Abstract
In our country every year some 180 severely deaf children are detected in the youngest age groups. Their education, communication and socialization is associated with a number of problems which in the course of their life are tackled by various specialists.
Phoniatrists and ENT specialists for children are among the first who encounter these children. Their tasks are by no means easy: 1. to assess the state of hearing of the child, 2. in case of a severe defect, correct the defect by means of a hearing aid and in case of failure 3. select for implantation a cochlear implant.
The attending phoniatrist is in the centre of all these activities. The tasks of the attending phoniatrist are discussed step by step in three papers.
The result of this analysis is the creation of a diagnostic-therapeutic protocol. The latter is, consistent with practice, divided into four stages: diagnostic stage, compensation stage, evaluation stage and surgery.
The protocol describes the activities which must be implemented in different stages and attention is drawn to a number of difficulties and obscure points. The protocol should serve as a general instruction and not for solving individual problems.
In the first diagnostic stage it is necessary to assess objectively and as accurately as possible the hearing status of the child. This must be done at the earliest possible age.
Attention is drawn to some possible inaccuracies of interpretation of objective results, in particular results of BERA, To assess a mild, medium severe and severe auditory defect is not difficult for the BERA method. On the other hand, assessment of the auditory threshold in very severe hearing defects in particular in the whole frequency range is sometimes impossible.
The mentioned SEEP examination gives some hope in this respect. In compensation stage it is necessary to use always binaural correction by sufficiently flexible hearing aids.
Allocation and setting of the hearing aids is necessary as soon as possible after assessment of the auditory status. In this stage in these patients hearing aids with adequate possibilities of amplification and precise assessment of the acoustic pressure in front of the ear drum rather than hearing aids of other groups.
The binaural use of hearing aids and checking of the acoustic pressure in situ is a basic requirements. In the evaluation stage it is necessary to evaluate the dynamics of the communicating abilities.
The general reaction to sound is evaluated, the differentiation of silence vs. sound, the ability of aimed and expedient formation and use of the own voice, the ability of lip reading and general endavour of communication. In decision making it is always important to respect views and wishes of the family.
The decision should be made very responsibly - either it is possible to proceed with correction by means of hearing aids with speech education, or it is necessary to consider whether hearing and speech of the child may be developed by means of a cochlear implant. In the last surgical stage the authors emphasize briefly the conditions which make it possible to administer an implant.
They discuss conditions which concern the affected child, his family and last not least the possibilities of rehabilitation. The ideal condition is if a severely affected child starts after being given a hearing aid and speech education to communicate verbally, because the hearing centre of the brain if not stimulated becomes involuted.
Its involution occurs approximately between the age of 3-4 years. The best results for verbal communication in implanted children, deaf from birth are when the implantation is performed at the age of ca 2 years.
It is thus essential to implement all described stages before the age of two years but not later than at the age of three. It wold be ideal if we could with the help of screening find children where we could start with correction of the impaired hearing and follow up the development from the age of six months.
It is a difficult task but at the same time a challenge.