Screening tests are screening tests

Screening tests are screening tests

originally posted on The Pediatric Insider  © 2014 Roy Benaroch, MD

All of these children, who fail the initial screen, need more evaluation to make sure there isn’t something important going on.

Sometimes we do a poor job explaining this to parents. If your child failed our hearing screen, it doesn’t mean he is deaf, or that he even definitely has a hearing problem: It just means he might have a hearing problem, and needs further evaluation. Maybe a retest, or a more-thorough hearing test at an audiologist. The follow-up testing might be normal, and that would be good news.

 

The Pediatric Insider

The Pediatric Insider

© 2014 Roy Benaroch, MD

In pediatrics, almost all of our patients are healthy. We’ve got some doozies of special-needs kids, but by-and-large your ordinary pediatric patient is doing well, and does not need extensive testing or elaborate procedures to ensure good health.

Still, we do run across some occasional problems. Some children have poor vision, or hearing problems, or kidney disease, or hypothyroidism. Or autism, or Tay-Sachs Disease, or a penny up their nose. A whole lot of what we do in our “check ups” are easy, cheap, and quick tests to screen for these and many other problems. Just a taste:

  • We look at height. If Junior is gaining height as expected, he almost certainly doesn’t have hypothyroidism.
  • We look at blood pressure. If it’s normal, kidney disease is less likely.
  • We look in noses. Usually you can see a penny up there.
  • We test…

View original post 467 more words

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School Hearing Tests do not Detect Noise Exposure Hearing Loss

School hearing tests cannot effectively detect adolescent high-frequency hearing loss, which is typically caused by loud noise exposure, according to researchers at Penn State College of Medicine.

The Pennsylvania Department of Health mandates school-administered hearing screens for children in kindergarten to third, seventh and 11th grades.
The school screenings primarily focus on low-frequency hearing loss. This is logical for young children, who are more likely to develop low-frequency hearing loss due to fluid in the ear after a bad cold or an ear infection.

Adolescents, however, are more susceptible to high-frequency hearing loss, usually brought on by exposure to loud noises, but the same tests are used on adolescents and young children.

Deepa Sekhar, assistant professor of pediatrics, compared the results of a special hearing screening designed to detect noise-related high-frequency hearing loss with the results of the standard Pennsylvania school hearing test. The researchers reported their findings in the Journal of Medical Screening.

Both screenings test the ability to hear a tone at a specific loudness. The tone is played at different frequencies, or pitches. The screening for noise-related hearing loss tests the ability to hear higher pitches, up to twice the frequency of the Pennsylvania school screen.

Screening participants were 11th grade students at Hershey High School. Researchers administered both the statewide school screening and a high-frequency screening. Of the 282 participants, five failed the Pennsylvania school test and 85 failed the noise-related test. Of the group of 48 students returned for testing by an audiologist in a soundproof booth, nine were diagnosed with hearing loss.

“More participants failed the initial screening than we predicted,” said Sekhar. “Even with the effort and care put in by school nurses across the state, the current Pennsylvania school screen just isn’t designed to detect high-frequency hearing loss in adolescents.”

One in five adolescents experiences hearing loss, and most of this is high-frequency hearing loss related to continued exposure to noise hazards. Early detection and avoidance of loud noises can prevent hearing loss from progressing.

To efficiently detect adolescent hearing loss, schools across the U.S. may need to consider alternate tests that are better designed to detect noise-related high-frequency hearing loss.

“The results of this study have the potential to reach schools across the nation, as many use screens similar to those used in Pennsylvania schools,” said Sekhar. “We are currently working on a follow-up study at Lebanon High School in partnership with Penn State Nursing to further improve the high-frequency school hearing screen for use in the school.

Other Penn State College of Medicine researchers on the study were Tonya King, professor of biostatistics; Beth Czarnecki, audiologist; Shannon Grounds, audiologist; Ashley Barr, audiologist; and Ian Paul, professor of pediatrics and public health sciences.

Other researchers include Soha Ghossaini, associate professor of otolarynglogy, University of Illinois, Chicago; Thomas Zalewski, Bloomsburg University; Julie Rhoades, Impulse Monitoring, Inc.; and Barry Deese, Summit ENT & Hearing Services.

