auditory processing disorder.....the hidden problem in many kids.

Yet another child diagnosed today with Auditory Processing disorder (APD)

The parents were left open mouthed when they were told about it. They were expecting a diagnosis of Autism for their 3.6yr old!

So what is APD?

Auditory processing disorder (APD), also known as central auditory processing disorder (CAPD), is a complex problem affecting mainly school-aged children. These kids can't process the information they hear in the same way as others because their ears and brain don't fully coordinate. Something probably adversely affects the way the brain recognizes and interprets sounds, most notably the sounds composing speech.
Kids with APD often do not recognize subtle differences between sounds in words, even when the sounds are loud and clear enough to be heard. These kinds of problems usually occur in background noise, which is a natural listening environment. Very often, they repeat the last part of a word or a question asked to them.

How do you find out if your child has this problem?

Kids with APD usually have normal audiograms (Pure-t
one). But they do not process auditory information normally.
If the auditory deficits aren't identified and managed early, many of these kids will have speech and language delays and academic problems.
Symptoms of APD can range from mild to severe and can take many different forms. If you think your child might have a problem processing sounds, consider these questions:

• Is your child easily distracted or unusually bothered by loud or sudden noises?
• Are noisy environments upsetting to your child?
• Does your child's behavior and performance improve in quieter settings?
• Does your child have difficulty following directions, whether simple or complicated?
• Does your child have reading, spelling, writing, or other speech-language difficulties?
• Is abstract information difficult for your child to comprehend?
• Are verbal (word) math problems difficult for your child?
• Is your child disorganized and forgetful?
• Are conversations hard for your child to follow?
• Are there frequent repetitions (of your speech) with blank expressions?

Although APD is often confused with ADHD, it is possible to have both. It is also possible to have APD and specific language impairment or learning disabilities.

Once diagnosed, kids with APD usually work with a speech therapist. Diagnosis in India is hampered in the absence of standardized tests for the same. However we co-ordinate with other team members like the occupational therapist and zero in on the diagnosis.

Problem Areas for Kids With APD

The five main problem areas that can affect both home and school activities in kids with APD are:

1. Auditory Figure-Ground Problems: when a child can't pay attention if there's noise in the background. Noisy, low-structured classrooms could be very frustrating.
2. Auditory Memory Problems: when a child has difficulty remembering information such as directions, lists, or study materials. It can be immediate ("I can't remember it now") and/or delayed ("I can't remember it when I need it for later").
3. Auditory Discrimination Problems: when a child has difficulty hearing the difference between words or sounds that are similar (COAT/BOAT or CH/SH). This can affect following directions, and reading, spelling, and writing skills, among others.
4. Auditory Attention Problems: when a child can't stay focused on listening long enough to complete a task or requirement (such as listening to a lecture in school). Kids with CAPD often have trouble maintaining attention. Very often they keep repeating parts of commands and other verbal instruction.
5. Auditory Cohesion Problems: when higher-level listening tasks are difficult. Auditory cohesion skills — drawing inferences from conversations, understanding riddles, or comprehending verbal math problems — require heightened auditory processing and language levels. They develop best when all the other skills (levels 1 through 4 above) are intact. Very often this is a feature confused with other diagnoses.

 Remediation:
Speech-langauge therapy , occupational therapy (sensory integration),  Remedial education.

One of the most important things that both parents and teachers can do is to acknowledge that APD is real. Symptoms and behaviors are not within the child's control.
What is within the child's control is recognizing the problems associated with APD and applying the strategies recommended both at home and school.

Early Intervention...... SO IMPORTANT!

Yesterday our Rehabilitation team reviewed 2 clients after 2 months of therapies (Speech-langauge and Occupational therapies).
CHild 1: aged 2y5m. with traces of Autism.
Child 2: aged 5y with Mild-Moderate Autism and Hyperactivity.
In the first case the child was probably evolving (Autism) and was caught on time. He has progressed very well and shows great promise in all areas. I am sure he will get admission in a school of his choice and may not require much of remedial intervention later.
 The second child was diagnosed about 3 months back. Usually we blame parents for not being alert to symptoms. But these parents were apparently being made to "wait" by their peadiatrician, saying, "dont worry, your child will speak, wasn't his father delayed in his speech?"
Very sad for them, its going to need an herculean effort on part of the parents and the therapists to get the child integrated into the society and then regular schools!

