WEBVTT 00:00.000 --> 00:30.000 position:50% align:top line:0% *This machine-generated transcript may have errors. If remediation or a manually-generated transcript is needed, please contact NLM Support at https://support.nlm.nih.gov.* 01:26.040 --> 01:27.550 At some point in your practice, 01:27.560 --> 01:30.110 most of you have faced an anxious mother 01:30.480 --> 01:32.060 worried about her child's hearing. 01:33.080 --> 01:33.700 I am Dr. 01:33.700 --> 01:34.410 David Mitchell, 01:34.410 --> 01:37.080 an otolaryngologist at the hospital for sick Children 01:37.840 --> 01:40.430 and in this video tape I hope to demonstrate how 01:40.430 --> 01:42.850 significant hearing loss can be determined 01:43.280 --> 01:46.140 in the physician's office we will look at 01:46.140 --> 01:49.130 three cases that might present to the general practitioner 01:49.140 --> 01:50.360 or the pediatrician. 01:51.340 --> 01:54.250 Each child is suspected of having a hearing loss. 01:55.340 --> 01:58.250 We hope the clues provided will allow you to determine 01:58.640 --> 02:01.440 whether or not such a problem exists and if not 02:01.820 --> 02:03.260 what the problem might be. 02:04.040 --> 02:05.900 At the end of each case presentation, 02:05.900 --> 02:08.560 we will provide you with the exact diagnosis. 02:09.240 --> 02:12.190 The general practitioner involved takes an appropriate case 02:12.190 --> 02:14.770 history from the mother and interprets the 02:14.770 --> 02:17.260 clues that she provides about his development. 02:19.500 --> 02:21.920 This discussion in history taking is most 02:21.920 --> 02:24.890 important because it is the mother who knows her child's 02:24.890 --> 02:27.440 best and is aware of the 02:27.450 --> 02:29.160 failure of normal development. 02:29.940 --> 02:32.460 Part of hearing Children may be slow in attaining 02:32.840 --> 02:35.660 normal milestones such as walking and toilet training, 02:36.140 --> 02:38.820 but most important they are slow in the area of speech 02:38.820 --> 02:39.350 development. 02:41.240 --> 02:43.430 We believe that early 02:43.430 --> 02:46.250 diagnosis can significantly help these 02:46.250 --> 02:49.200 Children for the longer it 02:49.210 --> 02:52.000 takes to make a diagnosis the longer it takes to 02:52.000 --> 02:54.720 establish some training in regard to the 02:54.720 --> 02:57.600 child's critical speech and language development which takes 02:57.610 --> 03:00.460 place at a nerdy phase and 03:00.460 --> 03:02.930 after all speech and language is what allows the 03:02.930 --> 03:05.460 individual to communicate with the world around him. 03:06.820 --> 03:07.840 In this videotape, 03:07.850 --> 03:10.680 we hope to demonstrate to you how the practitioner 03:11.220 --> 03:13.950 in his office using good history taking and simple 03:13.950 --> 03:16.920 tools may diagnose significant hearing 03:16.920 --> 03:17.640 problems. 03:18.440 --> 03:20.040 Once he has made the diagnosis, 03:20.040 --> 03:22.790 he may choose to send the child to a hearing 03:22.790 --> 03:25.220 clinic for further evaluation 03:25.610 --> 03:26.310 and therapy. 03:26.310 --> 03:29.220 If indicated will be performed we will show you some of 03:29.220 --> 03:30.660 these more elaborate tests. 03:31.400 --> 03:33.520 Now let us look at our first case. 03:35.140 --> 03:35.360 Hello? 03:35.360 --> 03:35.910 Mrs huff, 03:35.920 --> 03:36.580 how are you? 03:36.790 --> 03:39.670 I'm very well thank you doctor but I am a little worried 03:39.670 --> 03:41.460 about erin my youngest here, 03:42.140 --> 03:44.820 he's nearly six months now and he seems pretty 03:44.820 --> 03:45.310 healthy. 03:45.310 --> 03:48.260 But lately my husband and I have been 03:48.270 --> 03:50.260 a bit worried about his hearing. 