The Academic Pediatric Association/Maternal and Child Health Bureau Young Investigator Award funded this research.

 SOURCE: http://www.eurekalert.org/pub_releases/2014-03/ps-sht032014.php.

Read More About hearing tests.

Speak ‘N’ Play- Summer Camp at Audicco Speech hearing Center, Vashi, Navi Mumbai

1Summer Camp Special Kids-Audicco Speech Hearing Center, Vashi, Navi Mumbai

 

The Speak’ N’ Play Summer Speech Camp, is an intense speech and language based program by Audicco Gliriaa Speech Hearing Center. Team includes Speech- language therapist, clinical psychologist  and dietitian.

The summer camp is open to children ages 3–12 yrs and is focused on helping children improve socialization with their peers, and learn to self-regulate sensory information through building relationships and fun activities.

Children are divided into small groups according to age and skill level and assigned a speech-language pathologist who organizes activities to help each child make progress toward set goals.

Parents will have interactive session with Dietitian and clinical psychologist on their child’s specific requirements and at the same time they have the opportunity to meet with other parents who are raising children with a speech disorder. The parents share their experiences and discuss techniques that worked and didn’t work for their children.

Seats are limited and our sessions fill up quickly.

Call 9322229159 or Mail Info@audicco.com for FREE SCREENING to determine each child’s needs and their appropriateness for the camp. If your child is accepted, a non-refundable part fee of Rs 2000 will be required to hold the space which will be adjusted in camp fee..

Camp Venue for Summer Camp May 2014

Audicco Gliriaa Speech hearing center

Neoalta Specialty Clinic,

11, Mahavir Center, Sector 17,vashi, Navi Mumbai

Who can attend:

  • Hearing  Loss
  • Autism
  • Downs syndrome
  • Mental retardation
  • Learning Disability

 For Inquiry & free Evaluation prior to camp registration call 9322229159

 

SPEECH THERAPY FOR AUTISM

Post written By Ms Ranjitha R. (Audiologist & Speech Therapist)

Again it is April, and also the ‘Autism Awareness Month‘.  Apart from the pomp and show of the autism awareness day, as a Speech Therapist,  I want people to know that the Children with autism are really amazing kids who go through so much of hardships every day.

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Image Flickr by Heather Katsoulis, Attribution-ShareAlike License

I want them to know that children with autism don’t want you to pity them but to understand just how love and respect are important to make at least a little change in their life.

What I have experienced as a speech pathologist is that Autism is not a disorder of poor IQ or poor thinking capability. Even a child who look severe autistic to the  others may have their senses overflowing and their body is nor cooperating, but they have a mind more competent than we have understood previously.

In my experience of dealing with autism, I have come across so many parents who want their autistic children to excel in academics as their school demands it. Many autistic kids are given academic tasks which are more challenging and uninteresting.

Studies have shown that uninteresting tasks can interfere with learning tasks. I wonder when parents would understand ‘communication’ has to be given priority than ‘academics’.

4846821544_1c694e1ec3_b

Image at Flickr by Lance Neilson Attribution License

In fact I am here to write something about how speech therapy would help autistic kids. Hence let me begin…

Children on ASD have difficulty in communication rather than speech and language problems. It’s difficult for them to use language in a social context and also to understand or read others mind. Hence they fail to make eye contact and to  use gestures and understand body language.

A delay in language development especially expression may the first sign that the parents think the child has a problem and the speech pathologist is one of the first few professionals who would be seeing the child. So it is important from the part of a speech pathologist to take in to account all aspects of communication and social functioning, not just speech and language.

While dealing with non verbal kids the therapists may use visual methods such as picture system, signing, symbols etc. They can also help the child in improving attention, eye contact, play skills, social use of language as well as comprehension and expression.

At the opposite side we have verbal autism, where they have good vocabularies and can talk on topics in great depth and all. In this case also there will be some children who have problem with pronunciation, some with language difficulty, and many also have problems with word and sentence meaning, intonation, and rhythm or content in speaking.

 

For children with autism, speech therapists can provide help with:

Articulation disorders: some children have trouble saying some sounds or words correctly.

•    Fluency disorders: some children repeat some sounds or have trouble saying complete words. Stammering is a common problem seen.

