Your doctor speaks II; Hearing Loss in Children

The University of Illinois Medical Center campus in Chicago percents your doctor speaks during this series doctors in the colleges of medicine dentistry pharmacy nursing and graduate college at the university don't I. Well discuss the latest advances in cancer and heart research. Painless dentistry psychiatry nursing care and modern drugs. All of these and more will be presented on your doctor speaks. Your host for this series is Jack Ray gamma quad nater a public service radio and TV programming for the University of Illinois Medical Center campus and champagne Urbana. This is Jack bring our our guests today Dr. Richard Marcus who's associate professor overlearned at the University of Illinois and director there were not the Institute of hearing and speech and Dr. Lewis temptin Sr. Professor learned Golgi universal and I and consult and hearing conservation program for the Chicago public schools. And then we're going to

discuss hearing loss in children. I gave the first question what is hearing loss what is meant by hand lost or deafness you want to call it in young children. Dr. Marcus I think that there should be two answers to that question. There are children who are born with deafness and there are children who after birth acquire a hearing loss or deafness. And if children are born with deafness it means then that they will not be able to speak in the normal fashion unless they receive special help and receive it as early as possible. Children who have been born with normal hearing and develop deafness. I have developed speech in the usual fashion and their problem of course is somewhat different although again the diagnosis should be made as early as possible

and the proper kind of therapy instituted in October. Can you add to this and also let me talk question here before I get into detection. Dr Marcus ended on. Which is more prevalent congenital hearing problems are acquired or can you answer that a difficult question to throw at you. Well I think it would depend a large bit on which segment of the population you're talking about and the the overall percentage of hearing loss is the acquired type that is the type that the person develops during the course of their life. All of this as we go through life will be subjected to the whole influences that will affect hearing the aging process noise levels about us infections injuries. So by far and away the most common cause of hearing loss and the entire population would be the acquired variety and the children in the very

early causes of deafness of course the most common would be the congenital. Now we're talking about the newborn child of course and the infant. Can you. Speaking of diagnosis tell me can you detect a congenital hearing problems in the infant in the first month two months three months or does your id have to wait till the child is a year old. I know these children can be found with a hearing loss shortly after birth. This does not mean to say that it is an easy thing to do but nevertheless there are some tests now available to pick up children who do not hear well within the first month or so after birth. And there are already screening procedures that is to determine those children who do respond to sound within the first few days after birth. I think it should be made clear however for the benefit of our listeners that this is generally not common practice would you say Dr. Michael said it's an

unusual thing to have screening tests for a hearing in every newborn child. That's correct. This is simply to indicate that these things are possible but they certainly are not yet widely used. So we can end this subject and go on to the detection of children who have acquired I have to tell me what how they would get acquired. You know hearing problem which is find some of the problem I have. But I also would like know if some of these hearing problems which are considered in general this could be I assume detected to some degree by the paediatrician. Is this possible. Yes but I think to it to speak further on the subject it ought to be brought out that there are certain so-called high risk groups that is there are children who are born of mothers who have had German measles in the first three months of the pregnancy there are children who develop a severe

jaundice as a result of various types of blood incompatibilities and so on who you will suspect of having a hearing loss and even though perhaps some of these tests may not be available in the first few weeks or months they would be on the highly suspect list and they would be followed and checked at various intervals so that they wouldn't go too long before at some point the final diagnosis would be made. And in this case of course the pediatrician can be extremely helpful because he knows that these children have come from pregnancies where there has been difficulty perhaps also he knows that the delivery has been extremely hazardous that is with a breech birth or perhaps there have to be certain types of. Instruments used during the delivery that might in some way affect the hearing mechanism and therefore on each of these children's records available for this pediatrician would be these facts and he would follow these children trying to find whether there would be any kind of hearing loss.

Once again the emphasis would be on the suspicion of hearing loss and I'm sure we all recognize the fact that simply because a child was born of a parent who perhaps had an illness during pregnancy perhaps German measles or some other influence. This does not necessarily mean that the child will be affected but the preservation are the assumption is that it might. And there are many causes for congenital hearing loss or what we might call birth defect and hearing loss. Heredity is an important influence on children who are born of parents who themselves have a hearing loss are more apt to be born with a hearing loss. We should also make it clear that deafness does that does not necessarily mean that the patient or the child or the adult is incapable of hearing any sound at all but that deafness is a relative. A relative matter one

that is a question of degree that is how much hearing loss is there and also a qualitative factor enters into this what kind of hearing loss is there. We've mentioned that heredity is important influences during the pregnancy that Dr. Marcus alluded to incompatibilities of blood premature birth. Dr. Marcus has been a one of the pioneers I would say in this area of the country in recognizing the thanks of premature birth and the susceptibility of the premature child to the hearing loss. I do know that very good I did know him such and such to exploit people I'm to talk about this big area I know that you're all experts in the learning algebra even more of an expert a double expert double expert and we might say here here. OK now let's get to our let's move on to