At this juncture, i want to throw light on an important parameter: EARLY INTERVENTION

• the moment parents feel that there is 'something' not correct in their  child's development, please consult a Neuro Developmental Peadiatrician at the earliest. (u can get the nearest contact from websites)
• Remember just because a parent or  family member spoke late, doesnt mean the child has to also do so. Delayed speech-language may have an underlying cause which need to get assessed. At least 90% of such clients i ve seen in the last 10 yrs had some or the other deep rooted problem.
• Language delay means academic delay.
• Different parameters need to be assessed before giving the child a clean chit.

SO Parents..... WATCH OUT!!

phillanthrophy............ is it?

Cover Story

(mumbai mirror, 12-5-12)


Temple reserves a floor in its new building to treat autism and other mental disorders



Ganpati fest gift for special kids from Siddhivinayak

The all-in-one clinic will offer treatment and support at a fraction of what it costs in private hospitals in the city


Thane resident Amit Khosla's son Ishaan was diagnosed with autism when he was two and a half years old. While the family took some time to accept this difficult truth, treatment wasn't easy.

In a city where the number of children with special needs could run up to more than 5 lakhs, finding therapists for the child is difficult. Doctors suggest different therapies, each of which is conducted at a different place.
Parents such as Khosla spend around Rs 35,000 per month on various therapies. The expense on the commute is an additional Rs 15,000.

To make the treatment more affordable and convenient, the Siddhivinayak Temple Trust has now planned to set up a state-of-the-art rehabilitation centre within the premises of the Prabhadevi temple, which annually gets over Rs 70 crore in donations.
The centre, which will be launched this Ganeshotsav, will be located on the first floor of the building that stands next to the temple.
Trust officials said that the centre - which is likely to come up in September - will have experts such as a paediatric neurologist, physiotherapist, occupational therapist, speech therapist, psychologist, ophthalmologist, orthopaedic surgeon and a dietician, all under one roof, and at a subsidised rate. Therapy sessions that normally cost around Rs 500 per hour will cost a maximum of Rs 100 at the Siddhivinayak centre.
The centre, which will work as a rehabilitation centre, will be open to children between the ages of six months and 12 years. It will provide quality care by experts to those with physical, mental, behavioural disorders as well as those with multiple disabilities.
Officials said that the trust will appoint a special coordinator for this centre who will allot time slots for each child. Each child will be provided a session of around one hour for his/her needs, the charges for which will range from Rs 50-100 depending on the parents' income. The frequency of the sessions will depend on the child's requirements.

Confirming the Shri Siddhivinayak Temple Trust's plans, its chairman Subash Mayekar said, "Our trust has always worked towards the benefit of people from poor financial backgrounds. After long discussions with various health experts we realised that there is a need to create such a facility for special children. We have heard of several families who had to discontinue treatment because it's very costly."
Mayekar added that the centre will work in two shifts of six hours each, the first starting at 8 am. The centre will also be affiliated with hospitals in case of emergencies. However, the centre will be shut on Tuesdays owing to the rush at the temple.

Among the prominent doctors already on board are Dr Anahita Udwadia-Hegde, consultant paediatric neurologist at the Wadia Children Hospital and Jaslok Hospital, Dr Sanjay Oak who is the dean of KEM hospital, Dr Shaila Weling, a consultant surgeon at Jaslok Hospital.
Besides the medical experts, the centre will also have a medical social worker who will assist the families get financial aid if they need treatment from outside the centre.
While this is not the first centre in the city where special children will be provided treatment under one roof - there are approximately 20 such centres in the city - medical professionals say that the demand is much higher than the supply. And the charges at these centres, which are run by private organizations, are also high with a minimum fee of Rs 20,000 per year for such care.

"Currently there is a shortage of medical experts who work in this field. So, parents have to run from one doctor to another. This also, hikes their expenses as such treatments are costly," says Dr Ashok Rathod, head of the department of JJ Hospital's Paediatric department.