•    Resonance or voice disorders: some children talk in a way which makes it difficult for people to understand them as if they talk through their nose.

•    Language disorders: some children find it very difficult to understand what people are saying to them as they don’t understand the meaning of words.

Children on the autism spectrum may have a difficulty in literal understanding of language or use their own idiosyncratic language. The correct use of pronouns is also often a problem.

New mobile devices can help educators and therapists engage children on the autism spectrum, using the power of edutainment. With recent advances in mobile technology, ipad, iphone,tablet which all fits on the palm — students on the autism spectrum are edutaining themselves and learning.

640px-Minimo

Image credit wikipedia.org

Studies show that this allows kids not only for motivation but also helps in concentration and learning.

Whatever the Speech therapy plan or treatment , keep in mind that Autistic kid need our help to communicate or talk to the world like all of us do and let us get the most out of them by working hand in hand as a team.

Role of ENT (Otolaryngologist) in Autism

Though pediatrician /developmental specialist will often diagnose autism but few kids may visit E.N.T. specialist (otolaryngologist) and we (ENT) should act early to make sure that every autistic child can develop their full potential.

We know now that early intervention results in dramatic improvement in child. That’s why it is important for  ENTs also to know how to diagnose autism spectrum disorder for timely referral.

Autistic-sweetiepie-boy-with-ducksinarow

Image credit wikipedia under GFDL 

Pediatric ENT specialist often come in contact with child with speech delay  to rule out ear or hearing problems and if we are aware of autism red flags and able to identify those warning signs of ASD we can refer child timely.

One step ahead we can be more vigilant for red flags for early signs in as most kids from 3 month to 3 yrs visit ENT clinic for middle ear infection.  

  We should be immediately referring child –

  • -To developmental pediatrician/pediatric neurologist/child psychiatrist for early diagnosis
  • -To speech therapist for speech & language therapy,
  • Occupational therapist/Behavioural Therapist for sensory integration.

Autistic child can have lots of intellectual potential and they are not able to tell us and we can help them achieve their full potential by guiding them in right direction.

During 3 years journey of Audicco Gliriaa Speech Hearing center Vashi, Navi Mumbai and working closely with paediatric audiologist – speech therapist gives me more opportunity to learn more about autism and about struggles of parents of amazing autistic kids.

Also being in close association with paediatrician, developmental paediatrician and pediatric neurologist helps me to act timely.

Help spread the word about Autism. Take developmental milestone quiz-

You can read more at Few Autism Sites and Blogs

Autism Society blog

circle-of-moms

entwellbeing.com.au

autismindia.com

doast.com/understanding-treatment-possibilities-in-autism/

_________________________________________

As per Int J Pediatr Otorhinolaryngol. 2013 May;77(5):629-34. doi: 10.1016/j.ijporl.2013.02.006. Epub 2013 Mar 29. —“ASD patients have a higher incidence of profound sensorineural hearing loss, middle ear infections, and abnormalities of the cochlear nerve and brainstem auditory pathways.”

Articles from Medline, Embase, Current contents, Psychlit,  CINAHL and Healthstar were reviewed, you can read abstract -“The otological manifestations associated with autistic spectrum disorders. Chin RY1Moran TFenton JE.” at  http://www.ncbi.nlm.nih.gov/pubmed/23541959
_____________________________________________________________

Holi , Ear care & Ruptured Ear Drum:

Holi , Ear care & Ruptured Ear Drum:

 While playing Holi people often neglect their Ear. Chemical colours and water may enter inside the ear resulting in ear itching, irritation, ear blockade and ear pain.  Water filled balloons can be dangerous and if hits the ear could cause ruptured ear drum.

 Ruptured Ear Drum:

A ruptured ear drum or perforated Tympanic membrane is a tear or hole in ear drum- a thin membrane which separates ear canal from middle ear.

Ear drum has two roles:

Hearing- Transmission of sound from ear canal to middle ear

Protection- Covers & protects delicate structures of middle and inner ear

 A ruptured eardrum can cause hearing loss, ear pain, or ear infections.

A ruptured eardrum usually heals within a few weeks without treatment. Sometimes, however, a procedure or surgical repair is required.

