Speech delayed due to

sensorineural hearing loss

Presented by Agatha Qyara Annabella
 Riwayat
Riwayat CHAT : Checklist for
Infeksi rubella Tumbuh
kehamilan Autism in Toddlers
Kembang
ACRS : Abbreviated
Riwayat Conners Rating Scale
Lahir prematur Developmental KMME : Kuesioner
kelahiran Anak Milestone Masalah Mental
perempuan
usia 4 tahun Emosional
Menonton TV Kemampuan
jarak dekat Riwayat
berkomunikasi
Mencondongkan kebiasaan
badan ke arah TV dan bahasa KMME

Anak tidak perhatian, Screening

Screening tidak peduli saat peyimpangan CHAT
Tes Tes
Daya kemampuan dipanggil, sulit mengikuti mental
Daya
Lihat mendengar instruksi sederhana emosional
Dengar
ACRS
 Speech delayed due to ASD (Autism Spectrum ADHD (Attention Deficit
sensorineural hearing loss Disorder) Hyperactivity Disorders)

Anak perempuan usia 4

+ +/- +
tahun
Bicara lancar, sulit
+ + +
dipahami
Keterlambatan bicara + + +
Riwayat kehamilan :
pernah terinfeksi rubella + +/- -

Riwayat kelahiran:
+/- +/- +/-
prematur
Anak tidak perhatian + + +
Tidak peduli jika dipanggil + + +
Sulit mengikuti instruksi
+ + +/-
sederhana
Mencondongkan badan ke
+ - -
depan saat menonton TV
Menonton TV dalam jarak
+ - -
dekat
 Supporting Data
Vital Sign Physical Examination Echocardiogaphy
Blood pressure : 90/60 mmHg Head circumference : 44 cm Small patent ductus arteriosus
Pulse : 100x/min (microcephaly)
Cataract (+)
Respiratory rate : 28x/min Birth history
Temperature : 37°C Premature (34 weeks)
Anthropometric Audiometry test
Low birth weight (1200 g)
Bilateral sensorineural hearing
Weight : 15 kg Birth height (38 cm)
loss
Height : 100 cm
Age : 4 years old Pregnancy history
Laboratory test
Rubella infection at 14 weeks of
Trombositopenia
gestation
Definition
• Language is the expression of human communication through which ideas, information, emotions, and
beliefs can be shared. Language is the use of systematic, arbitrary, and socially agreed upon signals (words
and sentences) to convey meaning within a group or community
• Language includes receptive language (understanding) and expressive language (the ability to convey
information, feelings, thoughts, and ideas).

• Speech is a manifestation of language that uses decodable vocal sounds as the medium of exchange. Speech
is created by a series of complex and coordinated movements of the respiratory, laryngeal, velopharyngeal,
and oral systems
• A speech or language delay implies that the child is developing speech or language in the correct sequence
but at a slower rate than expected, whereas a speech or language disorder suggests that the child’s speech
or language ability is qualitatively different from what is typical.

• Children often present initially in the toddler-preschool period with a developmental delay in language or
speech. When delays persist and affect communicative function, they become classified as disorders
Risk Factor
• Significant language delay should not be disregarded because the
child is a boy, second- or third-born in a family, or a member of a
bilingual household.
• Studies show that boys function on average only 1 to 2 months
behind girls in vocabulary and grammar development.
• Potential risk factors for speech and language problems include male
gender, family history of speech or language impairment, lower levels
of parental education, and various perinatal risk factors (eg,
prematurity, birth difficulties, and low birthweight)
Factors potentially contributing to late referral
before diagnosis
Factors potentially contributing to late referral
after diagnosis
Demographics factors potentially contributing to
late referral
• Pre natal hearing loss
- During the embryological period, the auditory system is reported to be particularly
vulnerable to toxic and teratogenic agents: ototoxic drugs (i.e., aminoglycosides,
chemioterapics) used during gestation or drugs/alcohol abuse can be responsible of inner
ear alterations, such as mother metabolic disorders (i.e., renal or liver failure, diabetes
mellitus)
- In particular, fetal alcohol syndrome is a consequence of the alcohol teratogenic effect
during pregnancy, and it is characterized by a growth defect, typical facies, microcephaly,
skeletal anomalies, mild-moderate mental retardation, behavioral anomalies, congenital
heart condition, and hearing loss also ototoxicity occurs due to cochlear hair cells and
irreversible death; it may also become evident in case of low hematic drug concentration
and short therapies for a particular genetic predisposition (a mitochondrial DNA
mutation)
- Furthermore, ototoxicity increases when other drugs are used in association. Also,
gestational infections represent a pre-natal cause of congenital hearing impairment; in
particular, CMV infection can be responsible also for late onset of sensorineural hearing
loss (SNHL)
• Peri and post natal hearing loss
- Among peri and post natal conditions at risk for neonatal hearing loss,
NICU (Neonatal Intensive Care Unit) hospitalization ≥ 5 days plays an
important role, as it is reported to increase hearing loss incidence by about
5-10 times, if compared with general newborn population. It may be
related not only to NICU equipment environmental noise but also to
therapies used, such as ototoxic drugs, or mechanical ventilation for more
than 5 days.
- Prematurity is not reported to be a risk factor itself, but the association of
several risk factors may represent a predisposition to develop hearing
impairment: very low birth weight (< 1500 g), peri natal asphyxia, jaundice.
- Numerous congenital infections have been linked to hearing loss, mono or
bilateral, sometimes progressive. Viral infections, such as varicella, herpes,
influenza, and mumps, may be responsible for SNHL as much as a bacterial
meningitis (Streptococcus pneumoniae, Neisseria meningitidis).
- The most frequent congenital infection is CMV, as vaccines have reduced the
incidence of rubella, mumps, and measles. Congenital CMV infection prevalence
is estimated in about 0.64% children at birth. It can be a primary or a recurrent
infection; only 10% of infected children are symptomatic at birth, and hearing loss
may be present in about half of the cases.
- Trauma represents another acquired post-natal etiology of hearing loss; generally,
a post-traumatic labyrinth damage can be responsible of a monolateral
conductive, sensorineural, or mixed hearing defect.
- However, about 60% of congenital hearing loss is genetic and it can be syndromic
(30% of cases) or non-syndromic (70% of cases
CLASSIFICATION
Clinical Presentation
 In addition, a
delay greater by
16 to 24 months of
age is considered
significant.

