’, ‘Show your tummy’ etc. • Will start speaking small 2-3 word sentences SH2030: Secondary Level Training Module.4

11. In case any of the milestones is not achieved…. SUSPECT HEARING LOSS: REFER for Hearing Test SH2030: Secondary Level Training Module.4

12. Ways to diagnose Hearing Loss SH2030: Secondary Level Training Module.4

13. What is the modality for testing? Hearing in an infant or young child can be tested by: • Use of Noisemaker (only for clinical screening) • Otoacoustic Emissions (screening test) • Auditory Brainstem response (diagnostic test) SH2030: Secondary Level Training Module.4

14. Noisemaker • In a quiet room • 2 persons are required • Mother/Parent holds the baby • Stand in front of the baby with a toy to distract him/her • 1 person standing behind the child with the noisemaker, shakes the rattle to make a noise. • Observe the baby: Does he try to look for the source of sound SH2030: Secondary Level Training Module.4

15. Use of Noise maker C A B A: Observer B: Parent with child C: Assistant with Noisemaker SH2030: Secondary Level Training Module.4

16. Diagnosis • Once there is suspicion, Diagnosis can be made by: • OAE testing • BERA test Refer the child to the District hospital for detailed assessment. SH2030: Secondary Level Training Module.4

17. In an older child: ASK, if the child has…. • discharge from the ear • recurrent pain in the ear • Difficulty in hearing • improper development of speech • Difficulty in understanding & following commands • Poor performance in school SH2030: Secondary Level Training Module.4

18. Suspect hearing loss if .. • Child • Cannot follow simple instructions • Gives wrong answers to questions • Does not respond to your call • Cannot sing/dance in time to music • Cannot identify different sounds SH2030: Secondary Level Training Module.4

19. Testing older Children and Adults • Clinical testing: Voice tests: excellent clinical indicator • Tuning Fork Tests • Pure Tone Audiometry SH2030: Secondary Level Training Module.4

20. Voice Tests (Child) • Ask the child to repeat the words that you say. OR • Ask him/her (child) to do simple actions eg: Touch your nose, Pat your head etc OR • Point to the object as you say the name eg Chair, pen etc If response is unsatisfactory: Refer for Hearing assessment SH2030: Secondary Level Training Module.4

21. Voice Tests • Sit about 1 meter from the child with one ear facing you. Other ear should be blocked. • Cover your lips while speaking (to prevent lipreading) First speak in whisper: Correct response=normal hearing Incorrect response: Repeat in conversational voice Correct response=slight H. loss Incorrect response: Repeat in loud voice Correct response=moderate H. loss Incorrect response: Repeat by shouting in the ear Correct response= Severe H. loss Incorrect response: Deafness SH2030: Secondary Level Training Module.4

22. Voice tests (Adults & Older children) • Ask patient to block off one ear. • Sit facing test ear at a distance of 1meter from the ear • Cover your lips while speaking (to prevent lipreading) SH2030: Secondary Level Training Module.4

23. Voice tests (Adults & Older children) • give stimulus in the form of spoken words, such as Bicycle, Post-office, Aeroplane etc • Ask patient to repeat back the spoken words • Start with whispered voice & progress to shouted voice, if required. • Repeat with the other ear. SH2030: Secondary Level Training Module.4

24. Voice tests (Adults & Older children) First speak in whisper: Correct response=normal hearing Incorrect response: Repeat in conversational voice Correct response=slight H. loss Incorrect response: Repeat in loud voice Correct response=moderate H. loss Incorrect response: Repeat by shouting in the ear Correct response= Severe H. loss Incorrect response: Deafness SH2030: Secondary Level Training Module.4

25. Pure Tone Audiometry • Standard technique for older children & adults. • Gives us detailed frequency specific information about the hearing of the child. • Requires cooperation from the child. SH2030: Secondary Level Training Module.4

26. In Adults Suspect hearing loss (Presbyacusis), if they are : • isolating themselves socially • Speaking too loudly • Speaking too much (so as to not have to listen to others) • Speaking too little • Raising the volume of the TV • Have difficulty in understanding what is being said over the phone Refer for Audiometry SH2030: Secondary Level Training Module.4

27. Suspect Noise Induced hearing loss If the person: • Has been working/living in noisy environment • Has noisy pastimes (eg walkman, I-Pods) • Complains of tinnitus • Complains of difficulty in hearing bells etc. • Complains of difficulty in understanding speech/difficulty in hearing. Refer for Audiometry SH2030: Secondary Level Training Module.4

28. Counselling The patient as well as the Parent needs advice & support in order to rehabilitate the deaf child. • Encourage the child and the family • Ensure that they start rehabilitative therapy • Encourage them to try to put the child in a regular school. • Warn the parents against overprotecting the child SH2030: Secondary Level Training Module.4

29. Thank You Whenever there is a suspicion of Hearing Loss: REFER SH2030: Secondary Level Training Module.4