Symptoms of ruptured ear drum:

Symptoms of a ruptured eardrum may include:

  • Ear pain
  • Drainage from your ear, may be boody
  • Hearing loss
  • Ringing in ear (tinnitus)
  • Air escapes out of the ear on blowing of the nose producing whistling sound
  • Spinning sensation

Diagnosis of ruptured tympanic membrane:

Video Otoscopy by ENT Specialist:

Tear in the ear drum, irregular in shape, and surrounded by blood clots.

Hearing tests:

Tuning fork tests and PT Audiometry may show conductive hearing loss.

 Complications:

  • Ear Infections Otitis media
  • Permanent drum perforation
  • Middle ear Ossicle dislocation
  • Cholestaetoma  (read more)

 Other Causes Of ruptured ear drum:

1.Indirect trauma: Due to rapid pressure changes:

  • A blow on the ear (commonest)
  • Otitic barotrauma
  • Blast injury (explosion)
  • Jumping in swimming pool
  • Forcible nose blowing

2. Direct trauma:

  • Foreign body in ear
  • Self-inflicted e.g. by a hairpin
  • Ear wash or instrumentation
  • Head injury, Fracture of temporal bone

 Treatment of Ruptured Ear drum:

Conservative treatment:

Most of the traumatic perforation of tympanic membrane heals spontaneously within a month. Early surgery is not indicated and waiting for three month should be allowed for healing. However close follow up visit to ENT doctor and repeat Audiometry is required to check any urgency of operation.

 Treatment and precautions includes:

  • Prophylactic antibiotic therapy
  • Decongestant nasal drops
  • Avoid ear contamination.
  • Do not wash the ear.
  • Do not use ear drops.
  • Do not blow the nose forcibly.

Eardrum patch:

If the hole in  the eardrum doesn’t close on its own, a patch can be used to seal it. It is an OPd/office procedure, an ENT specialists apply chemical to the edges of the tear to stimulate growth and then apply a patch over the hole. The procedure may need to be repeated more than once before the hole close

Surgical treatment:

Surgery is recommended –

If Perforation fails to heal after three months, there is no healing by a patch or hole is not likely to heal with a patch,

If there is disruption of the ossicular chain, or  if injuries affecting the inner ear ssurgery can be recommended earlier.

Myringoplasty or tympanoplasty is repair of tympanic membrane perforation by a graft taken from patient own tissue.

Technology Advancements In Hearing Aids

Post by Ranjitha R. (Audiologist & Speech Therapist)

RECEIVER IN THE CANAL  HEARING AIDS-

Receiver in Canal  RIC Hearing aids are similar to behind the ear (BTE) hearing aid-with one important, but crucial difference. The receiver of the hearing aid is placed in the ear canal of the user  and instead of plastic tube which is used in the BTE hearing aid, thin electrical wires are used.

These are useful for individuals with mild to severe losses.

 

2Reciever in the canal (RIC)

The RIC model consists of three parts

  • The housing/Case- which sits behind the ear
  • Thin ear wire- connecting the housing to the receiver
  • The Receiver-which goes directly in the ear canal

Benefits OF RIC:

‘Open fit’ technology does not plug up the ear like BTE ear molds, offering relief from occlusion.

Because receiver goes inside the ear canal there is small part behind-the-ear and the thin wire connecting the hearing aid to the speaker – this is extremely inconspicuous and for the majority of people, the most cosmetically acceptable hearing aid device.

The sound is smoother and free of distortion as the amplified signal is emitted by the receiver to the ear, rather than through a plastic tube from behind the ear to the ear.

 

INVISIBLE IN THE CANAL; HEARING AIDS

IIC-Invisible hearing aidIf you are a person with hearing loss, but do not wish to wear a hearing aid because of the cosmetic appeal that it gives, try wearing IICs. They are tiny, custom made hearing aids which snugly fits in to your ear canal, that nobody will ever know that you are wearing a hearing aid. IICs make use of the natural acoustics of your ear to give the best sound quality.

iic - CopyAn IIC hearing aid is one in which the faceplate is at or near the second bend of the ear canal, and the tip of the shell is much closer to the eardrum. The deeper  Canal placement of the hearing aid microphone retains some aspects of the ears natural filtering as compared to the behind the ear hearing aid. The performance and cosmetic advantages of this fitting style appeal to a wide variety of hearing aid candidates, many of whom may not consider more visible hearing aid options.