My Take: Yet another attempt at phillanthrophy. What irks me is most reporters just put up some rubbish without checking out the facts. Whether its the costs of therapies involved or parental grieviences. There have been many such trusts who ve trie...d to 'make things easy' for parents but landed up doing nothing eventually.... the child's precious time has been wasted. Why r pvt practitioners shown as devils........ is it just because they charge for their time and expertise? Why... dont we ve homes to run too? dont we face inflation too?



(for those who take this report seriously) Please spare a thought, why will therapists slog it out if they r going to be paid meagre amounts? So first compromise will be on quality. Secondly, many of the so called medical super specialists mentioned here, ve their callender running full for next few months in their pvt practises!! (my clients face it dialy) and they r to come here??? Come on........ we must be realistic.


Dear reporters do c the other side of the coin too!!

Is your hearing-aid suiting you???

Hearing aid industry has developed different types of hearing aids, some people need to personally control their hearing aids while someexperienced wearers,  still need either a volume control, multiple memory switch (quiet versus noisy situation switch) or a remote control in order to control volume or to access different hearing aid programs for handling different listening environments. Some people need control of their hearing aid for the following reasons: the automatic programmable feature does not meet their needs in 100% of listening situations; psychologically the hearing aid wearer simply must have control of their hearing aids; or they are long-term hearing aid wearers who are used to a volume control and are therefore unwilling to part with it through habit. (Usually happens with those who have used analog aids for long and are now suddenly fitted with digital programmable ones!!


Types of hearing -aids.
open fit,  BTE,              ITE              ITC         CIC
It is very important that the user determine his needs with respect to controlling the hearing aid. You don't want to fiddle with your hearing aids every ten minutes but then again you don't want to be frustrated because your hearing aids work well in most situations but not in 10% of your favorite situations (e.g. listening to soft music).

Sound Quality
One of the most important aspects of an enjoyable hearing aid experience is that you like the sound quality of hearing aids. So during hearing-aid trial, make sure that you consider the following 

•Do you like the sound of your voice?


•Is the sound clean and crisp (sound clarity)?


•Is the sound too tiny?


•Does your hearing aid seem to plug up your ear and in fact muffle sound?


•Does it make some pleasant soft sound audible to you?


•Are loud sounds uncomfortable to you?


•Are your hearing aids natural-sounding?


•Does music sound pleasant and rich in texture?


•Does the world sound like you are in a barrel?


•Does your hearing aid whistle, buzz or squeal on its own?

do you have trouble listening in niose?

With today's modern digital hearing aids, most of these problems should be solved. If you notice any of these problems during the trial and in your follow-up visits, by all means talk to your audiologist about these issues. Such professionals are capable of adjusting your hearing aids to your satisfaction. The extent to which all of the possible sound quality issues can be resolved is of course, dependent on the severity of your hearing loss. In other words, some types hearing losses (even some features like, if the audiogram is slopingor steeply aloping or reverse sloping etc) are simply more conducive to restoration of rich sound quality in many listening environments while others are not.

Cosmetic appeal???
 A lot many people these days request for invisible aids!! (read Completely in the Canal ). One must know that CICs do not suit everyone. Most of the times the request for CIC is always cosmetically linked.
Its imperative that one should discuss the candidacy with ur audiologist. As far as cosmetics go even Behind The Ear (BTE) are available in various sizes and provide a better range of options for the fitting as well as budgets!!

Realistic expectations....
Be realistic. At times during Trail  a relative accompanying the patient speaks to the client in a muffled voice in noisy background and expects the client to "hear normally". Many a times i ve to repeat the experiment on that 'normal hearing individual' to prove that even he cant hear it!!!!
Remember that it takes time to get used to hearing aids, especially if you're a new wearer. Keep in mind that background noise is almost always part of your environment, and adjustment to it is required. In time, you will tune out many of these everyday sounds. It's important not to become disappointed or frustrated while your brain begins to adjust to a whole new world of sound. If you're an experienced wearer trying new hearing aids, understand that they might not sound like your old ones. Before you reject them, allow your ears and the auditory system to adapt to these new sounds. Youing aids  just might find that you like this new sound better than the old one. Keep in touch with your audiologist to get ur queries answered.

