COCHLEAR IMPLANTATION IN CHILDREN WITH HEARING IMPAIRMENT

A cochlear implant is a surgically implanted device used for hearing rehabilitation of adults and children with severe to profound sensorineural hearing loss and poor speech discrimination who gain limited benefit from conventional hearing aids. There is growing evidence that early application of a cochlear implant in children affected by profound hearing loss is of the greatest importance for the development of adequate auditory performance and language skills. The indication for cochlear implantation in children is bilateral sensorineural hearing loss > 80 dB determined on the basis of hearing tests. In congenital deafness, after completing diagnosis, the cochlear implant should be placed at the age of 12 months. When the desired outcome of cochlear implantation is to develop listening and spoken language skills, intensive speech and language therapy is necessary. Although services differ based on each child’s current level of performance, it is recommended that children receive auditory-based therapy after implantation to maximize benefit from the cochlear implant. Whatever approach is selected, rehabilitation after cochlear implantation is a long process. Parents and family members have a big role in development of spoken language of the child

OBJECTIVE AND BEHAVIOURAL TESTS FOR AUDIOLOGIC ASSESSMENT OF CHILDREN WITH SUSPECTED HEARING LOSS

Audiologic assessment of infants and young children with suspected hearing loss requires selection of differential diagnostic techniques that are age-appropriate and appropriate to the child’s developmental capabilities. Objective assessment includes electrophysiologic and electroacoustic methods: otoacoustic emissions, auditory brainstem response, auditory steady-state response, tympanometry and acoustic reflex. The use of behavioural methods in audiologic assessment requires a response from the patient. Depending on the child’s age, the following methods can be performed: visual reinforcement audiometry, conditioned play audiometry, pure tone audiometry, and speech audiometry. Audiologic assessment in infants and children provides estimation of auditory sensitivity, evaluation of the integrity of auditory system andidentification of possible intervention options in case of existing hearing loss. Early detection and treatment of hearing loss in childhood is essential to ensure optimal speech and language development in the early years of life and optimal school performance for older children

Epidemiological aspects of developmental disorders in school aged children

Multiple factors infl uence the discrepancy between the prevalence rates of developmental disorders worldwide. In addition to different prevalence rates of developmental disorders, there are differences in terminology and their classifi cation. The purpose of the research was to estimate the prevalence and gender distribution of developmental disorders and to calculate the number of children with developmental disorders and special educational needs in a convenience sample of school-age children. We also calculated the number of children with congenital malformations and diseases that affect vision and hearing. We processed the data from medical records of 1750 children (835 males and 915 females) who were examined in the Pediatric Dispensary, Military Hospital, Skopje, Republic of Macedonia during the period of June 30 1992 to June 30 2011. A descriptive method was used. For statistical data analysis we used Chi-square test and Fisher exact test with level of signifi cance p<0.05. A total of 153 out of 1750 (8.7%) children had developmental disorders and special educational needs. Gender distribution shows that 97 children (11.6%) were males and 56 children (6.1%) were females. Specifi c developmental disorders of speech and language were most frequent (82.3%) from all developmental disorders. Prevalence rates of some diseases and developmental disorders were lower in comparison to other studies, e.g., specific developmental disorders of scholastic skills, hyperkinetic disorders, refractive errors and conductive hearing loss. Low prevalence rate of certain disorders could indicate their underdetection

