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Click to edit Master subtitle style PRESENTED BY : DR. PRIYANJAL GAUTAM PG- 2nd Yr. (M.S. - E.N.T.) NIMS MEDICAL COLLEGE & HOSPITAL, JAIPUR
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INTRODUCTION
In developed countries routine screening of newborn child for hearing impairment is a norm. But in developing countries, it is usually the parents who suspect hearing impairment & bring child to the physician. Early diagnosis & timely intervention gives best result in rehabilitating such children.
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Speech & hearing are inter-related. For normal speech child must hears sounds. Later child understands the sounds of the words & intimates the words & talks.
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(i) Michel aplasia : Complete failure of inner ear development. (ii) Mondini aplasia : Cochlea has 1 turns instead of 2 turns.
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Causes of permanent childhood hearing impairment : (A) Congenital disorders: (i) Genetic- Syndromic recessive dominant Nonsyndromic Mitochondrial
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Chronic
Mumps
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AIDS
An illness/condition requiring admission of 48hrs or greater to a NICU Auditory neuropathy/dys-synchrony. Stigmata associated with a syndrome known to include a sensorineural or conductive hearing loss. Family H/O early childhood deafness.
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Otitis media with effusion (OME) Passive smoking Bottle feeding URTI Admission to NICU as a newborn Day care Siblings having had OME
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HISTORY : A thorough history taking from parents of suspected deaf child is very important. Eg. H/O Attack of Measles, Herpes, Syphilis etc. to mother during early part of pregnancy is important. Body wt. below 1.5 kg at birth, H/O drug taken during pregnancy is important.
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Moros Reflex : Stimulation of the sleeping baby with a loud sound produces startle response in a normal child. Auriculo palpebral response : Stimulation of the child with loud sound produces closure of palpebral fissures in a normal hearing children.
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(i)
NEWBORN HEARING SCREENING: Tests used for newborn hearing screening are -:
Automated otoacoustic emissions (AOAE) Transient evoked otoacoustic emissions (TEOAE) Distortion product otoacoustic emissions (DPOAE)
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These are low intensity acoustic signals emitted by mechanical contraction of outer hair cells of the cochlea either spontaneously or in response to acoustic stimulus. Otoacoustic emissions are recorded with a sensitive, low noise microphone that is placed in the sealed external ear canal.
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These are typically presented as an amplitude/time plot of acoustic waveform recorded from the ear canal.
These are generated in the cochlea in response to 2 simultaneous pure-tone stimuli. This tonal response is not present in the eliciting stimuli & therefore referred to as distortion.
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Electrophysiological testing (0-6 months) Behavioural observation audiometry (0-6 month) The distraction test (6-18 months) Visual reinforcement audiometry (6-36 months)
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(A)
(A)
(A)
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BERA
BERA stands for Brain Stem Evoked Response Audiometry. It is an important clinical tool & more standard parameter in the diagnosis of hearing problems.
It is an accurate measure of auditory function & measures the electrical activity in 8/18/12 auditory pathways. the
Uses of BERA :
1.
Detection of deafness in the difficult-to-test patients like infants, mentally retarded or malingering subjects. Assessment of nature of deafness whether conductive or sensory or neural. Identification of the site of lesion in retrocochlear pathologies.
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1.
1.
Principle of BERA :
v
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Pathway : Sound Spiral ganglion (cochlea) Ventral & Dorsal cochlear nuclei (brainstem) Superior Olivary complex (midbrain) Lateral Lemniscus (midbrain)
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BERA MACHINE
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Sound stimulus nearly 60 dB above threshold is given to patient via headphones which deliveres a broad band click sound of 100 micro sec. (0.1 milli sec.) duration. The click sound is fed into the ear to be tested by a headphone and the contralateral ear is masked. A series of rapid sounds provide a stimulus & events are recorded during the 1st 10 milli sec. following the sound stimulus.
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Each of these waves represents a neuroelecritical activity generated by the neural generators at some site in the auditory pathway in b/w the cochlea & the brainstem. SITE OF NEURAL
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A normal BERA recording has 5 prominent peaks & 2 small peaks. These peaks are BERA potentials & since they have troughs & crests, they are known as BERA waves. Each wave give information about a specific segment of the auditory pathway from the cochlea to the brainstem region.
Wave 5th :
It is to be identified before all the other waves. It is most reliable & easily identifiable wave in BERA tracing. The hallmark of 5th wave is that there is a sharp negative deflection (downward) imediating following the peak.
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Wave 4th :
It is identified as a peak just preceding wave 5th. So, once 5th wave is identified, it is not difficult to recognize wave 4th.
Wave 3rd :
It is the wave preceding wave 4th. So, once wave 4th has been recognized wave 3rd is identified as upward peak b/w wave 2nd & 4th at or beyond 3 milli sec. mark on the graph. 8/18/12
Wave 2nd :
It is the peak immediately preceding the wave 3rd. This wave has a latency of appox. 2 milisec. & hence it is difficult to identify. So, it should be looked for at or just beyond 2 milisec. mark on BERA graph.
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Wave 1st :
It has to be recognized properly because it give an idea whether the stimulus has crossed over from the cochlea & the distal auditory nerve. If wave 1st is present & other waves 2nd, 3rd, 4th & 5th are absent, it suggest that the stimulus has reached the cochlea well enough but not able to proceed further. This means there is retrocochlear pathology.
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In case of newborns the graph has 3 peaks (instead of 5 to 7 peaks in adults) & wave 2nd & 4th are absent. Moreover the graph in newborns has a larger wave 1st & much smaller wave 5th than in adults.
Note: Other pathological conditions which alters the morphology of the graph includes- Acoustic 8/18/12 neuromas, on which the time interval b/w peak
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BIBILOGRAPHY
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THANK
YOU !
DR. S. P. SRIVASTAVA (Prof. & HOD) DR. AMIT MODWAL (Assoc. Prof.) DR. PRADEEP SHARMA (Assoc. Prof.) DR. RAKESH SABOO (Asst. Prof.) GURLEEN KAUR (P.G. 2nd Yr.)
DR. 8/18/12