Regular follow-up.
This is important if ur hearing aids have to last long (usually 5yrs is optimum). This also helps in fine tunning the hearing aid based on ur requirements if its a digitally programmable one.

School for slow learners

hello readers,
      while we rehab professionals rejoice about the RTE benafits for the specially abled. (i am talking only for Navi Mumbai)

 I am a die hard believer in integration but the issues are numerous.... These children (slow learners) cant cope with the academic load. Even Learning disabled are singled out and troubled and teachers are over worked in class room with avg 50-60 children. In 2006-07 our rehab team had tried convincing a popular chain of schools to start remedial ed classrooms for slow learners with a view to prevent discrimination and also to help them academically but it dint work. Also most of these children being specially abled with otheir concommitant problems, integration is a far cry. Ultimately an exclusive school is the only option.
  
2of my immediate clients rt now face a blank future from June and i for a change seem to ve no words to say anything to them.

Rajya Sabha clears amended RTE bill, kids with disability to get benefits


The writer has posted comments on this articleTNN
Apr 25, 2012, 04.46AM IST

NEW DELHI: The Rajya Sabha on Tuesday passed the Right of Children to Free and Compulsory Education (Amendment) Bill, making it possible for differently abled children to get benefits under the legislation. The amended law will also provide children with severe disability an option of receiving education at home.

Children with cerebral palsy, mental retardation, autism and multiple disabilities will also be "explicitly" covered under the amended law.

Moving the amendment bill for consideration, HRD minister Kapil Sibal said it would provide the right to receive home-based education to children with severe disabilities. "It is a historic piece of legislation and will have a huge impact on quality education to children between classes 1 and 8 in the 6-14 age group. The bill will change the way we look at education," he said.

Winding up the debate on the bill, Sibal said he shared the concerns of members against use of the word "disability". He hoped that concerns of members would be automatically addressed in the RTE Act once the social justice ministry amends laws to include some more categories under the definition of disability.

Referring to one of the provisions of the RTE Act under which all schools except unaided minority ones will provide free education to children from deprived sections, Sibal said the government will adequately contribute to these schools.


He said the government's contribution would be to the tune of Rs 6,000 to Rs 19,000 per student per annum. "There are 80-90% of private schools whose annual tuition fees are less than Rs 19,000 and less than the contribution made by the Centre," he said. The Act provides 25% reservation for students of disadvantaged sections in classes.

It also provides for establishing school management committees to prepare school development plan. However, the school management committee in respect of minority institutions will function only in an advisory capacity.

After passing of the amendment bill unanimously, the Upper House also took up for consideration the Central Educational Institutions (Reservation in Admission) Amendment Bill which seeks to extend the period for mandatory increase of seats in such institutions from over a maximum period of three years to six years.
The legislation, which came into effect in 2007, is meant for reservation in admission for students belonging to SC, ST and OBC to the extent of 15%, 7.5% and 27% respectively in certain central educational institutions -- established, maintained or aided by the central government.

My Take: I am personally not in agreement with certain provisions like Giving free seats for children from the economically lower segments. Not because iam against them studying but because i am worried about the psychological scarring that they may have to put up with for the rest of their life. I think the funds can be channalised to improve the conditions of the existing Govt and municipal schoold so that these children can avail of all facilities like in unaided schools. (AND THIS IS POSSIBLE).
As far as the specially abled are concerned, i applaud the efforts on the part of the Govt and hope the ball gets rolling and the  Act actually sees the light of the day!

Hearing aids for Senior citizens.... Need for a reality check!

 Usually senior citizens sufferring from hearing loss have a common complaint. " I can hear u but cant make out what ur saying", " dont increase the volume (speaker or TV) ... my ears ache" "I cannot tolerate loud sounds.... "

 Some who have been using hearing aids complain, " its a waste of money. i cant make out anything..", " the noise is irritating and i get a headache". Very often these hearing aids are discarded. Of all my senior citizen clientele that were aided before about 90% of them had rejected their hearing aids.
What goes wrong?