Audiometrijski nalazi pacijenata sa subjektivnim tinitusom

Tinnitus is the perception of sound in the absence of an external source. Most cases of tinnitus are associated with hearing loss expressed either in the audiogram or detected by more sensitive measures. The objective of this research was to determine the prevalence, type, and degree of hearing loss in patients with subjective tinnitus and to analyze the quality features and some tinnitus characteristics related to associated hearing loss. We analyzed audiometric, otoscopic fi ndings, and the medical reports of 1,046 patients, 573 males (54.8%) and 473 females (45.2%), aged 19 to 89 years. The patients were examined at the Department of Otorhinolaryngology, City General Hospital “8-September”, Skopje, Republic of Macedonia, during the period from January 2014 to October 2015. For statistical data analysis, we used a chi-square test with a signifi cance level of p<0.05. Most of the patients were males aged 60 to 69 years (13.4%), but there was no signifi cant difference in age and gender distribution (p=0.156). The prevalence of hearing loss among these tinnitus patients was 91.9%. Most of the patients had bilateral sensorineural hearing loss (58.2%), predominantly at high frequencies (p<0.00001), and described their tinnitus as high -pitch whistling. Bilateral tinnitus was the most common manifestation (59.4%), followed by left-sided unilateral tinnitus (22.8%). Acoustic trauma and noise-induced hearing loss were present in 27.8% of all patients with otological conditions. Most of the patients with subjective tinnitus have some degree of hearing loss. Bilateral, high-pitched tinnitus and bilateral sensorineural hearing loss, predominantly at high frequencies, were the most common findings. Acoustic trauma and noise-induced hearing loss were the most common otological conditions, and noise-induced tinnitus was the most common type of tinnitus.Tinitus je percepcija zvuka u odsutnosti vanjskog izvora zvuka. U većini slučajeva tinitus je prisutan uz istovremeno oštećenje sluha. Cilj istraživanja bio je utvrditi učestalost, vrstu i stupanj oštećenja sluha u pacijenata sa subjektivnim tinitusom te analizirati karakteristike tinitusa u odnosu na oštećenje sluha. Analizirali smo audiometrijske, otoskopske nalaze i medicinske izvještaje 1046 pacijenata, 573 muškaraca (54.8%) i 473 žena (45.2%), u dobi od 19 do 89 godina. Pacijenti su pregledani na Odjelu za otorinolaringologiju Gradske opće bolnice “8-mi Septemvri”, Skoplje, Republika Makedonija, u razdoblju od siječnja 2014. do listopada 2015. Statistička analiza podataka provedena je hi-kvadrat testom uz razinu značajnosti p<0.05. Većina pacijenata bili su muškarci u dobi od 60 do 69 godina (13.4%), ali nije bilo značajne razlike u distribuciji po dobi i spolu (p=0.156). Prevalencija gubitka sluha kod pacijenata s tinitusom bila je 91.9%. Većina pacijenata imala je bilateralni zamjedbeni gubitak sluha (58.2%), uglavnom na visokim frekvencijama (p<0.00001), te su opisivali svoj tinitus kao piskavi zvuk. Bilateralni tinitus bio je najčešće prisutan (59.4%), nakon čega slijedi lijevi jednostrani tinitus (22.8%). Akustična trauma i gubitak sluha izazvan bukom bili su prisutni u 27.8% svih otoloških stanja. Kod većine pacijenata sa subjektivnim tinitusom bio je prisutan neki stupanj gubitka sluha. Bilateralni, visoko frekventni tinitus i bilateralni zamjedbeni gubitak sluha, uglavnom na visokim frekvencijama, bili si najčešći nalazi. Akustična trauma i gubitak sluha izazvan bukom bili su najčešća otološka stanja, a tinitus izazvan bukom bio je najčešći tip tinitusa

Extended High Frequency Hearing Thresholds in Tinnitus Patients with Normal Hearing

The aim of the study was to compare the extended high-frequency (EHF) hearing thresholds (10–16 kHz) in tinnitus and non-tinnitus ears, in a group of 98 patients with unilateral tinnitus and normal hearing at standard audiometric frequencies, in a 0.125–8 kHz range. It was found that a total of 65 patients (66%) had a hearing loss (a threshold shift &gt;20 dB HL) in the EHF range and the EHF hearing loss occurred more frequently in the tinnitus ear than in the non-tinnitus ear. The data also indicate that the EHF thresholds increased with the patient’s age and were in most patients higher in the tinnitus ear than in the non-tinnitus ear

Psychoacoustic Characteristics of Tinnitus in Relation to Audiometric Profile

The aim of the study was to examine the relationship between tinnitus pitch and maximum heating loss, frequency range of hearing loss, and the edge frequency of the audiogram, as well as, to analyze tinnitus loudness at tinnitus frequency and normal hearing frequency. The study included 212 patients, aged between 21 to 75 years (mean age of 54.4 ± 13.5 years) with chronic subjective tinnitus and sensorineural hearing loss. For the statistical data analysis we used Chisquare test and Fisher’s exact test with level of significance p < 0.05. Tinnitus pitch corresponding to the frequency range of hearing loss, maximum hearing loss and the edge frequency was found in 70.8%, 37.3%, and 16.5% of the patients, respectively. The majority of patients had tinnitus pitch from 3000 to 8000 Hz corresponding to the range of hearing loss (p < 0.001). The mean tinnitus pitch was 3545 Hz ± 2482. The majority (66%) of patients had tinnitus loudness 4-7 dB SL. The mean sensation level at tinnitus frequency was 4.9 dB SL ± 1.9, and 13 dB SL ± 2.9 at normal heating frequency. Tinnitus pitch corresponded to the frequency range of hearing loss in majority of patients. There was no relationship between tinnitus pitch and the edge frequency of the audiogram. Loudness matching outside the tinnitus frequency showed higher sensation level than loudness matching at tinnitus frequency

