This is defined as disability that may range in severity from slight to profound hearing loss.
Etiology
Anatomic malformation
Malformations of the head or neck
Family history
Low birth weight
Ototoxic drugs, O2 administration
Chronic ear infections
Perinatal asphyxia
Perinatal infections
Cerebral palsy
Pathology
Conductive hearing loss: Middle ear
Sensorineural hearing loss: Damage to inner ear or auditory nerve
The most common causes are congenital defects of inner ear structures or consequences of acquired conditions, such as kernicterus, infection, administration of ototoxic drugs, or exposure to excessive noise
This results in distortion of sound and problems in discrimination.
Although the child hears some of everything going on around him or her, the sounds are distorted, severely affecting discrimination and comprehension
Mixed conductive-sensorineural loss: Interference with transmission of sound
It frequently results from recurrent otitis media and its complications
Central auditory interception
Organic
The defect involves the reception of auditory stimuli along the central pathways and the expression of the message into meaningful communication.
Aphasia, the inability to express ideas in any form, either written or verbal; agnosia, the inability to interpret sound correctly
Dysacusis, difficulty in processing details or discriminating among sounds.
Functional
No organic lesion exists to explain a central auditory loss.
Hysteria (an unconscious withdrawal from hearing to block remembrance of a traumatic event)
Infantile autism
Childhood schizophrenia.
Therapeutic management
Conductive hearing loss
Many conductive hearing defects respond to medical or surgical treatment, such as antibiotic therapy for acute otitis media or insertion of tympanostomy tubes for chronic otitis media.
The nurse should be familiar with the types, basic care, and handling of hearing aids, especially when the child is hospitalized
Types of aids include those worn in or behind the ear, models incorporated into an eyeglass frame, and types worn on the body with a wire connection to the ear
One of the most common problems with hearing aid is acoustic feedback
Annoying whistling sound usually caused by improper fit of the ear mold.
As a nurse
Stress to parents the importance of storing batteries for hearing aids in a safe location out of reach of children and teaching children not to remove the battery from the hearing aid (or supervising young children when they do so).
Treatment for sensorineural hearing loss is much less satisfactory.
This is because the defect is not one of intensity of sound, hearing aids are of less value in this type of defect.
The use of cochlear implants (a surgically implanted prosthetic device) provides a sensation of hearing for individuals who have severe or profound hearing loss
Clinical manifestation
Infants
Lack of startle or blink reflex to a loud sound
Failure to be awakened by loud environmental noises
Failure to localize a source of sound by 6 months of age
Absence of babble or voice inflections by 7 months of age
General indifference to sound
Lack of response to the spoken word; failure to follow verbal directions
Response to loud noises as opposed to the voice
Children
Use of gestures rather than verbalization to express desires, especially after 15 months of age
Failure to develop intelligible speech by 24 months of age
Monotone and unintelligible speech; lessened laughter
Vocal play, head banging, or foot stamping for vibratory sensation
Yelling or screeching to express pleasure, needs, or annoyance
Asking to have statements repeated or answering them incorrectly
Greater response to facial expression and gestures than to verbal explanation
Avoidance of social interaction; prefer to play alone
Inquiring, sometimes confused facial expression
Suspicious alertness alternating with cooperation
Frequent stubbornness because of lack of comprehension
Irritability at not making themselves understood
Shy, timid, and withdrawn behavior
Frequent appearance of being “in a world of their own” or markedly inattentive
When parents express concern about their child’s hearing and speech development, refer the child for a hearing evaluation.
Absence of well-formed syllables (da, na, yaya) by 11 months of age should result in immediate referral.
Care management
Lipreading
Exaggerating pronunciation or speaking in an altered rhythm further lessens comprehension.
The child learns to supplement the spoken word with sensitivity to visual cues, primarily body language and facial expression (e.g., tightening the lips, muscle tension, eye contact).
Facilitating lipreading
Attract child’s attention before speaking; use light touch to signal speaker’s presence.
Stand close to child.
Face child directly or move to a 45-degree angle.
Stand still; do not walk back and forth or turn away to point or look elsewhere.
Establish eye contact and show interest.
Speak at eye level and with good lighting on speaker’s face.
Be certain nothing interferes with speech patterns, such as chewing food or gum.
Speak clearly and at a slow and even rate.
Use facial expression to assist in conveying messages.
Keep sentences short.
Rephrase message if child does not understand the words.
Cued speech
Method of communication is an adjunct to straight lipreading
It uses hand signals to help the hearing-impaired child to distinguish between words that look alike when formed by the lips (e.g., mat, bat).
It is most employed by hearing impaired children who are using speech rather than those who are nonverbal.
Sign language
Encourage family members to learn signing, because using or watching hands requires much less concentration than lipreading or talking.
A symbol method enables some hearing-impaired children to learn more and to learn faster.
Speech language therapy
The most formidable task in the education of a child who is profoundly hearing impaired is learning to speak.
Speech is learned through a multisensory approach using visual, tactile, kinesthetic, and auditory stimulation.
Encourage parents to participate fully in the learning process.
Additional aids
Flashing lights can be attached to a telephone or doorbell to signal its ringing.
Trained hearing ear dogs can provide great assistance, because they alert the person to sounds, such as someone approaching, a moving car, a signal to wake up, or a child’s cry.
Special teletypewriters or telecommunications devices for the deaf (TDD or TTY) help hearing-impaired people to communicate with each other over the telephone
The typed message is conveyed via the telephone lines and displayed on a small screen.
Socialization
Classmates become a potential source of close friendships because they communicate more easily among themselves.
Encourage parents to promote these relationships whenever possible.
In a group setting, it is helpful for the other members to sit in a semicircle in front of the hearing-impaired child.
This is due to one of the difficulties in following a group discussion is that the hearing-impaired child is unaware of who will speak next, someone should point out each speaker.
Speakers can also be given numbers, or their names can be written down as each person talks.
If one person writes down the main topic of the discussion, the child can follow lipreading more closely.
Such practices can increase the child’s ability to participate in sports, organizations such as Scouts, and group projects.
Support child and family
Parents need extensive support to adjust to the shock of learning about their child’s disability and an opportunity to realize the extent of the hearing loss.
If the hearing loss occurs during childhood, the child also requires sensitive, supportive care during the long and often difficult adjustment to this sensory loss.
Early rehabilitation is one of the best strategies for fostering adjustment.
Progress in learning communication, however, may not always coincide with emotional adjustment.
Depression or anger is common, and such feelings are a normal part of the grieving process.
