Diagnostika a léčba těžce sluchověpostižených nejmenších dětí

Diagnosis and Treatment of Severely Deaf YoungChildren

In our country every year some 180 severely deaf children are detected in the youngestage groups. Their education, communication and socialization is associated with a number ofproblems which in the course of their life are tackled by various specialists. Phoniatrists and ENTspecialists for children are among the first who encounter these children. Their tasks are by nomeans easy: 1. to assess the state of hearing of the child, 2. in case of a severe defect, correct thedefect 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 thisanalysis 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. Theprotocol describes the activities which must be implemented in different stages and attention isdrawn to a number of difficulties and obscure points. The protocol should serve as a generalinstruction and not for solving individual problems. In the first diagnostic stage it is necessary to assess objectively and as accurately as possible thehearing status of the child. This must be done at the earliest possible age. Attention is drawn to somepossible inaccuracies of interpretation of objective results, in particular results of BERA, To assessa mild, medium severe and severe auditory defect is not difficult for the BERA method. On the otherhand, assessment of the auditory threshold in very severe hearing defects in particular in the wholefrequency range is sometimes impossible. The mentioned SEEP examination gives some hope in thisrespect.In compensation stage it is necessary to use always binaural correction by sufficiently flexiblehearing aids. Allocation and setting of the hearing aids is necessary as soon as possible afterassessment of the auditory status. In this stage in these patients hearing aids with adequatepossibilities of amplification and precise assessment of the acoustic pressure in front of the ear drumrather than hearing aids of other groups. The binaural use of hearing aids and checking of theacoustic pressure in situ is a basic requirements.In the evaluation stage it is necessary to evaluate the dynamics of the communicating abilities. Thegeneral reaction to sound is evaluated, the differentiation of silence vs. sound, the ability of aimedand expedient formation and use of the own voice, the ability of lip reading and general endavourof communication. In decision making it is always important to respect views and wishes of thefamily. The decision should be made very responsibly - either it is possible to proceed with correctionby means of hearing aids with speech education, or it is necessary to consider whether hearing andspeech 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 toadminister an implant. They discuss conditions which concern the affected child, his family and lastnot least the possibilities of rehabilitation.The ideal condition is if a severely affected child starts after being given a hearing aid and speecheducation to communicate verbally, because the hearing centre of the brain if not stimulatedbecomes involuted. Its involution occurs approximately between the age of 3-4 years. The bestresults for verbal communication in implanted children, deaf from birth are when the implantationis performed at the age of ca 2 years. It is thus essential to implement all described stages beforethe age of two years but not later than at the age of three. It wold be ideal if we could with the helpof screening find children where we could start with correction of the impaired hearing and followup the development from the age of six months. It is a difficult task but at the same time a challenge.

Key words:
impaired hearing of youngest children, diagnosis, use of hearing aids, cochlearimplant.