03:51.140 --> 03:53.200 I see what makes you think he's got a hearing loss. 03:53.210 --> 03:56.060 Well um he when I 03:56.060 --> 03:58.970 go into his room or say something to him he really doesn't seem to 03:58.970 --> 04:01.150 notice me until I'm right on top of him. 04:01.960 --> 04:04.500 And um well just generally he doesn't seem to 04:04.500 --> 04:07.450 respond in the same way that the other kids did at his age. 04:08.250 --> 04:10.890 Is he startled by loud noises or does he for instance, 04:10.890 --> 04:12.250 cry when he hears the telephone ring? 04:13.400 --> 04:14.360 No he doesn't. 04:14.820 --> 04:17.600 As a matter of fact he could be lying right 04:17.600 --> 04:19.560 next to the phone and it doesn't seem to bother him. 04:19.940 --> 04:22.860 Oh he responds but I think that's because he sees 04:22.860 --> 04:23.860 us running for it. 04:24.640 --> 04:27.640 Another thing the other day he was in the living room with my 04:27.640 --> 04:30.640 son tim he's a teenager and you know how they are 04:30.640 --> 04:31.310 with music. 04:31.440 --> 04:33.960 Well he turned the stereo on 04:34.640 --> 04:37.420 and put on his favorite rock band and turned it up full 04:37.420 --> 04:38.100 blast. 04:38.270 --> 04:39.650 It gave me a real start. 04:40.040 --> 04:41.660 But Aaron didn't seem to mind. 04:41.670 --> 04:43.760 In fact he looked like he was enjoying it. 04:45.140 --> 04:47.890 Let me ask you a few questions about his medical 04:47.890 --> 04:48.280 history. 04:48.280 --> 04:48.860 Mrs huff. 04:49.740 --> 04:52.350 Um When he was born was it a normal labor and delivery? 04:52.740 --> 04:55.630 Yes If you'd call 27 I asked for 1/4 baby 04:55.630 --> 04:56.110 normal. 04:56.240 --> 04:57.060 That is a long time. 04:57.640 --> 04:58.660 How much did he weigh then? 04:59.040 --> 05:00.350 Uh £7. 05:00.350 --> 05:01.220 14 ounces. 05:01.230 --> 05:02.780 Oh wait a minute I think metric 05:03.640 --> 05:05.570 3.7 kg. 05:05.570 --> 05:08.550 They said was there any difficulty with his breathing after 05:08.550 --> 05:09.110 he was born? 05:10.890 --> 05:13.880 And was there any jaundice or were there any blood problems at all? 05:14.440 --> 05:17.360 No no my husband and I both had blood tests before we were 05:17.360 --> 05:18.460 married and there was no problem. 05:18.840 --> 05:21.640 So he didn't have to go into the nursery for special therapy or anything like 05:21.640 --> 05:21.900 that. 05:23.340 --> 05:24.540 Did he go home with you? 05:24.830 --> 05:26.260 Oh yes we went home a day early. 05:27.240 --> 05:27.750 I see. 05:28.140 --> 05:29.930 And has he been sick since then? 05:30.340 --> 05:33.260 Um Well he had a cold or two in Montreal before 05:33.260 --> 05:34.260 he came to Toronto. 05:34.820 --> 05:37.530 And then when I took him in for a three month 05:37.530 --> 05:40.280 checkup the doctor there said that he had a 05:40.280 --> 05:43.230 slight ear infection but that's all is there 05:43.230 --> 05:45.400 any history in the family of hearing loss? 05:45.940 --> 05:48.840 um well my grandmother was hard of hearing for 10 05:48.840 --> 05:51.730 years or so before she died and I think it was, 05:51.730 --> 05:54.540 my husband's uncle had something wrong with one of his 05:54.540 --> 05:54.770 ears. 05:54.770 --> 05:57.190 He had surgery on it and then he was much better after that. 05:58.050 --> 06:00.840 Did anybody in the family have kidney disease as a child? 06:03.540 --> 06:06.340 Um Are you and your husband mrs 06:06.340 --> 06:07.950 half at all related to each other? 06:07.950 --> 06:10.400 I mean are you blood relations apart from being married to each other? 06:11.430 --> 06:11.810 No, 06:11.810 --> 06:12.720 I don't think so. 06:13.090 --> 06:13.380 Though. 06:13.380 --> 06:16.340 We were brought up in the same small town in the north of England 06:16.900 --> 06:19.650 and our families have been there for generations. 06:19.730 --> 06:21.060 Perhaps it's possible. 