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[Diagnosis of juvenile hearing disorders].

Disordered hearing in childhood has a major negative effect on the entire development, in particular the development of speech. Thus, early detection and proper assessment of a hearing impairment is of considerable importance. Only adequate diagnostic information makes it possible to initiate the necessary corrective measures without delay. The diagnostic possibilities for detecting and differentiating hearing impairments are discussed. The general need to perform a hearing test at the age of six and seven months, and the performance of hearing tests designed for the newborn who are at risk, are emphasized.

Audiometry

[Rehabilitation of patients with hearing disorders using hearing aids and tactical hearing measures].

After a brief summary of the problems of rehabilitation of hearing-impaired subjects, the optimal conditions for rehabilitation with hearing aids are presented: a) The right timing is crucial. b) Optimal provision of hearing aids must be carried out in close co-operation between the patient, the hearing aid technician and the otolaryngologist. c) Easy handling of the hearing aid and the use of attachments must be guaranteed. d) The hearing-impaired person must be fully informed as to the extent and type of hearing loss. He/she must accept the affliction and know about the possibilities of rehabilitation. The patient's motivation is a pre-requisite for all further steps. e) The patients must learn tactical measures to make optimal use of their hearing ability in relation to their environment. Hearing tactics consist of hearing training and a change in the attitude of the hearing-impaired patients themselves and their attitude towards their surroundings.

Auditory Perception

[Juvenile psychogenic hearing disorders].

Psychogenic hearing problems exist even in childhood. They must be differentiated from the stimulated or aggravated hearing losses. A characteristic is the discrepancy between the understanding during conversation and the bad results of the hearing tests. The psychical case history of the patient shows his conflict-situation and personal problems. If the psychogenic hearing problems do not improve on their own or by means of oto-rhinolaryngical placebo-therapy, psycho-therapy will be needed. Taking the example of 2 children, where the suspected primary diagnosis was sudden deafness, the problems of diagnosis was shown.

Adolescent

[The status of psychogenic hearing disorder today].

The general symptoms of psychogenic hearing disorders are pointed out and exemplified by 16 own cases seen by the author in 1987 to 1988. Psychogenic hearing disorders imitate various constellations of findings and histories of genuine organic hearing disorders. The individual's experience and the contemporary consciousness of hearing disorders seem to enter into the individual manifestation. The 16 cases can clearly be divided into 3 groups of equal size: 1. The unilateral acute hearing loss, imitating either an acute traumatic damage or an idiopathic sudden hearing loss. This was seen almost exclusively in children. 2. The bilateral chronic hearing loss. This, too, was seen mainly in children and youths. 3. The acute bilateral recurring or progressing hearing disorder. This was seen predominantly in adults, mimicking dramatic courses ending up in bilateral profound deafness. In part of the cases the psychological background of the neurotic reaction could be explored quite easily. Knowledge of the various manifestations of psychogenic hearing disorders is important, because otherwise, as the reported cases demonstrate, misleading interpretation of findings entails costly diagnostic procedures (computerized tomography, arteriography) and expensive therapeutic measures (hospitalization, fitting of hearing aids).

Adolescent

Vestibular findings in sensorineural hearing disorders. Results of caloric, oculomotor and hearing tests in 205 patients with unilateral hearing dysfunction.

