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Check if your child's hearing is worse. According to research carried out at the Institute of Physiology and Pathology of Hearing, every sixth school-age child has hearing problems. However, problems can arise earlier, even as a result of banal infections. Dr. Anna Geremek-Samsonowicz, MD, PhD, specialist audiologist, head of the Rehabilitation Clinic at the Institute of Physiology and Pathology of Hearing in Kajetany, talks about how not to overlook the problem.
More and more young children go to the hearing care clinic. We discuss the causes of this condition with Dr. Anna Geremek-Samsonowicz, MD, otolaryngologist, audiologist, head of the Rehabilitation Clinic at the Institute of Physiology and Pathology of Hearing in Kajetany.
- There are more and more little hearing impaired patients. Why is this happening?
Dr. med. Anna Geremek-Samsonowicz: Indeed, we have more and more little patients and they come to us earlier due to the fact that paediatricians refer for consultations faster, but also parents themselves, concerned about the child's behavior, report see a specialist. It turned out that even banal infections of the upper respiratory tract and prolonged fever-free catarrhs have a very large impact on the middle ear and on the auditory functioning of the child. Increasingly, the consequence of catarrh is exudative otitis. These are changes in the middle ear, the mucosa of which is built like the mucosa of the nasopharynx and nasal space. Our ear only connects through a very small tube called the Eustachian tube to the nasopharynx, and this is the ear's "safety valve" that equalizes the pressure in the tympanic cavity. The position of the Eustachian tube changes during adolescence - it is located differently in relation to the nasopharynx in children and differently in adults. The gate of infection through this tube into the middle ear is easier for a child. When a toddler has an ordinary runny nose, he does not have a fever, the same "runny nose" often occurs in the ear as well. The mucosa in the middle ear produces a mucus secretion that stays in it, thickens and remains, creating a barrier. This causes chronic otitis exudate, but also very often results in hearing loss.
- How does chronic otitis impair hearing?
A. G.-S .: Ifthe middle ear cavity, in which the ossicles are located, is filled with thick secretion, the membrane and ossicles stop working, the auditory ossicles cannot move properly, which means that the process of mechanical sound conduction is disturbed.
- What if an allergic factor is added to the problem of frequent infections?
A. G.-S .: More and more children suffer from allergies and they are not so easy to diagnose. We know that we not only have an inhalation or food allergy. Often we also start to have cross-allergies that produce symptoms that are uncharacteristic and difficult to interpret. If there is any allergic factor in a child, then the state of the sensitivity of his mucosa is greater and a runny nose and exudative changes occur faster.
A. G.-S .: It can have the same symptoms as an inhalation allergy, i.e. children with food allergies may develop prolonged infections of the upper respiratory tract, often manifested by prolonged runny nose. It is not that this type of allergy results in a runny nose, but there is a certain sensitivity of the mucosa with food allergies that makes it easier to get sick. We associate bronchitis or even pneumonia more with allergy. But, as we observe, these diseases do not necessarily occur, there can be catarrhs as well as ear inflammation, and as a result, hearing deteriorates.
A. G.-S .: We always try to heal pharmacologically, we look for the cause, we pay attention to the allergic background. We check if there is an overgrowth of the third tonsil - it can block the opening of the Eustachian tube, because this is its position in the child's nasopharynx. We also try to remove allergic factors by diet, and introduce pharmacological treatment. If it does not
succeed, and this unfortunately happens in a large percentage of cases, then we have to set up the so-called drain. During the procedure, we evacuate the dense mucous contents under the microscope through incision of the eardrum. At the same time, we decide to remove the tonsil to increase the nasopharyngeal space. We leave a small plastic drain in the eardrum. The left "valve", which is located directly in the middle ear, has a healing and prophylactic effect. Through the drain left on, the mucus from the ear cavity can evacuate on its own. At the same time, the process of the so-called better oxygenation of the lining, i.e. oxygen gets through the drain, which causes the lining to regenerate and defend itself better. The drain lasts for about 6 months, ithen, when the membrane begins to move properly in the hearing process, it ejects it. A larger group of children function well after drainage, removal of the tonsil or cutting of the palatine tonsils. If we find an allergic factor, diet or support with antihistamines is often helpful. But there is also a group of patients who still have the problem. The next treatment is most often required by children with an anatomical defect, e.g. after a cleft palate.