06:21.440 --> 06:24.210 Well it does sound likely that erin has a small hearing 06:24.210 --> 06:27.150 problem but we'll know more about that when I've examined 06:27.150 --> 06:27.350 him. 06:28.140 --> 06:29.460 Let's have a look into his ears. 06:35.540 --> 06:37.440 Can you turn him around? 06:37.450 --> 06:39.400 Yes. 06:40.140 --> 06:40.520 Oops. 06:41.040 --> 06:41.360 Mhm. 06:45.330 --> 06:46.620 Well his ear drums look normal. 06:46.630 --> 06:48.060 Let's see how he responds to. 06:57.540 --> 06:57.750 Okay, 07:02.550 --> 07:04.140 well he seems to be responding quite well. 07:04.140 --> 07:04.750 Mrs huff. 07:05.590 --> 07:07.850 I don't know why he doesn't seem to be responding at home 07:08.640 --> 07:10.030 to make sure he's all right. 07:10.040 --> 07:12.790 I think I'd like some special tests done that I can't do here in the 07:12.790 --> 07:15.750 office will send him to have these tests done. 07:15.970 --> 07:18.830 Because there are a few things that we should think about this. 07:19.110 --> 07:20.950 I'm relieved that you think he's all right. 07:21.210 --> 07:23.480 But what are these special tests you want to do? 07:23.480 --> 07:24.520 What are they going to do to him? 07:25.680 --> 07:28.340 The ideologist tests the child's hearing in a special 07:28.340 --> 07:31.070 soundproof room uses VR 07:31.070 --> 07:33.920 A or visual reinforcement audiology with Aaron? 07:34.640 --> 07:37.580 The child responds to a Saudi here is by looking up to 07:37.580 --> 07:38.690 see a flashing light. 07:39.400 --> 07:42.340 The light is his reward for looking at the appropriate time. 07:43.240 --> 07:44.140 This machine, 07:44.150 --> 07:46.750 an audio meter can make high and low pitch 07:47.210 --> 07:48.760 and loud and soft sounds. 07:50.980 --> 07:52.910 The audiologist adjust these dials, 07:52.910 --> 07:55.650 which control the sound levels in the soundproof room. 07:56.340 --> 07:58.450 By observing the responses to these sounds, 07:58.450 --> 08:00.990 it is usually possible to find out which sound 08:01.260 --> 08:04.130 Aaron hears best in which he has the most 08:04.140 --> 08:04.950 difficulty with. 08:06.500 --> 08:07.900 If the response is poor, 08:07.900 --> 08:10.650 the audiologist may try other types of tests, 08:11.220 --> 08:12.080 evoked response. 08:12.080 --> 08:15.050 Audiology looks at the brain's electrical responses 08:15.060 --> 08:15.760 to sound, 08:16.630 --> 08:19.460 electrical choreography measures the cochlear as electrical 08:19.460 --> 08:20.460 response to sound. 08:21.510 --> 08:21.970 Aaron, 08:21.980 --> 08:24.870 at his age should startle to measure its speech stimuli 08:24.870 --> 08:27.720 at 65 To 70 decibels 08:27.730 --> 08:30.150 and should be aware of it at 20 decibels. 08:31.440 --> 08:33.710 Fortunately Aaron's hearing tests, 08:33.720 --> 08:36.610 showed responses that were all within the normal range 08:37.340 --> 08:38.410 frequently infants, 08:38.420 --> 08:41.090 Aaron's age with significant loss are not 08:41.090 --> 08:42.950 detected until they are much older. 08:43.840 --> 08:46.610 Although the parents may be aware of the early signs of 08:46.610 --> 08:47.320 hearing loss, 08:47.810 --> 08:50.520 they feel the child is going through a stage which he will get 08:50.520 --> 08:52.380 over often. 08:52.490 --> 08:55.270 It is not until the child is 2.5 to 3 years of 08:55.270 --> 08:58.200 age and has failed to develop real speech that 08:58.210 --> 09:01.060 the parents become alarmed and seek medical 09:01.060 --> 09:01.360 help? 09:02.440 --> 09:04.860 Let us take a look at one such case. 09:06.740 --> 09:08.750 What makes you think that Jason has a hearing problem? 09:09.840 --> 09:12.630 Well doctor he's 2.5 years old and he's not 09:12.630 --> 09:13.800 talking very well yet. 09:14.440 --> 09:17.350 His sister at that age never stopped 09:17.350 --> 09:17.800 talking. 