In 205 patients with unilateral hearing loss, 117 of cochlear and 88 of retrocochlear origin, thorough audiovestibular examinations were performed to establish the occurrence and severity of vestibular dysfunction. The results were also analysed with the aim of determining the relationships between the severity of the hearing loss, the etiology and the topical location of the hearing disorder, on the one hand, and vestibular dysfunction, recorded as reduced caloric sensitivity and occurrence of oculomotor disturbances, on the other. No correlation was found between severity of hearing loss and recordable vestibular dysfunction, in either the cochlear or retrocochlear group of patients, or in the etiological subgroups of these main groups. With respect to the relations between the topic locations of the lesions and the results of vestibular tests, distinct characteristics were observed. In the affected ears, totally extinguished caloric reactions were more than six times as frequent in the retrocochlear group as in the cochlear group and appeared as a specific but rather insensitive sign of acoustic neurinoma. Oculomotor disturbances were only exceptionally observed in patients with cochlear lesions, but were noted in nearly half of the retrocochlear group; when only those patients with lesions of the brain stem or cerebellum were considered, all were found to exhibit such disturbances. The relations between audiometric hearing test pattern, caloric sensitivity and oculomotor disturbances seem to form interesting diagnostic paradigms of great value for the topical localization of audiovestibular disorders.

Auditory Pathways

Screening for neonatal hearing disorders in the Province of Central Finland.

Screening for congenital hearing disorders in newborn infants has been carried out in the Province of Central Finland since 1967. In 1967-1971, a total of 23 children (12 boys and 11 girls) were found to have congenital hearind disorders. From this it can be calculated that 90 infants are born each year with congenital hearing disorders in Finland. Our sample did not include slight or moderate hearing disorders (under 45 dB). 11 children under the age of 18 months were provided with a hearing aid. In spite of the screening, 12 cases (mean age 2 years) were not diagnosed until they came to the phoniatric clinic because of delayed speech development. These children were presumably also congenitally deaf. Most of the children in the delayed group reacted favourably to the auropalpebral reflex test on the obstetrical ward; their speech development was better and they also profited more from having a hearing aid than those children whose hearing defect had been discovered earlier. Screening for hearing disorders should be made nation-wide in order to avoid the harmful effects of the delay of rehabilitation on the child's development. The possibility of a hearing disorder should be kept in mind in those cases where there is a delay in speech development and also in those cases where the child has some other severe congenital defect which demands the attention of the nursing staff.

Child, Preschool

Auditory perceptual problems in non-organic hearing disorder.

A series of 22 patients who presented with non-organic hearing disorder were examined for auditory perceptual problems. A test battery that examined eight areas of auditory perception revealed significant auditory perceptual problems in each of the 22 patients. The results indicate a view that differs from the traditional view of non-organic hearing disorder as either conscious feigning of a hearing disorder or an unconscious symptom of an unidentified emotional disorder. The information presented here indicates that specific auditory processing disorders could adversely affect patients' hearing and that auditory perceptual disorders could be diagnosed and treated.

Adolescent

[Treatment and rehabilitation in juvenile hearing disorders].

The early fitting of a hearing aid to a child with a proven hearing disorder is decisive for the further development of the child. Depending upon the age of the child, the fitting of a hearing aid requires a variety of strategies, and differs considerably from aid fitting in adulthood. It is more difficult, requires more time, and needs a lot of patience and experience. The individual steps and procedures for fitting an aid are described, and the possibilities of rehabilitation of a child with such a hearing impairment are discussed. Apart from the optimal provision of a hearing aid, the child requires intensive early and long-term aftercare to ensure normal speech and normal development.

Child

Psychoacoustic and electrophysiologic correlates of central hearing disorders in man.

Evaluation of central hearing disorders in neuropsychologic patients is handicapped by their insufficient ability to describe auditory deficits and by the lack of easily applicable audiological tests. A novel psychoacoustic discrimination test (PDT) was developed to determine ear asymmetries in the discrimination of changes in intensity, frequency, or temporal structure of regularly presented dichotic stimuli. In 19 of 21 patients with lesions of the auditory cortex or the acoustic radiation according to CT scan evaluation a higher error score was observed for target stimuli presented at the ear contralateral to the side of brain infarction (6 right, 15 left). In the remaining 2 and in 3 other patients with lesions sparing auditory structures no significant ear asymmetries were seen. This may indicate that auditory perception is reduced in patients with only one intact auditory cortex or one intact acoustic radiation, possibly because of a limitation in information processing capacity. Auditory evoked potential results are presented for a normal subject and two patients to illustrate electrophysiologic correlates of central hearing disorders. Using a transformation of scalp into dipole source activity (Scherg and von Cramon 1986), a unilateral loss of middle latency activity was found in case A, who had a lesion of the left acoustic radiation. The extended lesion of the right auditory cortex in case B resulted in a loss of both middle and late latency dipole source potentials of the right temporal lobe. In both cases a corresponding increase in the PDT error score on the contralateral ear was found.