WATER PROOF AND WATER RESISTANT HEARING AIDS

Siemens Waterproof hearing aidPeople with hearing loss has to take some extra precautions for keeping their hearing aids dry especially for individuals who have an active lifestyle ,who heavily perspire  or for people who exercise and need hearing aids to hear instructions or listen to music through Bluetooth transmission.

To make things simpler, manufactures have a few solutions for you.

A water-resistant hearing instrument can withstand the effects of water, perspiration, and other forms of moisture. Water-resistant means it can get wet and stay functional and in some cases can be submersed in a meter of water for up to a half hour.

A“waterproof,” hearing instrument is able to withstand total submersion in water. A waterproof hearing aid can be worn while swimming as long as a special custom ear mold is worn in place of the slim tube.  Waterproof means the hearing aid can endure swimming and other underwater sports for any length of time. Currently few hearing aids meet the standard of waterproof.

REMOTE CONTROL FOR HEARING AIDS

Hearing aid Remote control If you are searching for a more flexible way to operate your hearing aids, a remote control is an ideal choice.

Modern hearing aids are becoming technically advanced and smaller, and a remote control allows you to access hearing aid functions simply and easily. The remote control’s large keys are simple to operate like changing environmental programs, and adjust the volume of sound coming from the environment, or streaming to your hearing aids from TV, PC, phone and more.

To be continued in next post…

Music from the ear: Researchers show how an objective audiometric test can become even more reliable

Music from the ear: Researchers show how an objective audiometric test can become even more reliable.

Physikalisch-Technische Bundesanstalt (PTB). ,ScienceDaily, 10 Jan. 2013. Web. 11 Jan. 2013. 

Not only can the human ear detect sounds, it can also generate them. If the ear hears the two upper tones of a major triad, it produces the fundamental of the chord which can then be measured. This phenomenon, called “otoacoustic emission” (OAE), is used by otologists for objective audiometric tests, e.g. in newborns. Investigations at the Physikalisch-Technische Bundesanstalt (PTB) have shown that an OAE audiometric test becomes even more reliable if the two sounds are transmitted to the ear not via a loudspeaker, but by bone conduction.

pi130110_b_big

image from PTB

Combined stimulation of otoacoustic emissions: the first tone is transmitted via air conduction (probe speaker in the ear), the second tone is conveyed via bone conduction (bone vibrator behind the ear).

Regardless of where people come from, whether they are Europeans or Asians, the human ear is always tuned to a major scale. If the ear hears the two upper tones of a major triad, the ear itself produces the third, lowest, tone of the chord. This tone is called “distortion product otoacoustic emission (OAE)” and is generated due to anatomic and physical laws:

if the hair cells in the inner ear are healthy and sound, they are stimulated by the two matching tones to vibrate at a third frequency. This lower tone comes out of the ear again and can be measured by means of a highly sensitive microphone. With the aid of this phenomenon, it is possible to check objectively whether the hearing of newborns or infants is intact.

Such a test used to be performed using two tiny loudspeakers, each of which emitted a tone into the ear, as well as a miniaturized microphone, which recorded the third tone (if it came out at all).

If this tone is not generated, physicians have a first inkling that the baby might need therapy or a hearing aid.

However, it may be that the ear is healthy but does not “hum”. This can be caused by a badly calibrated loudspeaker, or due to the fact that the loudspeakers which are placed close to each other emit standing waves into the auditory canal which weaken one of the two tones.

To preclude such malfunctions, alternative tone generation methods have been investigated at PTB within the scope of a DFG project: so-called “bone vibrators” which, in analogy to a tuning fork set onto the bone, convey the tone directly to the bone located behind the ear.

The results have shown that both with two bone vibrators and in combination with a loudspeaker, correct otoacoustic emissions are generated. This not only allowed calibration errors to be reduced, but also provided physicians with improved differential diagnosis possibilities, since with the new procedure, they can test the function of the inner ear without a doubt and, potential damage of the middle ear, thus, has less influence. Clinical studies should follow.