some of the acquired problems that you know would cause deafness in children and those especially which might be preventable. And then I want to get into how you detect this and then treatment. Dr. Marcus the acquired causes of deafness generally for the very young child that is say within the early weeks and months after birth various types of ear infections can occur. And some of these children actually may be born with some fluid in the middle ear that is sort of caught in the tympanic cavity. You'd be able to see it through the ear canal but you'd have to look very carefully through the tympanic membrane in order to find it. This would be acquired and would reduce the hearing to a certain extent. This can be treated

also sometimes. The ear drum or ear drum membrane would have to be opened and the fluid removed. If the child is older various types of treatment may be necessary including removal of tonsils and adenoids and also then opening the middle ear cavity to remove the fluid so this kind of hearing loss can be helped. But there are other types of acquired losses that follow up illnesses in children such as measles or mumps. And believe it or not occasionally after chicken pox chorused very rarely but nevertheless there are instances on record where an inner ear hearing loss has occurred following the chicken pox know these types of hearing loss are not reversible that is they are not easily treated. So that you can get any real improvement. In that case of course there are other types of treatment used including the hearing aid

auditory therapy that is training the child how to listen and how to hear the sounds through a hearing aid and subsequently also the development of speech and language. Now that you come in pretty well I kind of lost for words to go on to other areas. How do you detect this other certain type of mind others are this kind of recycling of a certain type of testing procedures that you would use for a child who may be the parent or the pediatricians as they sound like they have a hearing problem now. What procedure would you do. Good points because it is in the true that in the schools public schools here in Chicago they have hearing procedures for children testing procedures. How extensive is that and would they miss hearing problems in the school and wouldn't pick them up and a child might you know go on with this hearing problem.

Well the complicated thing what I want to do John with a take off on this and go oh well we'll just that this around between us for a few minutes then the discovery of hearing loss in a in a child is really no different than discovering the techniques that we use are really no different than discovering some other disorder or malfunction on the child. For example were first interested in a history. Is there something in the history of the child that will lead us to suspect a hearing loss is their inattentiveness is the child some of the withdrawn. Does he make a lot of noise which seems to be somewhat of a paradox but often depending on the type of hearing loss we may find a child being somewhat withdrawn on the other hand we may find other children with different types of hearing loss. Being more outgoing in their activities. The history is important in detecting and hearing loss then would follow of

course an examination of the child. And this is a total examination and appreciation of the general functions body functions vital organ functions as well as the specific function of the hearing apparatus which includes the ear. Central Nervous System Of course the eye and speech. Following this we can then you merge into the realm of special testing including X-rays and hearing tests. The X-rays will indicate to us whether the development of the inner ear with a very fine nerve endings come to meet the small bones of the middle ear whether the you know here has developed well and there are techniques that have been developed to to better identify the structures in the middle ear to determine whether the little vibrating bones of hearing that are present in the middle ear or are well-formed just the X-rays can help

us so far as the hearing tests are concerned. Dr. Marcus can you can you tell us what is available in that area. Well the tests that are used are different for different ages in the very young. Child that Is a child under 2 years of age. We would depend pretty much on what we would call auditory behavior. That is we all know that children young children even newborn babies when a loud sound is made they blink their eyes as they bring their arms up or respond in some fashion to that loud sound. Now in autumn This is a type of auditory behavior that is in response to the sound that's made a child behaves in a certain fashion. We use this kind of response as a means of testing the child under two years of age so that as you test them in a sound proof room for instance and you bring the sound from below the level that he can hear it to the

point at which he hears it he will either look for the sound try to find out where it's coming from that is he tries to localize it in space. And this then is a type of auditory behavior that is a response to the sound and gives us a threshold of hearing. For the children that are older let's say going up two and a half and more. We can then use conditioning tests. That is you can show a child that when he hears a tone in his ear he may take a block that he's holding and drop it into a special canister and he quickly catches on to the game so that in very short order every time he hears the tone he drops the block. And in this fashion two and a half years of age on up to five or six you can get very good threshold of hearing for these children on each ear. It's more difficult of course to get each ear threshold on children under 2 and a half because of the problem of getting earphones on them. Now there are other more specialized tests that are being used but only in certain instances where necessary it is

not necessary to use the specialized tests in many of these cases. For instance there is a so-called psycho galvanic skin test that is you may put a special type of device on the tip of the finger introduces a very slight kind of stimulation before you give the tone into the ear and the child responds then to the tone having been conditioned to it or. We know maybe using electroencephalogram feet using the brain wave test by introducing tones into the ear and now using also the computer. We may read off the many tones that are fed through the ear into the brain and then through the computer as to exactly what the child hears and in this instance of course he doesn't have to give you any response at all that is he doesn't show you any auditory behavior he doesn't have to do anything because the computer does all the work. Now once again I'd like to emphasize that these tests are used only in highly specialized instances when you feel that all the other

