Speech is the most used tool in communication between people. Babies learn by hearing them spoken in the conversation in circles. With normal hearing normal speech development is possible. Babies with hearing loss learning to speak, therefore, may have detrimental effects on the learning of the language. The degree of loss increases, the effect on speech improves speech intelligibility of hearing impairment speech spontaneously and gradually above a certain level can't be learned.
An energy that was forwarded by air which is collected by the outer ear from the external ear canal and sound transmitted into the environment after it has been through the outer ear canal eardrum vibration with the vibration that generates the effect of pressure on the eardrum and middle ear to the inner ear through the bones is transferred. Here electrical energy is converted into mechanical energy in the nerve cells and is transmitted to the brain via the auditory nerve. Outer and middle ear deafness the sound loses energy as it passes through the environment, and the cells of the inner ear induced decreased sensitivity to the voice of ventilation in the event of loss of hearing, so they can be stimulated to provide a sound with a higher intensity is required. Sound Energy decibel (DB) unit is expressed in. The average of the lowest energy sound that can be heard in society is regarded as 0 dB. The percentage expression of hearing loss in decibels as follows::
- 20-25 dB – %0
- 30 – dB – %8
- 35 – dB –
- 45 – dB – 30 %
- 55 – dB –
- 65 – dB – 60 %
- 75 – dB – 75 %
- 85 – dB – 90 %
Different sounds have different energies, especially the “S, Z, P, T” of consonants, such as a fairly low energy, it becomes even 30 dB to be heard in a hearing loss, speech impairment has occurred. Though losses in the brain after learning speech sounds may not be heard because these spaces are filled speech may be affected. New babies in the learning period, but if we hear all sounds correctly and clearly they can learn to speak correctly.
Babies are not corrected by the difference in speech and language delay, hearing loss, speech impairment, emotional and social problems, school performance degradation of causes. As the diagnosis is delayed, negative results increase. Therefore, hearing loss in babies with corrective measures should be taken.
Speech Development
A baby with normal hearing;
- In the six weeks to the human voice starts to have a very different reaction,
- He was six months old when the pieces started recording in the memory of the language,
- The first year the stimulus from the environment, and you spend learning the language, the words, the sentences begin to understand,
- After an age the vocabulary reaches a certain level, starts to speak.
During the first year of mature nerve cells in the auditory pathway auditory stimuli in parallel along different regions of the brain nerve cells in the brain and hearing-related nerve is composed of numerous new connections between regions. This is unheard of auditory stimuli impairs neurological development, if the loss is not replaced can cause problems that are hard to reverse. Therefore, with the appropriate method to detect hearing loss as early as possible and treatment, therefore, should be provided towards the development of speech and language.
The Degree Of Hearing Loss
In adults, while infants and children above 15 dB 20 dB hearing levels are considered normal hearing levels of hearing loss is considered.
The main factors that affect the development of language related to hearing;
- The degree of loss,
- The type of holding and loss frequencies,
- The loss is progressive,
- The time of diagnosis,
- Baslanma treatment time
- The education I received,
- The child's intelligence,
- The family approach.
Mild hearing loss (15-30 DB)
Has very little effect on speech and language, mild language delay, speech impairment causes slight and mild learning difficulty. School age in distraction, can have consequences such as failure in the course. Vowels are easily heard “S Z” consonants like it. Losses at this level may not be noticed.
Mild hearing loss (30-50 dB)
All the sounds have difficulty in hearing spoken, you need to understand what a device. Delays in Speech, Language Development Delay, Speech impairment, a learning disability is. Vocabulary remains limited, make mistakes in sentences.It is difficult to understand their conversation.
Moderate hearing loss (50-70 dB)
Speech and language can not develop without help. The application of the device early and special education needs. Speech is not a serious problem.
Forward-severe hearing loss (70 dB)
Without the device can not hear voices. Severe speech and language problems. Perceive the rhythm of the conversation. Learning difficulties are serious, they can't learn a language without special training. Speech is monotonous.
Diagnosis
Hearing loss in newborns and infants is observed between 1 and 3 in 1000 live births. The risk of hearing loss in infants conducted in surveys, however, half of them at the appropriate time can be detected. The losses must be determined within the first 3 months of life and at the latest until 6 months as a complication of a suitable method is critical.
