EARLY DIAGNOSIS AS A PRECONDITION FOR A SUCCESSFUL COCHLEAR IMPLANTATION

All researches point to the fact that the early de­tection and diagnosis are still performed late (after the third year of life), so in the first three years of life there is no establishment of the developmental changes in a way that they include the interrelation aspects of the human development and its natural sequences. With the start of early rehabilitation procedures we encourage the positive manner of communication in the small deaf child, so that it manufactures and processes information that can lead to positive quality changes in the develop­mental process.The hearing technology has dramatically changed over the last decades. With the contribution of audiometers in the 40-ties of the last century we started to learn how to precisely estimate the de­gree and type of the hearing impairment, which has an enormous meaning for the optimal fitting of the powerful hearing aids and the cochlear im­plants. In the same period hearing aids for small children are developed which enabled children with a sig­nificant hearing loss a better opportunity to de­velop speech and their spoken language

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

SOCIAL FUNCTIONING OF CHILDREN WITH MALIGNANT DISEASES

The purpose of the research was the assessment of the functioning of children with malignant diseases in the social surroundings.The basic paradigm was based on the research that explores the relation of malignant disease and social competence. The sample consisted of 120 examinees (60 examinees from the E group and 60 examinees from the K group). The criteria for the formation of the E group were: age 8-18 years old; diagnosis of the malignant diseases confirmed with a histopathological verification (consistent tumors and malignant hemopathy); treatment on the children department for OR (hemiotherapy, radiotherapy, combined hemopathy); fine pre morbid status. The control group consisted of healthy examinees that according to the number, age, sex and the level of education were adequate to the examinees from the E group.With comparison of the average accomplishments of the examinees from groups E and K in the field of social competence we obtained a statistically significant difference between the examined groups in benefit to the examinees from group K. The social incompetence and social exclusion that follow the malignant disease represented a basic indication for special education and rehabilitation of children and young people that suffer from malignant diseases

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