Hearing Impairment by dfgh4bnmu



          Hearing Impairment
                                  R          Mulligan, DDS, MS
                                  Roseann M lli        DDS
                      Herman Ostrow School of Dentistry of the
                              University of Southern California

                                                                 1                                                  2

                                                                                JAMA, July 4, 2007—Vol 298, No. 1

   278 million - moderate to profound bilateral hearing loss.
    (WHO 2005)
   ↑ population and longer life expectancies.
                           g    p
    80% of deaf and hearing-impaired -low- and middle-                  50% of deafness and hearing impairment
    income countries.
   Leading cause of mild to moderate impairment in
                                                                         is avoidable through prevention, early
    children –                                                           diagnosis, and management.
     Chronic middle ear infection.

FACTS ABOUT HEARING                                                  FACTS ABOUT HEARING
IMPAIRMENT AND DEAFNESS                                              IMPAIRMENT AND DEAFNESS
                                                                 3                                                  4


   Congenital: congenitally deaf; born with                                  Deafness can be inherited.
   Acquired or adventitious: born normal; suffer
    diminished hearing later.                                                 Pre-natal and peri-natal causes
                                                                               P       t   birth
                                                                                 Premature bi th
    ◦ Prelingual deafness
    ◦ Postlingual deafness
                                                                               ◦ Anoxia during birth
    ◦ Presbycusis                                                              ◦ Infections of the mother: e.g. rubella, syphilis
                                                                               ◦ Ototoxic drugs
    Evidence suggest that normal language patterns are                        ◦ Jaundice of newborn
     maintained if deafness occurs after age 5
                                                                           CAUSES OF HEARING
Classification by age of onset                                             IMPAIRMENT

   Post Natal                                                                    Current annual production of hearing
    ◦ Infectious diseases such as meningitis, measles, mumps and
      chronic ear infections.                                                      aids is estimated to meet less than 10%
    ◦ Ototoxic drugs at any age.
                   g       y g                                                               need.
                                                                                   of global need
    ◦ Head injury or injury to the ear can cause hearing impairment.
    ◦ Aging
    ◦ Smoking
    ◦ Excessive noise
                                                                                          Cochlear Implant

CAUSES OF HEARING                                                          FACTS ABOUT HEARING
IMPAIRMENT AND DEAFNESS                                                    IMPAIRMENT AND DEAFNESS
                                                                       7                                                            8


   Hearing impairment impacts development in                     Facts about hearing:
    ◦   Speech
    ◦   Language                                                      Presbycusis is a common
    ◦   Education
                                                                       problem among older
    ◦   Social integration
   Severity of impact related to                                     Hearing loss = 3rd most
    ◦ level and type of hearing impairment,
                                                                       common chronic health
    ◦ age of onset, especially if it begins before the age
      of speech development.                                           condition among older


                                                                                                 HEARING IMPAIRMENT
IMPAIRMENT AND DEAFNESS                                                                                AND DEAFNESS
                                                              9                                                                                               10

                                                                   Blockage by wax or foreign bodies
   Refers to complete or partial loss of the                      Excessive noise – environmental, work -
    ability to hear from one or both ears.                          related, recreational
                                                                   Accumulated exposure to noise will result
   There are different levels of hearing                           in hearing impairment or deafness.
    impairment: mild, moderate, severe or
                                                                  CAUSES OF HEARING
Hearing Impairments                                               IMPAIRMENT AND DEAFNESS
                                                             11                                                                                               12


Types:                                       Conductive:

 Conductive                                  ◦ problem - outer or middle ear
                                                  childhood middle ear infection
 Sensorineural
                                                  punctured eardrum
 Neural                                          presence of fluid in the middle ear
 Mixed                                           accumulation of ear wax in the external ear canal

                                             Hearing Impairments
Hearing Impairments                     13                                                             14