• The first fault lies in testing itself. Many people go for 'fitting' hearing aids (usually to distributors) without doing a hearing test or an audiogram. How on earth can the fitting be done?
• It is very important that a complete audiometry which includes an audiogram and speech audiometry be performed on the client. Also the tolerance levels can be checked. Speech discrimination scores are particularly needed if the person has "clarity" issues.
• Many people do not use ear moulds (when needed).
• Due to financial reasons amny senior citizens compromise on the quality of hearing aids. For instance, a programmable hearing-aid will give better clarity than non-programmable ones but they do come at a cost. These days there are good programmabble aids which are reasonable. One must ask the audiologist for the same.
• A very important factor is "realistic expectations" from hearing aids. The end user should be told about what is to be expected after the fitting.

A point to draw home: Senior citizens with hearing loss usually suffer from nerve deafness which makes it imperative that their hearing aid fitting be accurate considering different factors and more importantly the outcome expectation should be 'realistic'....

Autistic Spectrum.......

Autism Awareness

I saw this little child all of 2yrs 2 m, who was reffered for lack of "speech". It dint take long to see that he demonstrated features of Autism (apparantly mild). tHe reason i am mentioning it here, is because this child has a history of G6- PD deficient anemia, when he was a few months old. Though health wise he is now better, i was wondering if the features of autism were in anyway linked to the genetic disorder. According to wikipedia, Glucose-6-phosphate dehydrogenase deficiency is an X-linked recessive hereditary disease characterised by abnormally low levels of glucose-6-phosphate dehydrogenase (abbreviated G6PD or G6PDH), a metabolic enzyme involved in the pentose phosphate pathway, especially important in red blood cell metabolism. G6PD deficiency is the most common human enzyme defect.^[1] Individuals with the disease may exhibit nonimmune hemolytic anemia in response to a number of causes, most commonly infection or exposure to certain medications or chemicals.

But what is important now is Immediate commence ment of Sensori integration (occupational ) therapy, Followed a little later by Speech-language therapy. Ideally he should progress well. But only time will tell. In this case it is also vital that proper genetic counselling be done particularly if the parents wish to go in for a second issue.
Good luc to the kiddo.
(pic courtesy: Parenting4tomorrow.com)

Earmolds: Practical Considerations to Improve Performance in Hearing Aids | September 2009 | The Hearing Review | Hearing Review Products

Wonderful article. A must read for audiologists.

Earmolds: Practical Considerations to Improve Performance in Hearing Aids | September 2009 | The Hearing Review | Hearing Review Products

Hearing aid batteries:


Zinc-air button batteries use highly caustic potassium hydroxide as the electrolyte, which causes severe burns when exposed to delicate tissue, as the batteries have vent holes in them to extract oxygen from the atmosphere to use as part of... the battery chemistry.
In fact, the 24/7 National Button Battery Hotline (202-625-3333) was established over 20 years ago by the industry specifically for cases like these. It's also the reason why hearing aids have tamper-proof battery compartments, to keep kiddies out.

This information was shared by a good friend and a fellow audiologist.
Whenever we as audiologists instruct ppl about batteries we forget these little important things.

Three important points to drive home:

1. Keep hearing aids out of reach of children and pets!
2. Do not keep hearing aids very cose to or on any electronic item.
3. Do not leave batteries loose...... If its done with then discard it.

Noise hazards......

(also read earlier blog: Noise...... Beware!)

Noise Induced Deafness........ partial though!!

   I wonder if its a co-incidence, but For teh last 3 weeks continuously, i have seen clients reporting with the complaint of unable to hear soft sounds.... especially amidst murmurs (like in offices). Typically follwing were the complaints:

• Unable to 'make out' what the speaker just said... though i heard it.
• Unable to follow speech while i drive.
• unable to follow speech when there is background noise (even though its not loud)
• Unable to follow speech if i dont lip read..... especially if its a woman talking!!
• difficult to follow conversation in board meetings.