09:18.540 --> 09:19.930 She was always babbling away. 09:19.930 --> 09:22.000 Even if we couldn't understand everything she was saying 09:23.640 --> 09:26.100 and Jason doesn't always pay attention to me. 09:26.420 --> 09:28.750 He maybe he's just not listening but 09:29.540 --> 09:31.790 he seems like he's off in another world sometimes. 09:32.540 --> 09:33.690 What if he wants something? 09:34.240 --> 09:35.520 Can he communicate with you? 09:36.380 --> 09:37.620 Supposing he wants a cookie. 09:37.920 --> 09:38.950 What does he do about it? 09:40.320 --> 09:42.510 He has no problem getting what he wants. 09:42.520 --> 09:44.720 He just takes my hand and points to the cookie jar. 09:45.640 --> 09:46.580 Tell me Mrs Proctor. 09:46.850 --> 09:48.160 How aware is he of you? 09:49.040 --> 09:50.960 Does he hear you when you go into his room? 09:51.540 --> 09:52.950 And how soundly does he sleep? 09:54.250 --> 09:56.150 I'm not sure if he hears me or not. 09:57.140 --> 09:58.550 He's such a sound sleeper. 09:59.140 --> 10:00.750 I have to shake him to wake him up. 10:01.590 --> 10:03.160 At first I thought it was a blessing. 10:03.740 --> 10:05.220 But now I'm not so sure. 10:06.780 --> 10:08.220 What does he do with your phone rings? 10:08.940 --> 10:11.630 Well he looks mildly interested him he watches us and we 10:11.630 --> 10:14.390 answered but he doesn't seem to want to play with it 10:14.940 --> 10:17.370 or to talk into the mouthpiece as his sister did. 10:17.730 --> 10:20.560 What about the doorbell does he head for the door when it rings? 10:20.740 --> 10:23.630 He does particularly at night when my husband comes home from 10:23.630 --> 10:23.960 work. 10:24.420 --> 10:26.880 Jason seems to recognize the sound of his car in the 10:26.880 --> 10:28.910 driveway and his key in the lock. 10:29.110 --> 10:31.410 He gets all excited and he runs to the door to meet him 10:31.980 --> 10:32.990 when he gets excited. 10:32.990 --> 10:34.580 Does he babble or talk at all? 10:36.440 --> 10:39.170 As a matter of fact he does last week we took him to the zoo 10:39.170 --> 10:41.800 and he ran about babbling for 10:41.910 --> 10:42.560 hours. 10:43.640 --> 10:46.310 Sometimes I understood several words that he said. 10:47.240 --> 10:48.830 I couldn't understand everything he said. 10:49.330 --> 10:50.560 Does he understand you? 10:51.340 --> 10:52.860 How does he respond when you talk to him? 10:53.940 --> 10:54.880 Well it takes a while. 10:54.880 --> 10:56.610 He doesn't always respond right away. 10:56.850 --> 10:58.650 He has my husband's stubborn streak, 10:59.340 --> 11:01.750 but if I repeat myself several times to him, 11:01.790 --> 11:02.960 he usually does it, 11:03.740 --> 11:04.740 but he gets confused. 11:04.740 --> 11:06.580 He doesn't always understand what I say. 11:06.820 --> 11:09.740 Sometimes he brings me the wrong thing as 11:09.740 --> 11:10.860 if you misunderstood me. 11:11.410 --> 11:12.090 For example, 11:12.090 --> 11:14.720 just this morning before breakfast he was standing beside the 11:14.720 --> 11:16.710 table and he grabbed the serial, 11:16.720 --> 11:18.400 started to spill it all over the floor. 11:20.840 --> 11:22.780 Well I said pick that up please. 11:23.340 --> 11:25.110 But he thought I said pick up the cup. 11:25.270 --> 11:27.990 So he dropped the cereal and picked up his cup of orange juice, 11:30.100 --> 11:32.830 confusing similar words and phrases is common at Jason's age, 11:32.830 --> 11:34.750 particularly if a child has a hearing impairment. 11:36.240 --> 11:38.660 Now let's get some of his medical history. 11:39.040 --> 11:40.060 When did he first walk? 11:41.140 --> 11:43.400 About a year but he didn't walk for long. 11:43.400 --> 11:45.960 He ran can he feed himself? 