The role of otoacoustic emissions in audiological assessment of children with suspected hearing loss

Introduction: Otoacoustic emissions are sounds that result from energy generated in the cochlea. The otoacoustic emissions test helps to confirm outer hair cell function. Aim: The objective of the study was to evaluate the expression of distortion product otoacoustic emissions in children with suspected hearing loss. Method: This retrospective study included 115 children, 65 males (56.5%) and 50 females (43.5%), aged 0 to 14 years (mean age of 6.9±3.5 years), examined during the period from January 2017 to March 2021. The audiological assessment included Distortion product otoacoustic emissions test, tympanometry, and pure-tone audiometry in children older than 4 years. Distortion product otoacoustic emissions were recorded in the form of DP- gram elicited by two primary tone stimuli L1=65 dB SPL and L2=55 dB SPL. Levels of the 2f1-f2 distortion product otoacoustic emissions were registered at frequencies from 1000 Hz to 8000 Hz at four points per octave. For statistical data analysis we used Chi-square test with level of significance p<.05. Results: From the total of 81 children with tonal audiogram, 13 children (16%) had sensorineural hearing loss with mean distortion product otoacoustic emissions amplitude -7.4 dB SPL, and 68 children (84%) had normal hearing with mean DPOAE amplitude 9.9 dB SPL. In children without tonal audiogram, distortion product otoacoustic emissions were present in 23 children (67.6%) at control examination after absence during middle ear pathology and 9 children (26.5%) at first examination. Otoacoustic emissions were absent in 2 children (5.9%) without middle ear pathology. They were mostly absent at frequency of 4000 Hz (p=.036). Conclusion: The otoacoustic emissions test is good cross-check for pure- tone audiometry. In children with sensorineural hearing loss, the otoacoustic emissions are absent in the range of hearing loss. In young children not cooperative for pure-tone audiometry, expression of otoacoustic emissions after previous absence during middle ear pathology would indicate that there is no coexistent sensorineural hearing loss

Development of Macedonian monosyllabic and disyllabic tests for speech audiometry

The aim of the study was to develop Macedonian monosyllabic and disyllabic tests for speech audiometry, to record the speech materials, and to conduct clinical validation of the tests. The following criteria were applied: word familiarity, phonetic balance, and homogeneity of audibility. Clinical validation was conducted on a sample of 30 normal hearing subjects, aged 18 to 30 years. We developed four open-set tests for speech threshold and suprathreshold testing in quiet. The tests contain two word lists with 50 monosyllabic words and two word lists with 36 disyllabic words. Each word was introduced by a carrier phrase. Psychometric function slope from 20% to 80% correct recognition for all words was 5%/ dB. The difference between the presentation levels at which the subjects repeated all the words was ≤ 4 dB. Developed phonetically balanced word lists have relatively steep psychometric function slope and they are homogeneous in terms of the audibilit

Прирачник за наставници - Насоки за примена на учебникот по математика за трето одделение од деветгодишното основно образование

Прирачникот по математика е наменет за наставниците од одделенска настава кои во својата наставна практика го користат учебникот по математика и работните листови-математичка работилница за трето одделение од деветгодишното основно образование од авторите Т.А.Пачемска и други.Дневните планирања се работени според најновите насоки и барања од БРО

CORRELATION BETWEEN TYMPANIC MEMBRANE PERFORATION AND HEARING LOSS

Introduction: Perforation of the tympanic membrane primarily results from middle ear infections, trauma or iatrogenic causes. The perforation causes conductive hearing loss by reducing the surface area available for sound transmission to the ossicular chain. Objective: The objective was to analyze the characteristics of tympanic membrane perforations in relation to hearing loss and to determine the type and degree of hearing loss. Materials and methods: We analyzed audiometric, otoscopic findings and medical reports of 218 patients, 114 males (52.3%) and 104 females (47.7%), aged 9 to 75 years (mean age of 47.9 years), examined during the period of November 2012 to October 2015. For statistical data analysis we used Chi-square test with level of significance p<0.05. Results: Most of the patients had unilateral perforations (89%) with right ear predominance and involvement of two quadrants of pars tensa (37.2%). Mean air-bone gap was 23.9 dB. The largest air-bone gap was at frequency of 250 Hz. Most of the patients (73.1%) had mixed hearing loss (p=0.032), and average hearing thresholds from 21 to 40 dB. Conclusion: Mean air-bone gap is largest at the lower frequencies, and decreases as frequency increases. Size of the perforation has effect on hearing loss. Mean air-bone gap increases with increasing size of the perforation. There is no big difference between the mean air-bone gap in posterior versus anterior perforations