The most used tool in interpersonal communication is speech. Babies learn to talk by hearing what is said around them. Normal speech development is possible with normal hearing. Hearing loss negatively affects babies' learning to speak and therefore their ability to learn language. As the degree of loss increases, its effect on speech increases and the intelligibility of speech gradually decreases, while speech cannot be learned spontaneously in cases of hearing loss above a certain level.
Sound, which is an energy transmitted through the air, is collected from the environment through the auricle and transmitted to the external auditory canal. Passing through the eardrum, it creates vibration with the effect of pressure on the eardrum, and this vibration is transferred from the eardrum to the inner ear through the middle ear ossicles. Mechanical energy is converted into electrical energy in the nerve cells here and transmitted to the brain via the auditory nerve.
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20-25 dB – 0%
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30 – dB – 8%
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35 – dB –
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45 – dB – 30%
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55 – dB – 45%
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65 – dB – 60%
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75 – dB – 75%
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85 – dB – 90%
The energies of different sounds are also different, especially “s, z, Consonants such as "p, t" have very low energy, and since they become difficult to hear even in mild hearing losses of 30 dB, speech impairment occurs. In cases of loss occurring after learning speech, even if these sounds are not heard, speech may not be affected because the gaps in the brain are filled. Babies in the new learning period can only learn to speak correctly if they hear all sounds correctly and clearly.
Hearing losses in babies that are not noticed and corrected cause speech and language delay, speech impairment, emotional and social problems, and decreased school success. As diagnosis is delayed, negative consequences increase. For this reason, corrective measures should be taken as soon as possible in babies with hearing loss.
Speech Development
Baby with normal hearing;
- At six weeks, they begin to react differently to the human voice. begins,
- At the age of six months, he started to record the language in his memory piece by piece,
- In the first year, he He learns the incoming audio stimuli and the language, begins to understand words and sentences,
- After the age of one, he reaches a certain level in terms of vocabulary and begins to speak.
During the first year. Along the auditory pathways, nerve cells in different parts of the brain mature and in parallel with auditory stimuli, many new nerve connections are formed between nerve cells in the brain and hearing-related regions. Failure to hear auditory stimuli also disrupts this neurological development, and delay in replacing the loss may cause irreversible problems. For this reason, hearing loss should be detected as early as possible and the correct development of hearing and therefore speech and language should be ensured with the appropriate method.
Degree of Hearing Loss
Hearing levels up to 20 dB in adults While it is considered normal, hearing levels above 15 dB in infants and children are considered as hearing loss.
Main factors affecting hearing-related language development;
- The degree of loss,
- Type of loss and its frequencies,
- Progressiveness of the loss,
- Time of diagnosis,
- Time to start treatment,
- Training received,
- Child's intelligence,
- Family's approach.
Very Mild Hearing Loss (15-30 dB)
Speech and has little effect on language, causing mild language delay, mild speech impairment, and mild learning difficulties. It may have consequences such as distraction during school period and failure in classes. While they can hear vowels easily, they have difficulty hearing consonants such as "S, Z". Losses at this level may not be noticed.
Mild Hearing Loss (30-50 dB)
They have difficulty hearing all sounds, they need a device to fully understand what is being said. There is a delay in speech, delay in language development, speech impairment, and learning difficulties. His vocabulary remains limited, he makes mistakes in sentences. It is difficult to understand his speech.
Moderate Hearing Loss (50-70 dB)
Speech and language cannot develop without assistance. Early device implementation and special training are required. There is a serious speech problem.
Profound-Profound Hearing Loss (above 70 dB)
They cannot hear sounds without the device. He has serious speech and language problems. They cannot perceive the rhythm in speech. The learning problem is serious, they cannot learn a language without special education. Their speech is monotonous.
Diagnosis
Hearing loss in newborns and infants is seen in 1 to 3 in 1000 live births. Only about half of babies at risk of hearing loss can be detected at the appropriate time in screenings. It is critical to detect losses within the first 3 months of life and to provide hearing with an appropriate method until the age of 6 months at the latest.
Hearing screening protocols in newborns are becoming increasingly common. In order to increase diagnosis and timely treatment rates in this field, it is necessary to increase the awareness of obstetricians, pediatricians, family physicians, nurses and midwives and the society on the subject. Although hearing screening should be performed in all newborns, hearing should be evaluated very carefully, especially in the presence of some risk factors.