11:46.540 --> 11:46.860 Yes, 11:46.860 --> 11:47.490 fairly well. 11:47.500 --> 11:48.550 He's pretty well coordinated. 11:49.250 --> 11:50.460 And is he still in diapers? 11:51.440 --> 11:52.780 Only at night during the day. 11:52.780 --> 11:54.160 He's pretty well dry. 11:54.640 --> 11:57.220 So you feel apart from a possible hearing and speech defect, 11:57.220 --> 11:58.310 he's developing normally. 11:58.740 --> 11:59.360 Oh yes, 11:59.360 --> 12:00.270 definitely. 12:00.320 --> 12:03.190 At first I thought maybe he wasn't as bright and as quick as a 12:03.190 --> 12:05.310 sister and maybe that's why he wasn't talking so 12:05.310 --> 12:06.450 soon. 12:06.790 --> 12:09.520 But he's pretty well normal in 12:09.530 --> 12:10.720 other respects. 12:11.840 --> 12:14.580 I see from his chart that he's had some recurring ear problems. 12:14.660 --> 12:16.760 How has he responded to the antibiotics we gave him? 12:17.440 --> 12:17.790 Well, 12:17.800 --> 12:19.560 initially there's always a great improvement, 12:20.640 --> 12:22.730 but after a couple of months he's as bad as ever 12:23.600 --> 12:24.470 and it bothers him, 12:24.470 --> 12:24.720 you know, 12:24.720 --> 12:25.830 he pulls at it. 12:25.830 --> 12:26.780 He's always touching it. 12:26.790 --> 12:29.630 Like some kids sucking your thumb and he's turned 12:29.630 --> 12:30.610 into a mouth breather. 12:30.800 --> 12:32.410 I've told him to close his mouth, 12:32.420 --> 12:33.410 but he just doesn't listen. 12:33.420 --> 12:33.710 Yes. 12:33.710 --> 12:35.500 You mentioned that the last time you were here, 12:35.940 --> 12:37.950 I checked his sinuses then they seemed fine. 12:38.140 --> 12:38.490 All right, 12:38.490 --> 12:38.840 Jason. 12:38.840 --> 12:40.260 I think it's time we had to look at you. 12:41.040 --> 12:42.260 Let's just look in your ears now. 12:50.540 --> 12:50.940 Yes, 12:50.950 --> 12:52.470 there seems to be a little fluid in the left. 12:52.470 --> 12:53.710 Is that the one that's been bothering him? 12:53.720 --> 12:54.070 Mm hmm. 12:54.070 --> 12:55.110 That's the one he's been pulling. 12:55.110 --> 12:55.370 Yes. 12:55.370 --> 12:55.530 Well, 12:55.530 --> 12:57.040 perhaps I'd better have another look at that one. 12:57.830 --> 12:58.870 Let's have a look in here again, 12:58.870 --> 12:59.260 Jason. 13:02.140 --> 13:02.640 Yeah. 13:04.440 --> 13:04.680 Yes. 13:04.680 --> 13:06.710 He seems to have a mild acute infection in there, 13:06.710 --> 13:09.030 which should clear on medication if it doesn't, 13:09.360 --> 13:10.760 we'll have him seen by the specialist? 13:11.540 --> 13:13.160 I'll leave your prescription before you leave. 13:14.140 --> 13:14.860 Now Jason. 13:16.040 --> 13:16.760 Look at your mother. 13:22.340 --> 13:23.220 Well he seemed to hear that. 13:23.220 --> 13:24.080 All right didn't he? 13:25.240 --> 13:25.750 Yes. 13:28.000 --> 13:28.900 Look at mother Jason. 13:30.740 --> 13:31.460 That's good. 13:32.030 --> 13:32.770 Where's he knows? 13:35.040 --> 13:35.730 That's good. 13:36.060 --> 13:36.960 Alright. 13:37.340 --> 13:38.270 How many noses have you got? 13:39.150 --> 13:39.620 No. 13:40.540 --> 13:42.960 Well now I bet you'd like one of these now wouldn't you? 13:46.340 --> 13:46.970 Would you? 13:49.340 --> 13:49.900 Thank you. 13:49.910 --> 13:50.960 Thank you. 13:51.440 --> 13:54.330 Well mrs Proffitt Jason seems to be 13:54.330 --> 13:55.590 hearing well out of his right here. 13:55.590 --> 13:57.260 But the problem is really on the left. 13:58.140 --> 14:01.030 I think it would be worthwhile referring him to a specialist to have his 14:01.030 --> 14:01.950 left ear drained. 14:02.640 --> 14:05.360 It would probably help to have his adenoids out at the same time 14:06.520 --> 14:08.360 as I said the hearing problems in his left. 14:09.040 --> 14:11.750 Um So I'm going to send him to the hearing clinic for a few 14:11.750 --> 14:14.680 more hearing tests and we should know what's 14:14.680 --> 14:17.660 wrong with them as a result of those about his speech. 