Mia Gavriloska, special education teacher, master's degree in clinical psychology: Impaired hearing in children (impaired part of sensory development)

Mia Gavriloska/ Photo: Private archive / Flickr

Early intervention of children born with a risk factor is a series of necessary investigations and treatments (medical, psychological, educational, social) aimed at children who show any degree of delay in their development or belong to a risk group of children and at the same time meeting their needs. Timely prevention and intervention (if possible) during the woman's pregnancy, after the birth of the child and after discharge from the neonatal intensive care unit.

There are different t. n. models for intervening in term and premature children. The results of the application of the intervention programs for the motor development of the child show greater efficiency if the parents are also involved in it and are implemented in the first months in the home where the child lives. When implementing and evaluating the early intervention program, it is necessary to identify all the peculiarities of the child, but at the same time to use all the available potentials of the child himself, as well as the members of the family and the local community.

Offices for early psychomotor stimulation at the Rehabilitation Center should continuously promote the needs of implementing early intervention in children with neurodevelopmental risks, support from the whole family and the necessity to establish early intervention in all local communities (including small living areas). .

It is important to emphasize that there is early, continuous and comprehensive treatment. Early intervention is carried out by a team consisting of various profiles of professionals with appropriate education, competence and experience. The duty of each of them should be well defined and coordinated. The team is composed of a pediatrician, a child neurologist, a speech therapist, a special education teacher, a physiotherapist, a psychologist, in other words, an interdisciplinary and multidisciplinary approach to treatment.

Early intervention also involves hiring various services and support such as - family therapy service, counseling, home visit, health service for diagnosis, monitoring and evaluation, nutritional service, psychological and social work service... Every child does not need all of the above t. n. services.

An important segment to emphasize is to start the therapy as early as possible for better results or in the first three years of the child's birth. It is often implemented in three stages... the first two years from birth where the program is implemented in the child's home, on a weekly basis. From the second to the third year are transitional programs, and then preparation for the school program (early counseling, identification, recreation, health monitoring, special education...).

The purpose of early intervention is to stimulate the sensorimotor, emotional, social and intellectual development of the child, thus providing him with active and successful independence and entry into social life. The first five years are extremely important for the implementation of treatment, especially for children with developmental difficulties. During this period the brain has an exceptional ability to change and adapt experiences and stimuli.

Among other possible neurorisk and neurodevelopmental deviations in children is hearing impairment, where of course early prevention in the first months of life is of vital importance. Untreated hearing loss leads to the possibility of impaired speech, so timely screening can enable further normal development of the child. Detection of the risk factor is of great importance. Congenital damage is present from birth, but it can also be inherited or caused by other prenatal or perinatal factors.

Content

Hearing is one of the basic senses that guide us through life. Hearing impairment in children, according to the time when it occurred, can be divided into congenital (born) and acquired (which appeared after birth)

Possible risk factors for hearing impairment

1. Infections during pregnancy (measles, toxoplasmosis, cytomegalovirus)

2. Consumption of ototoxic drugs during pregnancy

3. Complications during childbirth (serious infections such as herpes, rubella, cytomegalovirus) - then it is necessary for the child to be hospitalized in neonatal intensive care

4. A newborn with a low body weight of less than 1,5 kg

5. Medicines prescribed to maintain the respiratory organs in premature babies

6. Disorder of the brain and nervous system

7. Genetic syndrome (Usherov, Downov or Waardenburg syndrome)

8. Data on genetic predisposition

Acquired hearing loss in children - possible causes

1. Untreated middle ear infection

2. Infections such as meningitis, mumps, chicken pox

3. Perforation of the eardrum/membrane

4. Enormously loud noise, fireworks, firecrackers... If the newborn or child is exposed to loud noise for a long period of time, the hearing cells can be irreversibly damaged

5. A disease such as abnormal growth of the eardrums in the middle ear (otosclerosis)

6. Serious head injury

7. Ototoxic drugs (which lead to hearing damage)

8. Unknown cause

Genetic hearing loss

Often hearing loss is genetically predisposed and can be autosomal dominant, autosomal recessive and X-linked.

1. In autosomal dominant hearing loss, one parent carries a dominant gene for hearing loss, which is characteristic for transmissibility in the generation. The possibility that the child will have hearing loss is 50 percent if both parents do not have this dominant gene.

2. In the case of autosomal recessive hearing impairment, even though both parents have normal hearing, they carry recessive genes and, measured in percentage terms, the possibility of passing it on to a child is 25 percent

3. In X-linked hearing loss – the mother carries a recessive predisposition on the sex-determining chromosome and is transmitted to male children

Ototoxic drugs

So-called ototoxic drugs are a major risk factor for deafness, causing damage to the inner ear, auditory nerve, and even the center of hearing and balance. There is already a well-known list of drugs that can impair hearing and are not recommended to be taken during pregnancy but also in children after birth – gentamicin, tobramycin, kanamycin, streptomycin, neomycin, amikacin, then drugs that stimulate urination, and at the same time, aspirin, which is often used for common colds. Often after taking these drugs, poorly developed speech, reduced concentration in the child, unsuccessful daily communication...

Hearing assessment

Tests with which the objective condition of the child can be observed are: subjective assessment of hearing and further tests that require a well-educated staff, but all this depends on the age of the child. The tests include: behavioral audiometry (which can be performed at the earliest in children over 6 months of age), tympanometry (examines the function of the middle ear), tonal audiometry (in children over 4 years and without other impairments), speech audiometry (suitable for 2-4 year olds), otoacoustic emissions (used to see if the cochlea is functional) and auditory evoked potentials or known as the BERA test. It is also carried out at the youngest age in a sedated state, where the responses are registered through an electrode that is placed on the forehead or behind the ear and with the help of special software, 5 waves are obtained as a response. There is no hearing if the response exceeds the threshold of 90 decibels.

If the progress in hearing and speech is not adequate or there is no progress, the implantation of a cochlear implant, which is in the form of an electrode and is surgically placed behind the ear, is recommended.

Connection between hearing and speech

The main link in the development of speech is hearing sounds, as clearly as possible. When the child has rich sound throughout the day, the possibility of understanding the environment and communicating with it is greater. Each period of life has different t. n. listening needs. A primary goal of babies and toddlers is to hear sounds around them. While at school age, directing concentration and direct address become a very important segment. Impaired speech includes - dyslalia, rhinolalia, tahilalia... Impaired language includes - alalia, aphasia, dysphasia... The source of the sound or speech becomes noticeable when the baby sees where they are coming from or who is sending them. It begins to get a complete picture of people, objects and phenomena. The first speech stimuli for the baby are only noises of different intensity, and he begins to understand their meaning by connecting the speech sound and the facial expression of the person from whom the sound is directed. In a child with developmental difficulties – the understanding of these emotional components may be lacking, and at a later stage of development – ​​speech and language begin to develop progressively or not (depending on the hearing impairment).

Conclusion

According to American statistics, every third child in the United States is hearing impaired, and the most common cause is premature birth. This imposes the need, as an early prevention, to perform a hearing test on every newborn baby. Undetected and untreated early hearing loss causes impaired speech, impaired intellectual ability. From this we conclude that the screening test of babies is necessary. However, if there is any doubt, a BERA examination is necessary for the child, for the purpose of objective investigation and prevention for taking further measures.

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