For example, a 24-

month-old child
who functions as a
typical 18-month-
old can be
considered to have
a clinically
significant
language delay.

Clinicians should
not wait until
children are 3
years of age or
older to evaluate
delayed language
or speech.
Kebiasaan anak dengan gangguan
pendengaran
• Kesulitan untuk merespon pembicaraan dan stimulasi auditori lainnya
• Sering meminta pengulangan
• Cepat lelah saat mendengarkan
• Memberikan jawaban yang tidak sesuai untuk pertanyaan sederhana
• Tampak terisolasi dari teman sebaya
• Memiliki kesulitan membaca
• Memiliki kesulitan untuk bicara dan menulis
• Mudah frustasi
Management
• Within the first 2 years, neuroplasticity increases rapidly and continues
until the age of 3 to 4 years. As a consequence of a cochlear damage during
infancy (and, above all, during the first 6 to 8 months), the development of
auditory pathways and cortical areas can be impaired.
• If an adequate auditory stimulation is restored (i.e., by hearing aids, to
rehabilitate a moderate-severe hearing loss), a reactivation of the neural
synaptic connections may be possible, ensuring a regular auditory pathway
development. Hence, the early identification of hearing impairment in
children and in particular within the first 3 months of life, is really
important in order to set the proper and earliest therapeutical-
rehabilitative plan.
• If hearing loss is not recognized and corrected, it has been reported that
scholastic learning and social activities may also be compromised, as well
as emotional and psychological development.
 Hearing Assistive Technology
• Hearing Aids
- The function of hearing aids is to provide the user with an audible
broad frequency range of speech at various input levels (soft, average,
and loud), and to ensure that loud inputs to the hearing aid are
comfortable for the user.
- For children with bilateral hearing loss, regardless of the symmetry of
loss between ears, the American Academy of Audiology recommends
bilateral hearing aids
- Audiologic appointments following hearing aid fittings be conducted
every 3 months during the first 2 years of amplification use.
In addition to monitoring
auditory status and
development, these
frequent appointments are
important for young
children because earmolds
must be replaced often
because of rapid ear canal
size growth during early
life.
Hearing Assistive Technology
• Remote microphone technology
- This technology requires a microphone to be placed close to the
target speaker’s mouth (eg, teacher, therapist, parent), where the
decibel level of the speech is well above that of the interfering noise.
- All children who wear hearing aids are candidates for remote
microphone technologies
Hearing Assistive Technology
• Cochlear implants
- Hearing aids provide significant benefit to those with mild to severe
hearing loss who have good speech perception ability
- Only children with severe-to-profound hearing loss were
eligible for cochlear implantation, some children with lesser degrees of
hearing loss might now be eligible depending on their auditory progress
with hearing aids alone
- When being considered for implantation, children should maintain full-
time hearing aid use, even after their child’s auditory progress has been
deemed “inadequate” with hearing aids alone.
Activities to Encourage Speech and Language
Development
Birth to 2 years
• Say sound like "ma," "da," and "ba." Try to get your baby to say them back to you.
• Look at your baby when he makes sounds. Talk back to him, and say what he says. Pretend to have a conversation.
• Respond when your baby laughs or makes faces. Make the same faces back to her.
• Teach your baby to do what you do, like clapping your hands and playing peek-a-boo.
• Talk to your baby as you give him a bath, feed him, and get him dressed. Talk about what you are doing and where you are going.
Tell him who or what you will see.
• Point out colors and shapes.
• Count what you see.
• Use gestures, like waving and pointing.
• Talk about animal sounds. This helps your baby connect the sound and the animal. Use words like "The dog says woof-woof."
• Add on to what your baby says. When your baby says, "Mama," say, "Here is Mama. Mama loves you. Where is baby? Here is
baby."
• Read to your child. You don't have to read every word, but talk about the pictures. Choose books that are sturdy and have large
colorful pictures. Ask your child, "What's this?" and try to get him to point to or name objects.
Activities to Encourage Speech and Language
Development
2 to 4 years