14:18.940 --> 14:21.730 If it doesn't improve in about three months 14:21.730 --> 14:22.130 time, 14:22.130 --> 14:24.860 I think you should probably see a speech therapist will go to the speech clinic 14:25.830 --> 14:28.460 and and what we should do about his ear 14:28.460 --> 14:29.150 infection. 14:29.830 --> 14:32.580 In addition to the visual reinforcement audie ometraco. 14:32.990 --> 14:35.810 Child Jason's age responds very well to 14:35.810 --> 14:37.860 what is known as play audio mama tree 14:38.740 --> 14:38.960 here. 14:38.960 --> 14:41.630 Jason puts the peg in the hole when he hears the test 14:41.630 --> 14:44.420 sound in the ear phones again. 14:44.550 --> 14:47.540 The audiologist varies the loudness and pitch of 14:47.540 --> 14:50.340 the sound to determine the degree of any 14:50.340 --> 14:52.010 hearing problem that may exist. 14:53.120 --> 14:54.510 The fact that it is a game, 14:54.510 --> 14:57.170 increases the child's attention span and 14:57.170 --> 14:58.500 willingness to concentrate. 14:58.940 --> 15:01.890 Middle ear function is assessed using a process known as 15:01.890 --> 15:02.770 impedance idea, 15:02.770 --> 15:03.280 mama tree, 15:03.590 --> 15:06.330 middle ear pressure estimates and compliance measurements are 15:06.330 --> 15:08.410 commonly taken from with this test, 15:08.810 --> 15:09.760 in Jason's case, 15:09.760 --> 15:12.760 he showed a significant negative pressure in his left ear. 15:14.140 --> 15:16.530 By the time a child reaches school age, 15:16.800 --> 15:19.780 a significant hearing handicap is usually readily 15:19.780 --> 15:20.350 apparent. 15:22.040 --> 15:24.730 The child's language and speech development may be 15:24.730 --> 15:27.180 limited and distorted in comparison to his 15:27.180 --> 15:27.960 classmates. 15:28.640 --> 15:29.370 Frequently, 15:29.370 --> 15:31.960 there is a history of difficulty with socializing 15:32.420 --> 15:34.260 with his peers and siblings. 15:35.240 --> 15:37.980 A child with a significant hearing loss tends to 15:37.980 --> 15:40.360 be demanding and strong willed. 15:41.040 --> 15:43.650 His inability to communicate is frustrating, 15:44.240 --> 15:46.610 leading to belligerent and aggressive 15:46.620 --> 15:47.280 behavior. 15:48.240 --> 15:51.150 Teachers frequently report difficulty at school 15:52.110 --> 15:54.860 and often note an inability on the part of the child 15:55.340 --> 15:57.950 to pay attention for long periods of time. 15:58.640 --> 15:59.500 At this stage, 15:59.500 --> 16:02.240 the child himself plays a major role in the 16:02.240 --> 16:04.990 history taking and in the diagnosis as he can be 16:04.990 --> 16:07.160 tested in much the same way as the adult. 16:07.910 --> 16:09.940 Once the diagnosis is established, 16:10.150 --> 16:12.550 the school system must be notified immediately 16:13.040 --> 16:15.580 in order that they may institute appropriate 16:15.590 --> 16:16.850 educational planning. 16:18.040 --> 16:20.300 Now let's take a look at Jamie, 16:20.310 --> 16:22.580 a five year old about to start school, 16:23.740 --> 16:24.240 Dr. 16:24.240 --> 16:26.060 Jamie started talking late. 16:27.040 --> 16:29.780 That didn't worry me at first because all of our Children are 16:29.780 --> 16:30.360 quiet. 16:30.370 --> 16:30.980 However, 16:30.980 --> 16:32.470 he just isn't progressing. 16:32.480 --> 16:35.350 He doesn't talk much better now than he did a year ago 16:36.040 --> 16:36.580 lately. 16:36.580 --> 16:39.260 I began to wonder if it's because he doesn't hear properly. 16:39.320 --> 16:40.610 Well that's certainly a possibility. 16:41.040 --> 16:43.510 Can you explain to me what's different about his speech? 