Types of Deafness:
A. Conductive deafness:
It is much more common than any other form of deafness in children and is due to inflammation in the middle ear which has caused either adhesions, distraction of the tympanic membrane or disintegration of the ear by bony disease. Such deafness should be avoidable by proper treatment of ear infections and is sometime open to cure or improvement.
B. Perceptive deafness :
It is the term used to indicate loss of reception or perception of hearing due to a fault in the nervous elements of hearing i.e. in the cerebral cortex.It may be congenital or acquired.The causes of perceptive deafness in newborn are inherited developmental defect,rubella in the mother in the early weeks or pregnancy, kernicterus or anoxaemia at birth. Later on damage to the neural pathways of hearing may result from meningitis, encephalitis, tumor or injury. Certain drugs such as Gentainicin may cause perceptive deafness.
Causes of Deafness :
A. Congenital or neonatal deafness or perceptive deafness:
Malformation of cochlear nerve Malformation of middle or external ear Maternal rubella during first trimester Kernicterus from hyperbilirubinaemia Intracranial birth injury Asphyxia.
B. Acquired deafness :
* Otitis media
* Meningitis - bacterial, tuberculosis
* Encephalitis
* Mumps
* Traumatic
* Neoplastic
* Toxic - streptomycin, neomycin, Gentamycin
Management of a Deaf Child:
Early diagnosis is essential for treatment and the proper development of speech. All babies should therefore be given a screening test for hearing around the age of two to six months. Particular attention to be given to those babies on the 'at risk' register.
Mothers are extremely competent at appreciating the inability of their young children to hear normally. Seldom being wrong unless the child is mentally retarded. Their complaint must therefore be treated very seriously. In understanding the management of the deaf child ,it is vital to appreciate that the normal child has to learn to hear, the first year of life being the most crucial for this. The ability to learn auditory discrimination diminished as the child grows older.
It is therefore obvious that the deal child must be taught to hear as early as possible. Delays cause diminished capacity for hearing the consequent impairment of speech being seen in its most severe form in the deaf mute. Total deafness is exceptional and only 1-2% of deaf children have no hearing at all. All children should therefore have to hear period of auditory training before being regarded as totally deaf.
Parent guidance starts from the day deafness is diagnosed being undertaken by the otologist and by a specialist teacher of the deaf.
For the first 1-2 years of life all the auditory training will be given by the mother who will be taught how to handle her child so as to bring sound to him. She must speak very close to her child's ear, repeating sounds again and again so that can learn auditory discrimination.
A hearing aid should be fitted at the earliest age at which the child will accept it. The aid should be double one since two ears are better than one, and must be worn continuously. It is particularly important that he should be wearing an aid when he starts to crawl since he will no longer be close enough to his mother for full instruction.
The child should be kept in normal environment so that he is able to listen to speech all day long. With auditory training it will be found that his capacity to hear, as measured by audiometry improves. Reading should be taught in order to fill in any gaps in his hearing, but sign language must be discouraged.
A child should he taught in an ordinary school if possible. This can be often achieved by means of a hearing aid and sitting him in the optimal position of class room. If specialized training is required he should be sent to a school for deaf children but outside school hours he ought to be in contact as much as possible with normal children. A child who become deaf alter speech has been acquired should never be educated in a school for deaf children. His problems are very different from those with cong. deafness.
There may he greatest difficulty in differentiating the moderately mentally retarded child from the deaf child for this reason all children, who are sent to a school for the educationally subnormal should have their hearing tested. It should also be remembered that some children react with behavior problems because they, can not hear normally.
To add to the problem some children with behavior problems who have normal hearing may appear not to hear, this also occurs in the psychoses,especially in autism. When the children live in the world of their own. Screening of hearing by "Sweep frequency test". Here the pure tone audiometer is used with the intensity control set at a predetermined level (usually 15 to 20 decibels). The operator sweeps through those frequencies (usually 250 or 500 octave steps to 4000) testing each ear separately.
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