AUDIOLOGY
HEARING DISORDERS IN
CHILDREN –PEDIATRIC
AUDIOLOGY
JANE ZINAMPAN
JEANELLE TORIBIO
OBJECTIVES
• To define common terms in audiology
• To discuss clinical auditory testing
• To discuss basic principles of audiometry
• To know the different audiometric tests; the techniques and its interpretation
• To discuss the different causes and effects of pediatric hearing loss
• To give a background on hearing rehabilitation and auditory devices
Acquired deafness –
refers to a loss of the
sense of hearing
Congenital deafness –
refers to the absence of
hearing
OBJECTIVE HEARING TESTS
• Test without eliciting active response from the patient
Immitance measurements • changes in the acoustic impedance in the TM via
intra aural probe
Auditory Evoked Potentials (AEPs) • acoustically evoked bioelectric responses of the
cochlea, auditory nerve, auditory tract neurons, or
cerebral cortex via surface electrodes and
averaging techniques
Otoacoustic Emissions (OAEs) • measure sound events in the ear canal that are
produced by spontaneous or acoustically evoked
active biomechanical vibrations in the cochlea via
microphone probe
IMMITANCE MEASUREMENTS
• Measure of resistance that the system
offers to the absorption of soundwaves
• Sound absorption = compliance
• Intra-aural probe; 220Hz
• Tympanometry: provides graphic
representation of impedance changes
caused by applied air pressure
• Stapedial reflex: produces and
acoustically evoked change in
impedance
• Ipsilateral stapedial
reflex
• Contralateral stapedial
reflex
Interpretation: absence or
increased stapedial reflex
threshold may be caused by
a lesion at various parts in
the freflex pathway
AUDITORY EVOKED POTENTIALS
• Recorded from the scalp using
needle or surface electrodes
Electrocochleography cochlea and auditory 1-3ms
nerve
Auditory Brainstem auditory nerve and 10ms
Response audiometry brainstem structures
Auditory Middle Latency thalamus and primary 10-100ms
Response audiometry auditory complex
Cortical Evoked 100-1000ms
Potentials
AUDITORY BRAINSTEM RESPONSE
• Most commonly recorded AEP for diagnostic purposes
• Mainly tests hearing at middle and high frequencies (>1kHz)
• Adhesive electrodes: placed on the vertex and mastoid
• differentiates cochlear and retrocochlear hearing loss
• neurologic diseases
• threshold testing in pediatric audiology
• intraoperative monitoring of hearing
• Interpretation: time intervals between waves and threshold for wave V
OTOACOUSTIC EMISSIONS
• Spontaneous or evoked
• Screening of cochlear function in newborns to small children
Spontaneous otoacoustic emissions no external stimulus
Transient evoked otoacoustic consistently detected in response to a brief stimulus
emissions
Distortion product otoacoustic detected by stimulation with 2 continuous tones that
emissions have different but adjacent frequencies
Stimulus frequency otoacoustic Stimulation with a sine-wae tone evokes tonal
emissions emission of the same frequency
REHABILITATION AND HEARING AIDS
• Restore or improve auditory communication
• Surgery: conductive hearing loss
• Hearing aids: amplifies auditory signals, BTE or ITE
• Active middle ear implants: sound waves to mechanical vibrations
• Cochlear implant: sound waves to electrical impulses
• Vibrotactile aids: acoustic signals to vibrations transmitted to wrist
• Other assisitive devices: vibrating wake-up alarms, TV headphones
• Training: selective listening, lip-reading
HEARING AID FITTING IN ADULTS
Determine candidacy • Hearing loss of 30dB HL or more in the better ear
by pure-tone audiometry, measured for at least
one frequency in the range from 500-3000Hz
• Speech audiometry: ≤80% correct responses for
monosyllabic recognition at 65dB SPL
• Willingness
Audiologic examination • pure tone audiometry, speech audiometry, dynamic
range
Hearing aid trial • ear mold
Final hearing aid selection • speech audiometric testing, subjective auditory
impression, in situ measurements
Follow-up care
COCHLEAR IMPLANTS IN ADULTS
Indication • Acquired, bilateral predominantly cochlear deafness
(postlingual deafness) with a functional auditory nerve
and intact central auditory pathway
• Congenital or early acquired (prelingual deafness)
• Lack of benefit from binaural hearing aid despite
optimum adjustment
• Willingness
✓ Partially functional auditory nerve
✓ Promontory test
Follow-up care • Technical check of the implant function
• Checking & adjusting speech processor
• Auditory training
PEDIATRIC AUDIOLOGY
CAUSES OF PEDIATRIC HEARING DISORDERS
• Hereditary genetic causes • Acquired causes
• Congenital • in utero
• Postnatal or later • perinatal
• Monosymptomatic Genetic • postnatal
hearing loss
• Hearing loss in genetic syndromes • Rubella syndrome
• Hyperbilirubinemia syndrome
• Congenital syphylis
EFFECTS OF HEARING LOSS
• Newborns: earliest sign: delayed
speech development
• kernicterus
• hypoxia
• Infants & small children: MC type
is the acquired temporary hearing
loss 2' to otitis media
Screening Diagnostic methods
• Risk screening: • Objective methods:
• ICU for 48h • Otoacoustic emissions
• Family history • Auditory evoked potentials
• Craniofacial anomalies • Immitance measurements
• Universal screening: 2-3 days • Behavioral audiometric
after birth methods:
• Reflex audiometry
• Newborn hearing screening: • Response audiometry
• OAEs & ABR • Distraction test
• older children: with • Visual reinforcement
behavioral tests audiometry
• Play audiometry
• Pediatric speech audiometry
TREATMENT
• General consensus: children with bilateral, moderate, permanent
hearing loss should be treated in order to prevent significant
impairment of speech and language development
• Hearing aids: moderate to severe hearing loss
• Cochlear implant: profound hearing loss
• Auditory devices:
• Hearing aids: children are generally fitted with 2 BTE hearing aids
• FM transmitters, vibrators
• Cochlear implants: indicated to patients with cochlear damage but with
responisve auditory nerve
• Congenital deafness
• Bilateral acquired deafness
• Education services