                                                Sensorineural
 Involves a reduction in sound level            ◦ Problem: inner ear or nerve going to the brain
 inability to hear faint sounds                   usually permanent
                                                   requires rehabilitation, w/ limited success
 can often be corrected through                   Common causes
      medicine or surgery                            ◦ aging
                                                     ◦ excessive noise
                                                     ◦ smoking
                                                     ◦ genetic disorders
                                                     ◦ infectious d sease
                                                          ect ous disease

Conductive Hearing Loss                      Hearing Impairments
                                        15                                                             16


   Sensorineural hearing loss may result
    from lesions in the inner ear or 8th CN.
       Cochlear: there is damage to the inner ear

Sensorineural Hearing Loss                                Cochlear Implant
                                                     17                                                                                           18

 Sensorineural hearing loss results in                      As a result of exposure to
  ◦ a reduction in sound level
  ◦ less ability to hear faint sounds
               y                                              ◦ Abrupt dangerous levels of
  ◦ affects speech understanding or ability to
    hear clearly.
                                                              • Loud sound over extended
                                                                   periods of time


Sensorineural Hearing Loss                                Noise Induced Hearing Loss (NIHL)
                                                     19                                                                                           20


             Reaching Hazardous Levels of Sound                                          Neural:
                                                       • Extended exposure to
                                                       sounds >85 decibels can
                                                       cause hearing damage               ◦ Problem – auditory nerve damage
                                                       • iPods can produce
                                                       sounds >105 decibels!
                                                                                               Profound and permanent
                                                                                               Auditory brainstem implant (ABI) is only possible
                                        Go To:               i d f     / h i ihl h l
                                        G T www.generationdeaf.com/whatisnihl.html

   Avoiding                             to calibrate your iPod setting

   Noise Induced Hearing Loss (NIHL)                                                     Hearing Impairments
                                                                                    21                                                                  22

                         Etiology of Sensorineural Hearing Loss
                 Category                                       Example                      Conductive and sensory hearing loss
Developmental and hereditary                                                                  ◦ Middle and inner ear affected simultaneously.
Syndromic                                  Alport syndrome, Usher syndrome
                                                                                             Causes
Nonsyndromic                               Large vestibular aqueduct syndrome
                                                                                              ◦   otosclerosis involving the ossicles and the cochlea
Infectious                                 Otitis media, viral, syphilis
                                                                                              ◦   transverse and longitudinal temporal bone fracture
Pharmacologic toxicity                     Aminoglycosides, loop diuretics
                                                                                              ◦   head trauma
Trauma                                     Head injury, noise-induced, barotrauma
                                                                                              ◦   chronic otitis media
Neurologic disorders                       Multiple sclerosis
                                                                                              ◦   cholesteatoma and middle ear tumors
Vascular and hematologic disorders         Migraine, cryoglobinemia, sickle cell
                                                                                              ◦   some inner ear malformations
Immune disorders                           Polyarteritis nodosa, HIV
Bone disorders                             Paget disease                                 Mixed Hearing Loss
Neoplasms                                  Vestibular schwannoma
                                                                                    23                                                                  24
Unknown etiology                           Presbycusis, Meniere disease


 Implies
    p             g
            hearing is defective, but                          Deafness    refers to the complete
    functional                                                    loss of ability to hear from one
                                                                  or both ears.

Hard of Hearing                                               Deafness
                                                         25                                                            26

 Congenital: congenitally deaf; born with                       Prelingually deaf individual
  impairment.                                                      born with insufficient hearing to acquire speech
 Acquired or adventitious: born normal; suffer                     normally, or
  diminished hearing later.                                        lost hearing prior to the age at which speech is
    ◦ Presbycusis
    ◦ Prelingual deafness                                        Delayed language acquisition
    ◦ Postlingual deafness                                       Delayed social development
                                                                   Inability to pick up auditory social cues
                gg                    g g patterns are
    Evidence suggest that normal language p
     maintained if deafness occurs after age 5                   Often results in irritability