All these guys were holding very good positions in their fields but the hearing problem was interfering in their lives. The audiogram was something like the following:
 It is to be observed that the hearing thresholds are normal till about 1000Hz but then on the thresholds dip mainly at 4000Hz. (Normal thresholds are upto 25 dB across all frequencies.

Indepth analysis of their heariing habits revealed, ALL OF THEM SPENT MOST OF THEIR WAKING HOURS ON THEIR CELL PHONES FOR THE LAST FEW YEARS.... MAINLY IN THE LAST 2 YRS!!

Phew..... 400-500 calls a day, occasionally on handsfree listening to music..

Not just these individuals but, i see so many young adults glued to their cell phones all the time....... either chattingor listening to music. At times the music played is so loud that even the neighbouring guy hears it!!

When this happens habitually, medically we are damaging our ears. The area which is damaged first is sensitive to high frequency hearing...... so that accounts for the typical audiogram seen above. If not curtailed, then eventually all the frequencies shall dip and the hearing loss will progress.

 

Point to drive home: The next time you feel tempted to use that handsfree or have long chats over

the mobile phone....... u know what to do!!

LEARNING DISABILITY (LD)

HI all.
whenever we admit our kids to school, we undergo a sense of euphoria... In bollywood style, "padh-likhkar badaa aadmi banega" and so on and so forth. Usually the school years pass by quickly even b4 we actually realize it!!
But what happens when there is a stumbling block? What happens if ur child is unable to study (not because he doesnt want to).... is subjected to humiliation in class and back at home? Well its time we have a reality check.
Aamir Khan had popularised Learning disability via his movie 'tare zameen par'. The young Ishaaan in the movie was the butt of jokes and ridicule till he was intervened.....


But such awareness is just a small beginning. We have a long way to go. Early diagnosis of children is the key to successful rehabilitation of children with LD.



(read more on Understanding and Supporting Learning Difficulties



by: Ms Areena Loo, Bridge Learning)


I had this child all of 8 yrs visiting me for a complete evaluation. He presented a picture.... he was smart, witty and quick to respond to any query abt anything under the sky.He apparently was very good in sports!  But when it came to reading and writing skills, he showed classic symptoms of LD. His shocked mother only said " why dint anyone tell me about this problem while i kept reprimanding him for his studies?"
It is surprising that though we ve come a long way since the establishment of Maharashtra Dyslexia Association, many school teachers, principals and peadiatricians and far from being aware of signs and symptoms of LD.

The catch here is the school boards (SSC, CBSE and ICSE) accept only reports from SIOn and Nair hospital and they inturn do not assess a child without a refferal letter from school! Most school principals whom i ve come across in my career DO NOT give any such letter and the child is left to fend for himself. Some manage by attending therapies and remedial education, but the severely afftected suffer the most due to apathy of a few.
Its time we wake up. Lets look around us. Most children with LD ve poor attention span  and are very distracted. They sometimes ve history of delayed motor milestones. These are red flags and an alert teacher or parent can make the most of it and prevent further debilitating effects.
PLEASE BE ALERT!



18-4-12

REcent updtae from the child:
As expected the school 'refused' to give a letter for his official diagnosis to the hospital, which now refuses to conduct evaluation. Occupational therapy assessment is done with and LD (with some features of ADHD......quite common)  is confirmed. His therapy has been initiated, but he needs help, i.e the facilities provided by the board.
My question to these schools, ' Why is the letter not given to the child? Its his right to ve a proper education.' There are very negligible schools for slow learners and those with scholastic backwardness...... where do these kids go, if the schools where they r in doesnt support them. I know that there r false positive cases too but most of these children are innocent victims and targetted for no fault of theirs. Why do they ve to suffer humiliation in class just because they ve some perception problems making reading and writing difficult for them?
AWARENESS is the need of the hour. ACCEPTANCE...... first by the parents then teachers and then classmates (through teachers) is very important, if the chld with LD has to have a normal school life.
I hope better sense prevails.

Hearing aids........ needed or not?