• Speak clearly to your child. Model good speech.
• Repeat what your child says to show that you understand. Add on to what she says. Use words like, "Want juice? I have juice. I have apple
juice. Do you want apple juice?"
• It's okay to use baby talk sometimes. Be sure to use the adult word too. For example, "It is time for din-din. We will have dinner now."
• Cut out pictures of favorite or familiar things. Put them into categories, like things to ride on, things to eat, and things to play with.
Make silly pictures by mixing and matching pictures. Glue a picture of a dog behind the wheel of a car. Talk about what is wrong with the
picture and ways to "fix" it.
• Help your child understand and ask questions. Play the yes–no game. Ask questions such as, "Are you Marty?" and "Can a pig
fly?" Have your child make up questions and try to fool you.
• Ask questions that include a choice. "Do you want an apple or an orange?" "Do you want to wear your red shirt or your blue shirt?"
• Help your child learn new words. Name body parts, and talk about what you do with them. "This is my nose. I can smell flowers, brownies,
and soap."
• Sing simple songs, and say nursery rhymes. This helps your child learn the rhythm of speech.
• Place familiar objects in a box. Have your child take one out and tell you its name and how to use it. "This is my ball. I bounce it. I play with
it."
• Show pictures of familiar people and places. Talk about who they are and what happened. Try making up new stories.
Activities to Encourage Speech and Language
Development
4 to 6 years
• Pay attention when your child talks to you.
• Get your child's attention before you talk.
• Praise your child when she tells you something. Show that you understand her words.
• Pause after speaking. This gives your child a chance to respond.
• Keep helping your child learn new words. Say a new word, and tell him what it means, or use it in a way that helps him understand. For example, you can use the word "vehicle"
instead of "car." You can say, "I think I will drive the vehicle to the store. I am too tired to walk."
• Talk about where things are, using words like "first," "middle," and "last" or "right" and "left." Talk about opposites like "up" and "down" or "on" and "off."
• Have your child guess what you describe. Say, "We use it to sweep the floor," and have her find the broom. Say, "It is cold, sweet, and good for dessert. I like strawberry" so she
can guess "ice cream."
• Work on groups of items, or categories. Find the thing that does not belong in a group. For example, "A shoe does not go with an apple and an orange because you can't eat it. It
is not round. It is not a fruit."
• Help your child follow two- and three-step directions. Use words like, "Go to your room, and bring me your book."
• Ask your child to give directions. Follow his directions as he tells you how to build a tower of blocks.
• Play games with your child such as "house." Let her be the parent, and you pretend to be the child. Talk about the different rooms and furniture in the house.
• Watch movies together on TV or a tablet. Talk about what your child is watching. Have her guess what might happen next. Talk about the characters. Are they happy or sad?
Ask her to tell you what happened in the story. Act out a scene together, or make up a different ending.
• Use everyday tasks to learn language. For example, talk about the foods on the menu and their color, texture, and taste when in the kitchen. Talk about where to put things.
Ask her to put the napkin on the table, in your lap, or under the spoon. Talk about who the napkin belongs to. Say, "It is my napkin." "It is Daddy's." "It is Tamara's."
• Go grocery shopping together. Talk about what you will buy, how many things you need, and what you will make. Talk about sizes, shapes, and weight.
Prognosis
• Language and speech delays and disorders, treated early and
appropriately, generally improve over time.
• The final prognosis is a function of the nature and severity of the
underlying disorder.
• However, some children whose isolated language and speech delays at
ages 3 or 4 years apparently resolved show difficulties in reading.
• Reading is a language-based skill that requires the child to appreciate the
subtle differences among speech sounds and link them to written symbols.
• Children who have reading disorders are likely to have difficulties
manipulating speech sounds, such as subtracting a syllable or sound from a
word (e.g, subtractthe “sky” from “skyscraper”or the “b” from “birthday”).