Scientific publication

Zebian, M.: Calibration of Distortion Product Otoacoustic Emission Probes. Dissertation, TU Braunschweig (2012)

Home Care Tips for Cold & Sore Throat

Re blogged from my old post

Usually with winter respiratory and throat infection cases increases, but this year physicians and ENT clinics are witnessing increased number of Patients as Mumbai is experiencing unusual low levels of temperature.

With High level of pollutants and particulate matter allergic cold (rhinitis) and sore throat cases are on rise.

3157516906_2df91217faphoto by quirkyrocket at flickr creative commons

Here are few home care tips to fight with stuffy nose/sore throat:–

Though it does not replace proper diagnosis and medical management but it helps as supportive treatment in faster recovery and reduces sleepless nights. Personally I have advised these tips to patients and it works in lessening patient’s discomfort.

  •  Proper rest
  •  Take balanced diet with plenty of vitamin and minerals to boost defense mechanism.
  •  Vitamin c and zinc supplements.
  •  Keep hydration adequate as cold air has drying effect
  • Hot soups like tomato soup, chicken soup works wonder in thinning of secretions.
  •  Black pepper, basil leaves, cloves and ginger boil with water and drink at night time; it’s soothing and helps in mucus coming out.
  • Honey is age old miraculous natural cure from cough.
  • One pinch of turmeric with 1 cup warm milk helps in easy expulsion of mucus.
  • Researches show ginger, garlic and onion has medicinal properties and helps in cold and cough.

_-______________ 

  • Gargles with warm saline (salt in warm water)
  •  Saline irrigation or nasal wash (1/4 teaspoonful of salt in lukewarm water)
  •  Humidification. Use of vaporizer (Steam inhalation) or humidifier can be done to increase the humidity in the air.
  •  Avoid smoking; active and passive.
  •  Avoid alcohol as it increases swelling of mucus membrane.
  •  Avoid dust, pollen, pets, deodorants, chemical irritants.
  • Do deep breathing exercises.

Get flu vaccine before season starts, it works.

  • Dress in layers wear woolen cloths
  • Protect hands and feet (30% of heat escapes through hands and feet
  • Cover head with hat or scarf (40% of heat lost through head)

Diabetics have More Chances of Hearing Loss

Most common causes of Hearing Loss are Aging, Heredity, loud noises and ototoxic medicines but studies suggest that diabetes also makes more prone for hearing loss.

Patients with diabetes routinely receive blood exams, kidney function evaluations, feet examination and eye exams, but routine ear and hearing examination is hardly known thing.

On “World Diabetes Day” we recommend hearing tests should be norm for diabetics.

 Reason for hearing loss in diabetics:

There are changes in the nerves themselves and it hypothesized that hearing loss in diabetics is because of damage to nerves and blood vessels in the inner ear.

Sign and symptoms of Hearing loss:

Self hearing Check  at neoalta.com

  • Often turn up the volume of T.V. or radio.
  • Find it difficult to follow a conversation in a noisy area or crowded room.
  • Feel people are mumbling or not speaking clearly.
  • Misunderstand what others are saying and respond inappropriately.
  • Ask others to speak up or to repeat themselves.
  • Sometimes miss birds chirping, doorbell or telephone ringing

How Hearing Loss is diagnosed ?

ENT consultation and hearing tests (Audiometry) by audiologist can diagnose hearing problem. DP OAE (distortion product otoacoustic emissions-test used for newborn hearing screening) can detect early hearing loss in diabetic patients.

Read in detail about Tests of Hearing

What is the treatment of hearing loss?

Treatment will depend on the type of hearing loss. Diabetics usually have sensorineural Hearing Loss which cannot be cured. However, most cases of sensorineural hearing loss can be treated with hearing aids.

Read more about treatment of Hearing Loss.

Protection of Hearing in diabetics:

  • Control of diabetes, Hb A1c should be kept under 7%, diet and exercise are vital
  • Protect your sensitive ears from noise and ototoxic medicine
  • Regular Ear and Hearing Screening : along with your eyes, feet, and kidneys, your ears need regular screening.

If you or a loved one has diabetes, we recommend to  visit hearing clinic to take a hearing test,

visit Audicco.com  ENT and hearing center at Vashi Navi Mumbai to know more.

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