16:43.940 --> 16:44.800 Yes. 16:44.810 --> 16:46.760 He doesn't say his words properly. 16:46.770 --> 16:49.570 Even simple words that he's known for a long time. 16:49.940 --> 16:52.860 For example he doesn't pronounce his younger 16:52.860 --> 16:54.170 brother's name correctly. 16:54.180 --> 16:56.780 He calls him divan instead of Stephen. 16:56.990 --> 16:59.760 I've also noticed that he leaves off the last 16:59.760 --> 17:00.730 part of words. 17:00.740 --> 17:03.260 He just doesn't say the last syllable 17:03.740 --> 17:05.170 does he hear when you talk to him? 17:05.840 --> 17:08.520 Well it's difficult to attract his attention 17:08.520 --> 17:11.500 even in a quiet room and when the tv is 17:11.500 --> 17:12.760 on forget it, 17:12.770 --> 17:15.720 he blares the set and I have to shake him to get his 17:15.720 --> 17:16.330 attention. 17:16.520 --> 17:17.760 Even that doesn't work. 17:17.760 --> 17:20.620 If Sesame street is on you could light a bomb under 17:20.620 --> 17:21.560 that child. 17:22.640 --> 17:24.440 What happens when you call him from another room? 17:24.840 --> 17:25.870 Nothing much. 17:25.880 --> 17:28.610 Even if I asked him if he'd like some candy or an ice cream 17:28.610 --> 17:29.000 cone, 17:29.010 --> 17:30.740 he doesn't seem to respond. 17:31.640 --> 17:33.860 Not unless I go into the room with him. 17:34.640 --> 17:37.470 And the other day he was sitting beside me on the sofa, 17:37.580 --> 17:40.270 I was reading him a story pointing to the pictures and 17:40.280 --> 17:41.690 asking him questions. 17:41.700 --> 17:44.120 He wasn't very quick with his answers and 17:44.120 --> 17:47.020 suddenly he grabbed my face with his hands and pulled it 17:47.020 --> 17:49.460 over to his so I was looking right at him 17:49.910 --> 17:52.670 then he said let me see you when you talked mommy. 17:53.000 --> 17:55.450 It was then that I decided to come to you? 17:57.940 --> 17:59.360 Has he had any problems with the ear, 17:59.360 --> 18:00.570 nose and throat in the past? 18:00.950 --> 18:01.330 No, 18:01.330 --> 18:03.360 he's always been a very healthy child. 18:03.940 --> 18:05.950 He's never been sick a day in his life. 18:05.950 --> 18:08.220 It's the hearing problem that's been bothering me. 18:08.230 --> 18:11.180 He starts to kindergarten in several months and I'd like to 18:11.180 --> 18:14.110 know how much of a hearing problem he has before 18:14.110 --> 18:15.210 he goes to school. 18:15.300 --> 18:17.050 Perhaps a hearing aid would help him. 18:17.050 --> 18:18.160 I just don't know. 18:19.240 --> 18:21.220 Well I can certainly see why you're worried Mrs Boyd in. 18:21.740 --> 18:22.910 If he does have a problem though, 18:22.910 --> 18:25.560 it can be corrected and he'll be able to understand teacher 18:25.560 --> 18:28.100 better and learn at the same rate as the other kids at school. 18:29.240 --> 18:30.050 How are you Jamie? 18:30.840 --> 18:32.160 Do you want to come and stand over here? 18:34.040 --> 18:34.960 How old are you now? 18:35.340 --> 18:36.060 Five? 18:36.440 --> 18:37.360 Did you go to school? 18:39.540 --> 18:40.380 You are a big fella, 18:40.380 --> 18:40.770 aren't you? 18:41.440 --> 18:43.030 Can you say something's after me? 18:43.360 --> 18:46.210 Can you say The boy saw six cats? 18:49.940 --> 18:52.360 The boy saw six cats. 18:53.340 --> 18:55.530 Oh boys are thick. 18:56.540 --> 18:59.280 I see you see this 19:01.040 --> 19:02.060 that's a tuning fork. 19:06.640 --> 19:07.450 Can you hear that? 19:12.240 --> 19:13.050 What about that? 19:17.440 --> 19:20.390 I see now I'm going to cover up 19:20.390 --> 19:20.980 your ears. 19:21.350 --> 19:21.800 All right. 19:24.740 --> 19:27.720 I'm gonna cover my face and I'm gonna say some words and I want you to 19:27.720 --> 19:28.810 repeat them after me. 19:29.120 --> 19:29.610 All right. 