In newborns Hearing Screening protocols is becoming increasingly common. To increase rates of diagnosis and timely treatment in this area obstetricians, pediatricians, family physicians, nurses and midwives, it is necessary to raise awareness on the subject and society. Although hearing screening for all newborns need to be done, especially in the presence of certain risk factors, the hearing should be considered very carefully.
These are;
Newborn (0 to 28 days)
- Those who have a history of seizures in childhood in the family
- During pregnancy, rubella, syphilis, toxoplasmosis, cytomegalovirus, herpes virus infections, a history of
- Ear abnormalities, abnormalities of head
- Birth weight under 1500 grams
- Have sufficient to require exchange transfusion in neonatal jaundice
- Pregnancy the use of drugs that are known to result in hearing loss
- The story of meningitis
- The story of a breathing device connecting to a five day long
- At birth, the Apgar score is too low
- Presence of syndromes known to have gone with signs and symptoms of hearing loss
29 days to 2 years during the period of reevaluation conditions
- Hearing loss in children confirms what we suspected, delay in speech, language
- Disease such as meningitis may affect hearing
- Undergo serious head trauma
- The emergence of symptoms of hearing loss syndromes
- The story of the drugs that are known to result in hearing loss
- Very often, or 3 months long-term accumulation of fluid in children
29 days between the ages of 3 conditions to check every 6 months
- Have hearing loss in the family
- Intrauterine infections (rubella, syphilis, herpes, etc.)
- Auditory nerve neurological diseases
- Classification Of Hearing Loss
Transmission type & sensorineural type
Hereditary (70% is not associated with a syndrome)
- Congenital
- Later that
Non-hereditary
- Congenital
- Later that
Non-hereditary hearing loss causes:
Infections
- Rubella
- Measles
- Mumps
- CMV
- Flower poliomiyelit
- Herpes
Causes occur during childbirth
Jaundice (bilirubin height)
Affecting hearing (ototoxic drugs and chemicals
Trauma
Noise
Rubella: do not leave permanent immunity, vaccination before pregnancy is recommended.
Mumps is the most common childhood is a cause of sensorineural hearing loss, 80% of a single ear disclosure.
Toxoplasma: Noisy is transmitted through contact with pets. 90 %was seen in the East. Hearing loss occurs.
Meningitis: is the most common cause of hearing loss. H. influenza is the most frequent factor.
Diagnosis Of Hearing Loss
The story
- Family history
- Pregnancy history:the organ of hearing, 3-20. occurs between the first week. In this period, especially infections is critical.
- Birth story
- Kid history:diseases, trauma, medications
Inspection: the external ear, middle ear problems in diagnosis is significant.
Hearing evaluation
Noise reaction
- Bounce (Moro reflex): to sounds above 85 dB is a reflex that occurs in the form of motion in the arms and legs. After four months is reduced.
- Blink: in blink when there are even new nature is given a voice high
- Voice pause in movement
- Looking towards the sound: 6-9 months
- Reaction to the name: 10 months
- Reaction to verbal commands: 12 months
Hearing Tests
Subjective tests
- Play audiometry: 3,5 years-can be made after
- Audiometry: after the age of 5
Objective tests
- Tympanometry
- Acoustic reflexes
- Brain stem audiometry (BERA)
- Oto-acoustic emissions (OAE)
Laboratory Tests
- Blood tests: Infection Research
- Genetic tests
- Vestibular testing
Radiological evaluations
Newborn hearing screening Protocol
Objective: identifying hearing loss within the first 3 months was 6 months old at the latest by the device when the application is to go to. All new born babies must be evaluated within the framework of a protocol.
In A Normal Environment Protocol For Babies
- When I was old 24-48 hours: Oto-acoustic emission (OAE) Hearing Screening Test control
- Babies who have not received a positive response in this Test: 1. OAE screening test for another month
- In babies who do not received a positive response as a screening test in the first year: 2. OAE screening test for another month
- The test in the second month, a positive answer is received: DRG test panel:
- Tympanogram + brainstem audiometry (ABR) + transient evoked Oto-acoustic emission (TEOAE)
Protocol For Babies Admitted To The Neonatal Intensive Care Service
- Before I was discharged: ABR screening test
- Babies who do not get a positive reply from this Test: 1. diagnostic ABR testing in the month
- Again, not babies who received a positive answer: 3. panel testing for the diagnosis of the month