Classification by age of onset                                Prelingual Deafness
                                                         27                                                            28


 Occurs after the age at which spoken                               Is the onset of deafness in older life.
  language normally acquired (~age 3)                              Hearing          loss with aging
 Effects on speaking, reading, writing, and                          ◦ Genetic (deafness often runs in families)
  speech                                                              ◦ Adventitious (from insult to the hearing system by
                                                                        environmental sound)
 Depends on the individual and duration of                           ◦ Smoking
  hearing loss                                                        ◦ Other factors

Postlingual Deafness                                              Presbycusis
                                                             29                                                                          30

   Sounds often seem less clear and lower in volume.
   Difficulty hearing and understanding speech.
   The speech of others seems mumbled or slurred.                   Auditory centers of the brain are affected by
   High-pitched sounds difficult to distinguish                      ◦ injury, disease, tumor, heredity or unknown causes.
     e.g."s" and "th“                                                                       loss.
                                                                      CAPD may have hearing loss
     women’s voices                                                 CAPD involves multiple components of sound
   Conversations difficult to understand, especially when            ◦ E.g. localization and lateralization, auditory discrimination,
    background noise present.                                           auditory pattern recognition
   Certain sounds seem annoying or overly loud.
               ringing, roaring,
    Tinnitus (a ringing roaring or hissing sound in one or
    both ears) may also occur.

Presbycusis                                                       Central Auditory Processing
                                                             31   Disorders                                                              32


                                                                                             •       Only speak to the patient when
 Oral Health Needs of Children with Hearing Impairments                                              he/she can see your face.
                                                                                             •       Always be at eye level.
                                                                                             •                                        g
                                                                                                     Turn off all extraneous sounds e.g.
                                                                                                     music, HVAC, etc.
                                                                                             •       No backlighting or shadows on
                                                                                                     your face.
                                                                                             •       Light face so that facial
                                                                                                     expressions, lips can be read.
                                                                                             •       Speak to patient before putting on
                                                                                                     mask and beginning treatment.
• Significantly higher rates of caries than a comparison general population
• Parental ignorance about oral health care
                                                                                             Communication tips
                                                Journal of Oral Science 50(20):161-165. 33                                                        34

    Modulate voice - speak slightly louder than normal, but                                      Eliminate extraneous noise in the operatory
     don't shout.                                                                                 Conclude all discussion with patient before
    Speak at your normal rate - do not exaggerate sounds.                                         beginning Tx
    Clue the person with the hearing loss about the topic of the                                 Hearing devices may emit feedback due to dental
     conversation if possible.                                                                     devices or even the caregiver’s body.
    When not understood - rephrase your statement into
                                                                                                  Have the patient turn off the hearing device and
     shorter, simpler sentences.
                                                                                                   place it in a pocket or purse.
    In restaurants and social gatherings, choose seats or
     conversation areas away from crowded or noisy areas.                                         Do not place on bracket table.
    Don’t talk with food or non-food items in mouth.

Communication tips                                                                           Dental Management
                                                                                       35                                                         36


 Patients may exhibit fear, hostility or paranoia in         ◦ Hearing Loss(Mayo Foundation for Medical Education
                                                                and Research)
  the dental chair.                                           ◦ Hearing, Ear Infections, and Deafness(National
 Use visual aids to augment or replace verbal                  Institute on Deafness and Other Communication
  communication (
           i   i   (models, d
                      d l drawings, di l i )
                                 i      disclosing)             Disorders
                                                              ◦ http://www.nidcd.nih.gov/health/hearing/hearingaid.
 May need to arrange for a sign language                       asp
  interpreter.                                                ◦ P. Hindley Psychiatric Aspects of Hearing
                                                                Impairments.J Child Psychol. Psychiat Vol 38 No 1,
                                                                pp 101-117, 1997
                                                              ◦ www cdc gov

Dental Management                                            References
                                                        37                                                       38


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