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Auditory neuropathy/auditory dyssynchrony (AN/AD) is a condition that affects the neural processing of auditory stimuli. Patients with AD/AN are able to respond to sounds accurately but their ability to decode speech and language is affected. AN/AD has only recently been described. In the late 1970s, clinical investigators began to describe groups of patients with normal or slightly elevated audiogram pure tone thresholds accompanied with absent or severely abnormal auditory brainstem responses (ABRs). With the advent of the otoacoustic emissions (OAEs) in the mid 1980s, these groups of patients were found to have normal cochlear function. The finding of normal cochlear function accompanied with abnormal brainstem responses was defined in 1996 as auditory neuropathy (AN). Whether this represents a true auditory nerve neuropathy is debatable. Further investigations led to the conclusion that AN may truly represent a dyssynchronous auditory nerve rather than a neuropathy. This finding gave rise to the newer term of auditory dyssynchrony (AD). [1] For the purposes of this summary, AN and AD are considered synonymous (ie, AN/AD). Now a days this condition commonly known as Auditory Neuropathy Spectrum Disorder (ANSD). Rather than just considering a condition some of researchers have labeled as syndrome. Treatment for ANSD is varies case to case and needs lot of trial and error method. Hearing aids have been effective of some of the cases where as cochlear implant is also being recommended strongly and found to be effective. Very short number of cases donot really benefits from above two option those advised to use communication strategies to be able to understand speech.
Pediatric Hearing Evaluation is one of the challenging task for every audiologist. Detailed case history, selection of appropriate physiological electrophysiological and behavioural testing is a key. Established hearing thresholds helps us select proper hearing aid and auditory training/ auditory verbal therapy approach. Child need to be evaluated subsequently to measure the benefit of amplification device and therapy. If no significant benefit is obtained by hearing aid further, child should be subjected to cochlear implant evaluation. Aided Audiogram, radiological study and therapists feedback helps team to consider the child for cochlear implant. Cochlear implant has really changed the world of children with hearing impairment. The goal of team is to integrate the child in mainstream and should get every opportunity as any other child with normal hearing. #brainstem evoked response #otoacoustic emission #Digital Hearing Aid #Aided audiogram #auditory Verbal therapy
Cleft and Hearing Loss The hearing loss in a cleft patient is a well known documented, but generally gets ignored. These children continue to have recurrent otitis media with effusion that affects the hearing abilities. Unfortunatley the middle ear function may not improve with palatoplasty. Cleft palate teams need to follow up all such children beginning at birth and going into adulthood, decades after a ‘successful’ palate repair. These patients should have careful otological and audiological surveillance with appropriate interventions whenever required. untreated and fluctuating hearing loss has impact on speech, language, social an academic progress. # pure tone audiogram, impedance testing, brainstem evoked response
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