Adult

[A diagnostic problem: hearing disorder in childhood].

Hearing losses of different etiology can impair the individual development during the entire childhood. Especially moderate hearing losses are difficult to diagnose because they rather present as speech or learning disorders. From the paedaudiologist's view methods are printed out for an early detection of hearing loss during childhood.

Acoustic Impedance Tests

Hearing disorders in children with fetal alcohol syndrome: findings from case reports.

Fourteen children with the fetal alcohol syndrome were evaluated by standard audiologic procedures. Thirteen of the 14 children had childhood histories of hearing disorders. All 13 of these children (93%) had clinically significant histories of bilateral recurrent serous otitis media (ie, they were otitis prone), and at least four children (29%) had bilateral sensorineural hearing losses in addition to being otitis prone. Many of the children with recurrent serous otitis media required repeated myringotomies with placement of ventilation tubes, and those with sensorineural hearing losses required sound amplification during childhood. Recurrent respiratory infections (secondary to immune deficiencies) and eustachian tube dysfunction (secondary to embryonic malformations of the first and second branchial arches) are discussed as possible etiologic factors in the presence of the recurrent serous otitis media. An alcohol-induced neuroectoderm syndrome and alcohol ototoxicity are discussed as possible etiologic factors in the occurrence of sensorineural hearing loss. The findings suggest that hearing disorders are a heretofore unrecognized characteristic of the fetal alcohol syndrome. Such hearing disorders may contribute to the speech and language and learning difficulties seen in children with fetal alcohol syndrome. The present study also provided confirmatory evidence of visual, health, and speech and language disorders in children with this syndrome.

Child

[Hearing disorders associated with vision disorders in children].

Hearing and eye-sight are very important for the development in children. Early diagnosis of disorders of these organs is therefore essential to ensure the development of affected children from early age, or to provide a correction (hearing aid, glasses) or to enlist these children in special schools. The authors found that in schools for children with impaired eye-sight and schools for children with impaired hearing there were 6.7% children with impairment of both sense organs. The most frequent cause of disorders of both sense organs was intrauterine damage (45.7%), in 25.7% of the investigated children the cause was unknown, in 20% it was genetically conditioned and in 8.6% the cause was postnatal. Therefore when a disorder of one sense organ is revealed, it is necessary to examine on a preventive basis also the other sense organ.

Child

[Quantitative evaluation of hearing disorders in expert assessment. A recent recommendation for calculating the percentage of hearing loss].

A short historical survey is given of grading the severity of hearing disorders and assessing the relevant disability for recompensation purposes according to the tables of Boenninghaus, Röser, and Feldmann. The present situation and the reasons giving rise to dissatisfaction with this procedure are analysed. They are the high threshold of 20% disability for recompensation, the rigidity of the tables, and the technical development of speech audiometry without concomitant adaptation of the tables. The following possible solutions are discussed and rejected: changing the tables, substituting speech audiometry by tone audiometry, speech audiometry with interfering noise, filtered speech audiometry, special bonus for recruitment. The following feasible solution is proposed: Retaining all tables in use up to this time, however, instead of using the sum of discrimination scores which simply adds the scores at 60, 80 and 100 dB SRL, weighting factors are introduced according to the formula [3 x (% at 60 dB) + 2 x (% at 80 dB) + 1 x (% at 100 dB)]: 2 The advantages and the effect of this procedure on calculating hearing loss and disability are discussed.

Audiometry, Pure-Tone