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

Proactive CBSE

hello readers,
the following article was publised in The Times of India (Mumbai) on 4th Feb 2010.

Take special kids or face action: CBSE Anahita Mukherji, TNN, 4 February 2010, 02:52am IST

MUMBAI: The Central Board for Secondary Education (CBSE) has taken a huge step towards offering equal opportunity to all children seeking an
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education, including those with ``special needs''. The board has reminded its schools that admission cannot be denied on the grounds that students were differently abled. A recent Board circular says, ``It is being reiterated that any school which fails to provide attention to a child with special needs or makes a pretext of denying admission to any category of differently abled children will be liable to stringent action even to the extent of disaffiliation. '' The statement in the circular is attributed to Vineet Joshi, chairperson of the CBSE. The circular makes it mandatory for schools to have a special educator and to create an ``individual evaluation programme'' for special children based on their abilities and skill sets.
Special children include a range of kids, including those who are physically challenged, visually impaired, hearing impaired, spastics, and those who have Down Syndrome, Learning Disability (LD) and autism. LD can include dyslexia, dysgraphia, dyscalculia and other conditions. Since special children may not be able to focus on the teacher during classroom interactions, and their pace of learning may be at variance with the rest of the class, schools have been told to allow a parent or aide to sit with the child in class and motivate him to ``move along with the rest of the class''. A senior CBSE official said the new policy would be easier to implement now that the board is set to make the Class X board exam optional and replace it with a system of continuous and comprehensive evaluation. ``Earlier, schools were obsessed with the marks their children scored in Class X and would even include these marks in the advertisements for their school. This also led to schools excluding children with special needs as they felt these kids would spoil their record at the board exams. The fact that board exams are losing their significance will help our new policy work,'' said the official. The CBSE board also wants to start grading schools, a system that would help the board pull up schools that do not offer inclusive education. ``Thank God for this decision,'' said Sheetal Kumar, the lawyer whose battle against an apathetic system led to the Bombay High Court's landmark ruling on LD three years ago. ``I feel this is a very proactive step on the part of the CBSE board, which is one of the most child-friendly boards in the country,'' said Avnita Bir, principal of R N Podar School, Santa Cruz. Cherian George, principal of Kendriya Vidyalaya, IIT Powai, also gave the policy a thumbs-up. ``This is a very positive step and will definitely give special kids a leg up. I think the new move will do a lot to spread awareness about kids with special needs,'' said Usha Bhatia, principal of the Shapurji Billimoria Trusts's teacher training course, the first in Maharashtra to train teachers in integrated education.
There are, however, sceptics who wonder how the policy will take off. ``Are teachers equipped to deal with special kids? Do we have the infrastucture and training to implement such a policy?'' asked the mother of a boy with Down Syndrome. Psychiatrist Dr Harish Shetty, a pioneer in the LD movement in the country, said India has way too many excuses for not implementing inclusive education. He said inclusive education does not need massive funds, just a change in mindset. ``We can't wait for schools across the country to be ready for integration before we pass a policy,'' said Shetty, adding that the CBSE's latest missive was a landmark for inclusive education.

i take this stance to congratulate the parents on the success of their long fought battle. This is the first step towards inclusive education. I thoroughly advocate mainstreaming children with special needs (in the educable category). The specially abled also need opportunities which can help them adjust to the society. In my experiense i have seen some children actually flourish when given opportunities and the school staff dint have to make any special provisions for them. they followed up therapies regularly outside and hollistic development was simply wonderful.
However as a caution i recommend parents to follow-up with the school regularly regarding the progress of the child. There have been instances where schools have hidden facts from parents and later have used the child's underperformance as a tool to expel him from school. And please co-operate with the school teachers on all issues.

This is indeed a pro-active step by the CBSE and i hope it will be taken by schools in a positive spirit.

Occupational therapy blues.

Dear readers,

First of all i apologize for not writing for long. Actually have been busy with work. In fact it was one of the reasons i got back to writing.
As most of us know, Occupational therapy (sensory integration) is one of the most important parts of rehabilitation for a child in the Autistic Spectrum. However most therapists i know have been taking undue advantage of unsuspecting parents. I put forth a few pointers which can help already harries parents confront erring therapists and coax them to do thier Job!!... this in the benefit of the child.

1. Sessions ahould be conducted individually, atleast till the child settles, on a one - to -one basis.
2. home programme should be provided to the parents at regular intervals and the goal behind each activity should be explained so that parents can work effectively.
3. there should be regular discussions (atleast once a month) with other professionals working with the child so that the holistic progress can be attained.
4. therapy schedules and timings should not be frequently changed as this hampers the routine of the child. I know of cases where the parents have to call everytime before the sessions to confirm timings and there is no progress in the children.

Hope these points are useful. Good luck and Take care!