Deafness, Lets Talk About It

1
Deafness, Lets Talk About It
Chair Kerryn Saunders
2
Early Intervention for Long Term Outcomes

• Jacqueline Small
• Childrens Hospital at Westmead,
• Disability Specialist Unit

3
Childhood Deafness

• 1 per 1000 children
• higher than other childhood disorders for which
  there are well established neonatal screening
  tests
• est 250-500 births per year in Australia with
  significant HI
• Foetal development cochlea mature at 24 weeks,
  near adult size at 30 weeks

4
Impact of Hearing Loss

• Mild 20-40dB
• misses whispers and soft voices
• Moderate 40-60dB
• able to hear raised voices
• Severe 60-80dB
• hears some words when shouted
• Profound gt80dB
• unable to hear shouted voice

5
Childhood Deafness

• Sensorineural (cochlear and retrocochlear)
• Conductive
• Assessment-
• Behavioural (VROA)
• Physiological (ABR, AABR, EOAE, EC)
• Mean age detection 2-2 1/2 years

6
Late Diagnosis, So What?

• If deafness is detected and treated late, the
  consequences for child and family may be
  devastating, and cost to society over a lifetime
  huge (Mutton, 1998)
• Adverse impact learning difficulties, language
  acquisition, emotional and social well being

7
Factors Influencing Outcome

• Age at diagnosis is the most important factor in
  outcome
• The degree of hearing loss is a less significant
  predictor of language ability

8
Universal Neonatal Hearing Screening

• Failure of existing child health surveillance
  programmes incl high risk screening
• High specificity and sensitivity of screening
  tools used
• Relatively high prevalence
• Substantial impairment if left untreated
• Existing effective intervention

9
Universal Neonatal Screening

• 1993-NIH recommended universal screening within
  the first 3 months of life using EOAE followed by
  ABR
• Nov 2000-PHA, Australia supported introduction
  of UNHS
• March 2001, Australian Consensus Statement
• JCIH 2000 rescreen high risk 3-6 mo until 3
  years

10
The Next Step

• Minimise other risk factors for impaired
  development
• Environmental modification
• Choice of communication system/language
• Sign
• Oral/auditory
• Total communication
• Educational considerations

11
Educational Factors

• Reduce reverberation
• Minimise background noise
• Background colours, lighting
• Location of seating in class
• Extra support in HSC
• Extra audiovisual aids
• Use gestures, facial expressions

12
Amplification

• Options-
• in/behind the ear, (body style),
• bone conduction
• FM auditory trainers
• Problems in young child- small ear, feedback,
  lack subjective information
• Monitoring

13
Cochlear Implant

• Prof Graeme Clarke, University
• Of Melbourne
• Bypass organ of Corti, directly stimulate the
  cochlear nerve
• Available for children in last 10-15 years
• gt7000 children implanted around the world

14
External Component Cochlear Implant
15
Internal Component of Cochlear Implant
16
Who Should Be Implanted?

• Children with inadequate benefit from hearing
  aids
• Less than 2 years age
• Deteriorating hearing

17
Outcomes With Implant

• Better outcome if implanted at younger age
• Time course for development of auditory
  perception may take many years
• Factors (ODonoghue, 2000) Age implantation,
  number of electrodes inserted, origin of
  deafness, mode of communication, social class
• ?Residual hearing

18
Outcomes With Implant

• After 3 years-100 using the implant
• Significantly better speech perception (c/w
  hearing aid use)
• Educational shift towards mainstream schooling
• Upper limits are not known

19
(No Transcript)
20
Deaf

• NSW Association for the Deaf, all deaf children
  should have access to Auslan as a first language
• Bilingualism
• Different use of gestures/space
• Resources

21
(No Transcript)
22
Deaf

• Deaf community-unique language, Auslan
• Australian Association Deaf-disadvantaged
  linguistic minority group
• Melbourne University, Renwick University,
  Griffith University

23
Historical Perspectives

• Congenitally deaf regarded as stupid for
  thousands of years
• 1755, School in Paris
• Early 19th century, American Asylum for the deaf,
  Hertford Connecticut
• Gallaudet College- 1864, Washington
• International Congress of educators of the Deaf,
  Milan 1880

24
Gallaudet University
25
Conclusion

• Congenital deafness, relative high frequency
• Choices
• Early detection vital for language development
• Choice of language, ultimately by parents
• Desired outcome is normal language development