Teach your child to clean their nose properly
Using a toddler's nasal aspirator only gives a temporary effect. - We only extract what is in the nostrils, the appropriate muscle systems are not activated, the ethmoid cells and the child's sinuses do not open up - explains Dr. Anna Geremek-Samsonowicz. - Besides, we do not know if we are pulling a mucus or a piece of mucosa from the nose. You need to teach your child to clean his nose as soon as possible, this is the he althiest thing. During this mechanism, if it is performed correctly, i.e. when one hole is covered, the other is cleaned and vice versa, the muscles of the palate are positioned differently and e.g. the Eustachian tube is cleared, which gives the effect of blowing this secretion out of the ears.
A. G.-S .: I always say that if there is any factor that may have a negative impact on hearing during pregnancy, or perinatal, then it is worth observing the baby and its auditory development. There are a lot of these factors: viral diseases of the mother during pregnancy, such as measles, mumps, rubella, influenza, cytomegaly, as well as toxoplasmosis, her use during pregnancy
of certain medications, family burdens, even very long ones, perinatal, i.e. hypoxia, prematurity, low birth weight, asphyxia, jaundice. Later in the child's life, this may include administration of aminoglycoside antibiotics, e.g. gentamicin, trauma, meningitis, sepsis. All this should sensitize the doctor to pay special attention to the child's auditory development. For me, parents' observations are equally important that despite the correct course of pregnancy and the positive results of the screening tests the child has undergone, the child does not react to sounds in various situations. Of course, this may be related to age, because we acquire certain auditory competences during development, but such observation of parents is extremely important and even with positive results, I always repeat the test.
A.G.-S .: Middle ear disorders are reversible pharmacologically or surgically in most cases. If, on the other hand, we have hearing impairment due to perinatal or genetic stresses - usually these are sensory-nerve damage, i.e. damage to the inner ear - they are usually irreversible. We are able to quickly diagnose them, determine the level of hearing loss and apply support with a hearing aid, an appropriate hearing implant and rehabilitation. You cannot wait here, because we have to enter the rhythm of the natural development of physiological hearing in a child.Important
A. G.-S .: Thanks to the screening program and the program of early detection of hearing impairment, conducted at the Institute of Physiology and Pathology of Hearing, we diagnose children in the first months of life, then we guide them through the audiological standards and those who qualify, usually with a deeper hearing loss Before the age of 1, we implant: we use a cochlear ear implant. We already have a very large group of patients who, after six months of rehabilitation, begin to function like hearing children - they learn to listen and speak on their own, without the need for speech therapy stimulation.
A. G.-S .: Anything that worries us - if a child reacts to sounds worse, does not always listen to commands, he or she looks at us as if he did not understand what we were saying. Parents often say that when a child focuses on something, he does not listen to them. This means that this part of listening is already some effort for him. Often, excessive mobility or incorrect behavior is interpreted by parents as rude, and it results from hearing problems. On the other hand, young children who are not yet verbalizing may be nervous, restless, sleep and eat worse, may knock their ears or pull on them. If something is bothering parents, it is better to check than to miss it. The sooner we diagnose a hearing impairment, the faster and more effective we can help.
A. G.-S .:First, to a pediatrician who may refer them to an otolaryngologist or audiologist. There are more and more ENT clinics that can fully diagnose and treat hearing problems.
A. G.-S .: All. In the first period of life, when the child is not cooperating, mainly objective examinations are carried out: examination of the middle ear, examination of evoked potentials from the brainstem, otoemission - depending on what is necessary. Older children can tell us how and when they hear, so we do subjective tests in the form of tonal audiometry, verbal audiometry, and we can extend this range even more. There are measurements to judge how accurately your baby hears. It is also often advisable to consult a speech therapist, educator or psychologist.monthly "Zdrowie"