Sharing with u readers about a client i saw very recently.  This lady had a lot of other issues besides her hearing loss. However a non-audiologist tried to fit her with an aid on the behest of an ENT (guys.... nothing personal here).  When they came to me for a second opinion, i found that she demonstrated classic symptoms of a medical condition and her 'fluctuating' hearing loss was just the tip of the ice-berg. I halted her hearing aid fitting, did a complete audiological evaluation and immediately reffered her to an ENT for complete evaluation.
Point to draw home: All hearing losses dont or cant be fitted with a hearing aid. There is a lot more to it than what meets the eye. One should always take things with a pinch of salt. Consult and audiologist for  complete testing before u decide on fitting urself with an hearing -aid!

8/04/2012
Just for an updtae here, She is confirmed with the medical diagnosis and is progressing well with treatment. I shudder to think of the damage that cud ve been caused to her ears had she been fitted with hearing aids!


We need to WATCH OUT!!

hearing education....

CONSUMER EDUCATION..... A MUST!

This is one of my experiences i want to share. Parents of children with hearing impairment are often at a loss when it comes to "what is best" for thier children. I saw a child with Moderate - moderately severe hearing loss (now 4 yrs old), diagnosed at a very good age i.e. 2yrs. HOwever parents were made to run from pillar to post over the hearing aid fitting and speech-language therapy.
An important reason for putting up this case here is, this child suffered from Middle ear infections. It is very very important to note that, the middle ear infections are often treatable and the hearing loss resulting from them are reversible. However very often the hearing loss is fluctuating and the child gives inconsistant responses. The parents and also the professionals involved should judge this.

A point to take home: Unless the child with hearing impairment also has Auditory Processing Disorder, it is highly unlikely that he will not develop adequate speech-language!!

BERA test!

Hello friends,

This happened a couple of days ago and i thought i must share it with you.

BERA (Brainstem Evoked Response Audiometry) is many times used for determining the extent of hearing loss in peadiatric patients and is also an important tool in test battery for diagnostic purposes. the procedure requires the child to be sedated before the electrodes are placed.

HOwever of late this has been widely misused by vested interests and put forth as a money making machine. A client of mine whom i had tranferred to another professional due to unavoidable reasons was a recent victim of such gimmics. The child in question is hyperactive with mental retardation. The therapist instead of catering to her speech-language status, insisted on getting her hearing status "confirmed " by BERA test. The child was tried sedation but it dint work and finally after gruelling attempts to try to make her sleep were in vain, the parents were charged a whooping Rs 3000/- I question: was this test needed? why was it even attempted?

In yet another instance, a Cerebral palsied child with a birth hisotry of severe kernicterus (jaundice) was fitted with strong hearing aids (worth Rs 1 lakh). On performing a BOA (behavioral audiometry), it turned out the child had normal hearing. I repeated the tests thrice and the child consistently responded to normal levels. From then on it was a struggle for the parents to get back the money!! (they eventually got it after 3 months  and after threatening the dispencer with media interference)

At this stage i only want to  point. BERA is NOT a test of hearing. It should be a part of the test battery. Hearing aids for children should be fitted only when the complete test battery is indicative of hearing loss.

UPDATE ON THAT CHILD:

I repeated this child's hearing test and now that his neck-control is much better, he gave me very good neck turning responses for sound and speech. The icing on the cake is he has started to speak in monosyllabic words, further strengthning the normal hearing diagnosis.
The point to draw home here is, the parents had to undergo undue anxiety (added to already existing ones) due to misdiagnosis. I wish the earlier guys had performed the test battery and observed the child .... this would have prevented all the heart burn. BUt then, 'better late than never'............

hearing loss!!

                                  Myths and challenges in hearing rehabilitation


What does one do when he has a hearing loss that is irreversible? Well, he uses a hearing-aid! (Wish the solution was as simple as that). Hearing rehabilitation is a challenge especially when those at the receiving end are children or senior citizens. Hearing aid dispensing these days is done indiscriminately. The aim of this article is to educate a potential receiver about the difficulties he may be facing and the possible options available for the same.