tests have not led you to a final conclusion. It was a last resort and I am so not OK it was a back time to have perhaps a refined test because as actor Mike Markus has mentioned the two basic ways we have of testing hearing are the introduction of a sound that is either a tone such as a tuning fork or a means of changing the loudness or intensity of the sound as well as the pitch or frequency of the sound. This is one type of testing we call this the pure tone testing. There is another type of testing and that is in which the spoken word. It must be interpreted by the by the child or the person being examined. Combinations of these tests are available and can indicate to us the not only the extent of the hearing loss but often the nature or type of

hearing loss whether it's primarily in the middle ear the outer ear the inner ear or a combination can be a combination yes a next loss as in where you're speaking there. Dr. Chen to the end of the older child probably one of the really good is just six who can hear these words and can tell you what they are. OK gentlemen we got the diagnostic procedure out of the way and it seems very elaborate and very good. Take a for instance an example I tired to do because there's so many hearing problems but for the sake of our listeners take one and what would you do for treatment. Is there one that's more common I guess there is. I try to put in a spot like that but the early in the program asked what's more common is your more common hearing problem but once again depending upon an age group when a child begins to enter into school these so-called middle ear infections. OK well remember our grandparents speaking about his being the Qatar of the of the middle here. These are

conditions in which fluid accumulates in the middle ear space which normally is filled with air and connect us to the nasal passages. When this fluid enters the middle ear and interferes with the transmission of sound from the air drum into the nerve of hearing by means of the bones in the middle ear then what we do for the dog. Well once again whatever we do for a child will depend upon accurately diagnosing the type of hearing loss and the extent you stress time Australia must be a ninety nine percent of the battle. The diagnosis being aware of the existence of the problem and then defining the type of loss determining through these tests examinations history how much hearing loss is there and more important still rather than how much hearing loss is there how much residual hearing does the child have what hearing what amount of hearing his left. I see Dr. Marcus who'll tell us in a few minutes what what that means

with regard to the child's education and his development speech. I don't think we can overemphasize the importance of accurately diagnosing the type of loss to determine what can be done either medically using medications or surgically means of operations to try to restore hearing of these avenues open if and when the diagnostic procedure has been completed. And you know for sure try not to Marcus. And I mentioned you were going to talk about this other aspect with communications with more than four hours of the trial going procedure in school. Yes you know earlier earlier in the program we were talking about the fact that when we say deafness of course many people think of it but think of it as an absolute and complete loss. And we know of course that there are gradations in hearing loss just as there are

gradations in visual loss. So that you may have a moderate kind of hearing difficulty and you may go on to a very severe kind of hearing difficulty in the child born with a hearing loss. He may have generally speaking a severe loss but still enough hearing remaining so that with amplification that is if you can't have any medical or surgical treatment for it with amplification he can get a great deal out of learning how to hear with his hearing aids. And what we do in general now is to group these children into categories depending on the amount of hearing loss so that we may say that a child is in class one class two three or four and in class 4 we would say that there would be practically no hearing at all. But in the other three classes 1 2 and 3 there is sufficient hearing so that with amplification many of them can do fairly well with intensive auditory therapy language and speech therapy and

with a great amount of parental help so that they understand what to do how to do it and for the very young children that is under too much of this work would have to be done at home there or the parents would have to be told how to proceed how to have the child listen to various sounds that are made in the home a door slamming a telephone ringing and things of that indicating to the child there is the door slamming. There's the telephone going off so the child not being able to hear without his hearing aid learns that these sounds are part of his background. Parents are often interested when to say Dr. Marcus and not so much the diagnosis. Of the hearing loss that is what what caused it. They're somewhat interested in them of course but more importantly there is one question that they seem to to ask so often is what can be done about this. And I would say I'm unequivocal

believe that in every instance of something or just every instance something can be done to improve the situation of the child either medically surgically or in the realm of re-education and rehabilitation. A very hopeful note. Yes we would like at least I would like to emphasize the importance of having the dear doctor follow these children particularly in the very young years because as Dr. Chen has pointed out and we have mentioned here. Many of these children do develop middle ear difficulties and these cannot be determined unless the child is followed regularly and the ears examined. Also if the child is wearing a hearing aid it is up to the doctor really to determine how that your mode is fitting. Whether there is any irritation of the external auditory can now determine also how the child is progressing under the circumstances to do further tests as required and so on.

Thank you gentlemen. Our guests have been Dr. Richard E. Marcus associate professor of otolaryngology University of Illinois and director of the win that the Institute of hearing and speech and Dr. Louis Temple also System professor or to learn going to university and I and consultant hearing conservation program for the Chicago public schools. You have just another in the series your doctor speaks produced by the University of Illinois Medical Center campus in Chicago in cooperation with this station. During this series such topics as cancer and heart research painless dentistry psychiatry nursing care and modern drugs will be presented on your doctor speaks your host for the series is Jack Gray camera coordinator of public service radio and TV programming for the universe their own II Medical Center campus and Champaign Urbana.

Your doctor speaks is produced and directed by Mr. Reagan. This program was distributed by the national educational radio network.