19:32.940 --> 19:34.510 Hey baseball, 19:34.940 --> 19:35.860 baseball, 19:36.540 --> 19:37.580 hot dog, 19:37.580 --> 19:40.060 hot dog ice cream, 19:42.440 --> 19:43.270 sidewalk 19:46.440 --> 19:47.460 french fries. 19:50.140 --> 19:51.160 Okay Jamie, 19:53.840 --> 19:55.160 can you hear this watch now? 19:57.240 --> 19:58.050 Can you hear that? 20:00.440 --> 20:01.270 Can you hear that? 20:03.710 --> 20:04.830 Tell me if you hear that? 20:11.540 --> 20:12.050 All right, 20:12.920 --> 20:13.730 well mrs Boyd in. 20:14.580 --> 20:17.180 I'm sure Jaime does have some hearing impairment. 20:17.500 --> 20:20.320 You must have noticed when I gave him the words and the tuning fork 20:20.320 --> 20:20.750 tests. 20:21.160 --> 20:23.870 He missed out parts of the words and he 20:23.870 --> 20:26.730 couldn't hear words and the tuning fork when they were quite audible to 20:26.730 --> 20:27.130 us. 20:28.040 --> 20:29.660 How serious is it Doctor? 20:29.670 --> 20:31.640 Will he ever be able to hear properly? 20:31.650 --> 20:33.170 And what about his education? 20:33.640 --> 20:33.800 Well, 20:33.800 --> 20:36.600 it's hard to say now I'd like him to go to the hearing 20:36.600 --> 20:37.960 clinic for some further testing. 20:38.540 --> 20:41.360 Um I guess he has a mild hearing impairment 20:41.740 --> 20:44.710 and it may be that the audiologist will suggest a suitable hearing aid 20:45.740 --> 20:48.700 and perhaps with some special help at school he can lead a normal 20:48.700 --> 20:49.160 life. 20:50.140 --> 20:52.360 Let's make an appointment for the hearing clinic. 20:53.340 --> 20:56.140 Jamie's hearing can be tested in much the same way as an 20:56.140 --> 20:56.720 adult. 20:57.440 --> 20:59.260 Rather than putting a peg in the hole, 20:59.260 --> 21:02.190 he is old enough to raise his hand when he hears a sound. 21:02.450 --> 21:05.300 And in addition the audiologist asked Jamie 21:05.300 --> 21:07.850 to repeat words which he presents 21:08.640 --> 21:11.630 a child like Jamie has a relatively good chance of leading a 21:11.630 --> 21:12.360 normal life, 21:12.370 --> 21:15.360 providing his hearing loss can be determined early enough 21:16.240 --> 21:19.170 appropriate history taking and simple office testing 21:19.740 --> 21:22.670 and provide the clues which lead the general practitioner to 21:22.670 --> 21:23.730 the diagnosis. 21:24.840 --> 21:25.640 Subsequent, 21:25.650 --> 21:28.300 more extensive testing by the audiologist and the 21:28.300 --> 21:31.260 autologous can determine the depth 21:31.270 --> 21:33.050 and the cause of the hearing loss. 21:33.940 --> 21:35.640 Treatment can be instituted. 21:36.640 --> 21:39.370 An appropriate hearing aid and suitable educational 21:39.370 --> 21:41.830 program can be selected to help 21:41.830 --> 21:44.270 minimize the effect of the hearing handicap 21:44.640 --> 21:47.280 on the child's general development and educational 21:47.280 --> 21:47.850 future. 21:48.940 --> 21:49.790 In conclusion, 21:49.790 --> 21:52.320 we have presented some typical case histories of 21:52.330 --> 21:55.050 Children who might present in a general practitioners 21:55.050 --> 21:55.560 office. 21:56.440 --> 21:59.380 There is no way I can overemphasize the importance 21:59.380 --> 22:01.860 of early diagnosis and assisting Children 22:02.340 --> 22:03.880 who have hearing handicaps. 22:04.940 --> 22:07.760 In a study conducted at the hospital for sick Children 22:08.140 --> 22:10.640 of Children with significant hearing 22:10.640 --> 22:11.190 loss, 22:11.620 --> 22:14.310 there was a delay of an average of 12 to 22:14.310 --> 22:16.900 14 months between the time the 22:16.900 --> 22:19.810 parents first sought help and the diagnosis 22:19.810 --> 22:21.210 was finally established. 22:22.240 --> 22:24.850 We hope this video tape will help you 22:25.540 --> 22:27.770 to help us to reduce this gap.