Hearing Loss In The Child With Downs Syndrome
Feb 24, 2016
Hearing Loss In The Child With Downs Syndrome
Frequency 3000-5000 a year are born with
Downs syndrome 75-89% of children with
Downs have associated hearing Loss !!
66-89% have a hearing loss greater than 15-20dBHL in at least 1 ear 75% found to have at least a mild hearing problem
Progress in Speech & Language performance is linked to factors which include – hearing status, speech, Non Verbal cognitive skills, and daily experience
Children with downs experience slower development of language relative to other cognitive skills
1/3 of these children have recurring problems with hearing throughout childhood which if not addressed lead to greater speech and language delay
Physical features affecting listening
Although the skull of a child with Downs grows to nearly the same side as the average adult, it has more of the shape of a newborn.
Leads to…… OME (middle ear fluid) Retraction (the
eardrum getting sucked in) CholesteatomaA type of skin cyst located in the middle ear and skull bone
Eustachian tube dysfunction (the tube that runs
from your middle ear to the back of the mouth) & cartilage anomalies
Promotes stillness of fluid in the ear and infection travelling up to the ear from the mouth
Otitis Media with Effusion The angle in
which the Eustachian tube sits in the child with Downs
Other structural differences that can lead to hearing difficulties
EAM stenosis – (narrowing of the ear canal)
Wax build up - impacted
Small nasopharynx (back of the nose & throat)
Impaired swallow Production of more
mucus which can then becomes infected due to a lowered immune system
Changes in the pinna
SO WHAT IS THE OUTCOME?
OME = MILD – MODERATE HEARING LOSS worse in the low frequencies
Congenital SNHL in the high frequencies – bony deposits along the cochlear
& Acquired/presbycusis (high frequency hearing loss) in the older years 35-40.
Medical Problems that can occur
40 –45% congenital heart disease Intestinal changes Thyroid dysfunctions Skeletal problems Sleep apnoea - 50% Obesity in adolescence & older Immunologic concerns Leukaemia Alzheimer's Seizure difficulties Skin disorders
Other possible symptoms Average IQ is 30-40 but some children have mild-
moderate difficulties -Marcell 98 A narrowed ear canal can make looking at the
eardrum difficult OME = pain, ↓ Attention , Distractibility, Feeling of
fullness, bunged up LEAKY EAR Inconsistent performance Low muscle tone
Management Myringotomy is a surgical procedure in
which a small incision is created in the eardrum to relieve pressure caused by build-up of fluid or to drain pus from the middle ear.
Tympanostomy tubes/PE tubes This tube is inserted into the eardrum in order to keep the middle ear aerated for a prolonged period of time to prevent re-accumulation of fluid, as without the insertion of a tube, the incision would heal spontaneously in two to three weeks
Grommets a very small tube that is inserted into your child's ear through a small cut in their eardrum. A grommet will drain away fluid in the middle ear and help to maintain the air pressure in the middle ear cavity.
Antibiotics Hearing aids Surgical repair or of
perforation
Age Recommended hearing evaluations
birth to 2 months
2 to 12 months
1 to 12 years
12 to 18 years
over 18 years
Refer for auditory brainstem response (ABR) test or other objective assessment of hearing to assess hearing by 6 months of age, if not performed at birth.
• Provide brainstem response test (ABR) or other objective assessment of hearing by 6 months of age if not performed previously or if previous results are suspicious. Evaluation by ENT specialist for recurrent otitis media.
• Yearly auditory testing for children 1-3 years old and every two years for children 3-13 years old.
• Hearing evaluations every other year.• Continue auditory testing every two years.
So What does a Speech Therapist do?
Observe Advise Monitor Refer to any other relevant professionals Support Remind MDT working Assess
Focus on the holistic Approach
Strategies that fit into everyday life
Fun Highlighting
great activities that are done anyway