Adult hearing rehabilitation:

Whenever hearing loss is suspected or if the person is genetically or environmentally pre-disposed to hearing loss, it is mandatory that he undergo a hearing test at least annually. A qualified audiologist will perform a Pure Tone Audiometry along with Speech Audiometry and determine the degree and type of hearing loss. Speech Audiometry becomes important when a person complains of ‘not being able to understand’ in spite of ’hearing’ it. If middle ear problems are suspected then the ENT recommends an Impedance Audiometry. Hearing disorders (loss) which can’t be medically reversed, need to be compensated with adequate amplification i.e. hearing aid(s).

The client today is spoilt for choice with a number of companies and a number of hearing aid models! The advent of technology (read programmable hearing aids) has only added to the audiologists’ challenge. Though a client may insist on a particular make or company (usually because he has heard more about it, it is the audiologist who should help him make the ‘correct’ decision based on:


• Audiological suitability

• The clients’ specific requirement (i.e., traffic, interviews, board room meets, home, etc)

• Cosmetic requirement

• Financial aspects.

Digitally programmable hearing aids are a blessing for those with slopping hearing losses or the post-lingual deaf. These hearing aids (barring a few) have their limitations in cases of severe to profound hearing losses. The client must know that, more the number of features, greater is the cost. These features should be discussed with the audiologist before zeroing on aid (s) for trial. Once the fitting is done, the client should be informed of the care and maintenance of the hearing aid. Fine tuning (in case of digitally programmable hearing aids) should be conducted at least within a month for adequate benefits.

The client should be clearly explained about realistic expectations from a hearing aid and the limitations of the same. An important point to draw home is a hearing aid is ultimately an amplification device which can never replace our ears. Remember this when you light that sutli bomb the next time…….. Ears are precious!!




Hearing loss in children:

Aural habilitation in children is of utmost importance due to the developmental issues involved. Even before adequate amplification, comes ‘the correct diagnosis’ of hearing loss. It is often observed that a child at-risk for hearing loss or suspected loss is advised to undergo OAE and BERA. No harm done! But BERA is not a test of hearing… if it indicates a loss, then it has to be clinically correlated. From the age of 4 months a Behavior Observation Audiometry (BOA) can be performed and after about 6-8 months a Visual Reinforcement Audiometry (VRA) may be done. If hearing loss is indicated, then the child undergoes observation therapy sessions and finally gets fitted with the hearing –aids. Option of cochlear implants too should be explained to the parents. Once the child is aided then begins the very important stage of auditory training and speech-language therapy. It is a myth that the child with hearing impairment will speak immediately after fitting with hearing aids, without adequate training.

Another issue is the concept of partial deafness in children. Usually the age of diagnosis is higher considering the loss. However it is important that the parents `accept’ the hearing impairment and do the needful.

Considering the critical period of language development, it becomes imperative that the child be diagnosed early and habilitated well. So parents…… if your child is at risk, gear up quickly, else you may miss the bus!!!

Hearing testing for Adults

Now that i ve my set up for audiological services, here r a few pointers that i would like to share with my clients and readers.
Hearing testing of adults begins from the time the client enters the clinic. Conversation with the client gives us an idea about the possible severity of the hearing loss. I.e is the speech just audible to them or is it intelligible too!! Proper questioning helps us later with the choice of special tests needed for differential diagnosis.

1. Initially the Tunning fork tests must be performed (Rinne and  Weber).
2. then the Pure Tone Audiometry
3. It is very important to perform the Speech Audiometry, particularly from Differential diagnosis point of view and if the person needs a hearing aid.
4. impedance audiometry

Hearing aid trial is very important. The client should be informed about the hearing aids available which suit him and the reason behind selecting the aid. Encourage the client to read up, if he doubts our decision.



Ultimately it is the trust of the client which will determine whether he will come back to the clinic for a follow-up or not . Hence it is important that the clinician be ethical and honest to his profession.

hi again

hello readers,
am back after a looooooong personal hiatus. A lot has taken place on the professional front that i will be sharing with u over a period of time. FOr firsts, i have my dedicated Speech and Hearing Set up in Navi mumbai!. I ve restricted speech-langauge therapy only to children and Audiological practise is for both children and adults. Once again, my goal is not just rehabilitation, but also educating the client on his/her rights. I hope to do a good job!!.
Priya