These are;
In the newborn period (0-28 days)
Those with a family history of auditory canopy in childhood
A history of rubella, syphilis, Toxoplasma, Cytomegalovirus, Herpes virus infection during pregnancy
Ear anomalies, head anomalies
Birth weight below 1500 grams
Neonatal jaundice that requires transfusion
Use of medications known to cause hearing loss during pregnancy
History of meningitis
History of being on a ventilator for more than five days
Very low APGAR score at birth
Presence of signs and symptoms of syndromes known to accompany hearing loss
Situations that require re-evaluation between 29 Days and 2 Years of age
Suspicion of hearing loss in the child, speech and language delay
Suffering from a disease that may affect hearing, such as meningitis
Severe head trauma
Symptoms of syndromes with hearing loss
History of treatment with drugs known to cause hearing loss
Very frequent or 3 Fluid accumulation in the middle ear for more than a month
&n bsp; Situations that require regular check-ups every 6 months between 29 Days and 3 Years
Hereditary hearing loss in the family
Intrauterine infections (rubella, syphilis, Herpes, etc.)
Neurological diseases that may involve the auditory nerve
Classification of Hearing Loss
Conductive type & Sensorineural type
Hereditary (70% Not associated with syndrome)
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Congenital
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Acquired
Non-hereditary
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Congenital
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Acquired
Non-hereditary causes of hearing loss:
Infections
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Rubella
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Measles
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Mumps
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CMV
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Smallpox poliomyelitis
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Herpes
Causes occurring during birth
Jaundice (high bilirubin)
Ototoxic drugs and chemicals that affect hearing
Traumas
Noise
Rubella: It does not leave permanent immunity, vaccination is recommended before pregnancy.
Mumps: It is the most common cause of sensorineural hearing loss in childhood, 80% affects one ear.
Toxoplasma: It is transmitted by contact with parasitic pets. There are no symptoms at birth in 90% of cases. Hearing loss occurs.
Meningitis: It is the most common cause of subsequent hearing loss. H. Influenza is the most common factor.
Diagnosis of Hearing Loss
History
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Family history
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Pregnancy history: Hearing organ 3-20. It occurs within weeks. Infections during this period are especially critical.
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Birth story
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History of the child: Previous illnesses, traumas, medications used
Examination: It is important in the diagnosis of outer ear and middle ear problems.
Hearing evaluation
Reacting to sound
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Jump (Moro reflex): It is a reflex that occurs in the form of movement in the arms and legs to sound above 85 dB. It decreases after four months.
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Blinking: Blinking is present even in newborns when loud sounds are given
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Pause in movements with sound
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Looking in the direction of the sound: 6-9 months
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Reacting to the name: 10 months
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Verbal commands reaction: 12 months
Hearing Tests
Subjective tests
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Game audiometry: from 3.5 years old can be done later
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Audiometry: After the age of 5
Objective tests
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Tympanometry
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Acoustic reflexes
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Brainstem audiometry (BERA)
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Autoacoustic emissions (OAE)
Laboratory Tests
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Blood tests: Infection investigation
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Genetic tests
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Vestibular tests
Radiological evaluations
New Born Hearing Screening Protocol
Purpose: To detect hearing loss within the first 3 months and start device application at the age of 6 months at the latest. All newborn babies need to be evaluated within the framework of a protocol.
Protocol for Babies in Normal Environment
- At 24–48 Hours of Age: Checking hearing with Auto Acoustic Emission (OAE) screening test
- In babies who do not get a positive response in this test: OAE screening test again in the 1st month
- In babies who do not get a positive response in the screening test in the first month: OAE screening test again in the 2nd month
- If there is no positive response from the test in the second month: Diagnostic test panel:
- Tympanogram + Brainstem audiometry (ABR) + Transient evoked autoacoustic emission (TEOAE)
- Before discharge: ABR screening test
- For babies who do not receive a positive response from this test: At the 1st month Diagnostic ABR test
- In babies with no positive response again: Diagnostic test panel in the 3rd month
Protocol for Babies Admitted to the Neonatal Intensive Care Service
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