Early screening of deafness in infants

Most children hear and listen to sounds from birth. They learn to talk by imitating the sounds around them. But unfortunately few are born deaf or hard-of-hearing. Many lose their hearing later during childhood. These children may need to learn speech and language therapy. Deafness in children can affect a child's potential to develop speech, language, and social skills. The earlier a child starts getting treatment, the more likely the child's speech, language, and social skills will improve. There should be provision for screening newborns for hearing loss before they go home. Babies who are deaf or hard of hearing should obtain services before they are 6 months old to get the best progress in developing use of audition for learning language.

Signs of hearing loss in children: Non advancing baby talk or delayed speech/language development, reduced vocabulary are missing endings while speaking, complaining about hurting ears or frequent ear infections, difficulty locating sounds, very soft or too loud conversations or turning up the TV volume to an excessively high level

1.Master ( Multiple Auditory Steady State Response)

Auditory steady state responses testing are electro-physiologic measurement of hearing loss in infants. They may provide more frequency-specific threshold information for infants who have severe to profound hearing losses which enables the audiologist to have more precise data to determine the treatment for deafness. Infant hearing screening can be analyzed by the activity of brain in infant which generate the audiogram. The Multiple auditory steady-state response (MASTER) technique allows the simultaneous screening of both ears for 4 tonal frequencies.

The MASTER technique is emerging as in significant clinical procedure for evaluating deafness in ear, owing to its speed compared to the tone-ABR techniques and is more thorough than oto-acoustic emissions testing. In addition to the central clinical role, the MASTER technique is being used to investigate abilities of the auditory system such as speech processing capacities, ability to process both frequency and amplitude modulation, ability to follow rapid changes in a sound, and even gap detection. MASTER is a Windows-based data acquisition system designed to assess hearing loss/deafness by recording auditory steady-state responses. The system simultaneously generates multiple amplitude-modulated or frequency-modulated auditory stimuli, produces electrophysiological responses to these stimuli, displays these responses in the frequency-domain, and determines whether or not the responses are larger than background electroencephalographic activity. The operator can print out the results, store the data on disk for more extensive analysis by other programs, review stored data, and combine results.

2.Bera (Brain Stem Evoked Response Audiometry)

Brain stem evoked response audiometry is an objective way of evoking brain stem potentials in response to audiological stimuli. BERA provides information regarding auditory function and sensitivity, but it is not a substitute for other methods of hearing screening tests. It should be considered in conjunction with other audiological investigations. The transducer placed in the insert ear phone or head phone transmit the stimulus either in the form of click or tone to the ear. The wave forms of impulses generated at the level of brain stem are recorded by the placement of electrodes over the scalp. BERA is an effective screening tool for evaluating causes of deafness due to retro cochlear pathology. An abnormal BERA is an indication for MRI scan. It can be used for the screening of child deafness and intraoperative monitoring of central and peripheral nervous system or diagnosing suspected demyelinated disorders. Brainstem Evoked Response Audiometry (BERA) is a non-invasive method of hearing assessment which detects electrical activity from the inner ear to the inferior colliculus.

3.SSEP ( Steady State Evoked Potential)

Hearing thresholds determination is crucial in assessing cochlear implant candidates. An objective measure of hearing is desirable in young children who are unable to undergo behavioral audiometry.

Steady-state evoked potentials (SSEPs) are potentials recorded from the scalp and simultaneously analyzed. Amplitude and frequency modulated pure tones are used as stimuli. A system has been developed which determine such response automatically, even in sleeping or awake subjects

This technique has a number of advantages over the auditory brainstem response. The automated response detection eliminates the subjective element of threshold determination, higher levels of stimulus presentation are possible, low frequency threshold determination is more accurate and a quick testing procedure.

The goal of ASSR is to create an estimated audiogram from which questions regarding hearing, hearing loss, and aural rehabilitation can be answered. ASSR was previously referred to as SSEP (Steady State Evoked Potential) and/or AMFR (Amplitude Modulation Following Response). ASSR uses amplitudes and phases in the frequency domain rather than depending on amplitude and latency. ASSR depends on peak detection across a spectrum, rather than peak detection across a time versus amplitude waveform. ASSR is evoked using repeated sound stimuli presented at a high repetition rate.

4.OAE (Oto Acoustic Emission)

The test shows whether parts of the ear respond properly to sound is called Otoacoustic emissions (OAE). The primary purpose of Otoacoustic emission tests is to determine cochlear status, specifically hair cell function. The information can be obtained from patients who are sleeping or even comatose because no behavioral response is required. They are the basis of a simple, non-invasive, test for hearing defects in newborn babies and in children who are too young to cooperate in conventional hearing tests.

A soft sponge earphone is placed into the ear canal of babies and emits a series of sounds and echo responses are measured that occurs in normal hearing ears. N echo could indicate hearing loss. The AOAE screening test takes a few minutes, whereas the Automated Auditory Brainstem Response screening test can take between 5 and 30 minutes. You can stay with your baby while the screening test is done.

5.VEMP (Vestibular Evoked Myogenic Potentials)

Vestibular Evoked Myogenic Potentials test checks the normal functioning of the saccule, one portion of the otoliths, as well the inferior vestibular nerve and central connections. Testing vestibular evoked myogenic potentials (VEMPs) may be the most important clinical test for evaluation of severity of vestibular damage due to different pathophysiologic processes such as Ménière's disease, vestibular neuritis, and vestibular schwannoma. VEMPs can also be used to document vestibular hypersensitivity to sounds. VEMP testing constitutes an electro physiologic method that is able to detect subclinical lesions in central vestibular pathways in patients with multiple sclerosis. This non-invasive test is usually used to assess people with dizziness. The VEMP is currently the only proven test available that detect non-symptomatic Ménière's Disease. Testing ocular VEMPs (OVEMPs) in response to bone-conducted vibration can be used for the evaluation of utricular function in future.

VEMPs are recorded using an evoked response computer, a sound generator, and neck muscle activation is picked up by the surface electrodes. VEMPs can be recorded easily and are well suited for everyday testing in clinical neurotology.
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