Sensory


Hearing Loss

Visit these blogs to read about families who have adopted a child with this special need:

Ears to Hear
…..Loving You


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There are many types and levels of hearing loss. Problems with the outer and middle ear cause conductive hearing loss – the sound cannot be properly transmitted (conducted) to the inner ear and brain. Ear infections and fluid build up in the ears can cause temporary hearing loss, which can become permanent because of scarring (this can be common in children with cleft palate, as well as others). The outer ears may be malformed or missing (microtia) or the ear canals narrowed or closed (atresia). The middle ear structures may be malformed. Problems with the inner ear (usually the hair cells of the cochlea) or the auditory nerve cause sensori-neural hearing loss. It is also possible to have a mixed loss with both conductive and sensori-neural components.

“Normal” hearing is defined as thresholds between 0 – 20 across the frequency range. Mild hearing loss is thresholds between 20 – 40. Thresholds between 40 – 70 are considered moderate loss; severe loss are thresholds from 70 – 90, with profound loss defined as anything beyond that. Loss can be fairly “flat” across the frequencies, or “sloping” with more loss for some frequencies than others (a child might hear low frequency sounds at 30 dB but not respond to higher-pitched sounds until they are 80 dB – this would be described as a “mild-to-severe” loss). It’s important to note that purely conductive hearing loss falls in the moderate range. Files of children with microtia/atreia from China will often say they are “severely” or “profoundly” deaf, but this is usually not correct.

Medical Factors

Hearing loss can have a variety of causes: genetics, structural issues, maternal illness, childhood illness, etc. In many cases, the cause cannot be determined. Most children with hearing loss are healthy and have no other issues, but there are a number of syndromes within which hearing loss may be a component. Because the ears, eyes, heart, and kidneys develop (prenatally) at the same time, issues with one are sometimes associated with issues with the others. Children with hearing loss should have their eyes, heart, and kidneys checked upon coming home. Children with conductive loss related to fluid build up or damage to the ear drum may benefit from placement of tubes and/or tympanoplasty (reconstruction of the ear drum). Some children with microtia/atresia are candidates for surgical repair of the ear canal and/or middle ear, as well as cosmetic reconstruction of the outer ear. Not all families choose this route, however. Sensory-neural hearing loss generally cannot be “treated” or “corrected.”

Amplification

Many children with hearing loss benefit from amplification of various kids. Children with conductive loss (esp. microtia/atresia) usually use bone conduction hearing aids. These devices, which are worn on a headband by young children and can be attached to a surgically implanted post or magnet for an older child), transmit the sound through the bones of the skull directly to the inner ear. Most kids with purely conductive loss have near-normal hearing with these devices. For kids with mild or moderate sensory-neural loss, hearing aids that work by making the sound louder are often beneficial. Some children with severe or profound loss benefit from hearing aids, but often not enough to understand and develop speech. Kids with severe to profound loss may be eligible for cochlear implants (CIs), which are hearing prosthetics. The CI has internal components, which are placed during surgery, and external components which are worn like a hearing aid.

Communication and Education

Families of hard-of-hearing or deaf children have to make major decisions about language and communication, which also impact educational choices. These choices include whether or not to use amplification (hearing aids and CIs), what language to use (spoken English, American Sign Language, or some combination thereof), and what kind of school placement to select (regular classroom with speech and language therapy and other special education support as needed; deaf education program with self-contained classrooms in a regular school; a separate school for the deaf; or home education). The level of the child’s hearing loss, the child’s age at adoption, and the family’s philosophy and preferences all impact these decisions.

Families considering a Deaf or Hard of Hearing child should carefully consider these questions and research the options as well as resources in their local community. This is especially important when considering a child with a severe/profound hearing loss (most children with mild to moderate loss are able to use spoken language through the use of hearing aids and therapy). Becoming familiar with the cultural understanding of Deafness (the view that Deaf people are not a disability group as much a linguistic and social minority with their own language (ASL), history, community institutions, etc) is important. Families should understand that there is a developmental “critical period” for language learning and especially for auditory development and an older child (over preschool age) who has never had access to language may struggle to develop a variety of concepts and skills. These older children are fairly unlikely to become highly successful CI users, though they may gain some benefit from the device. Families adopting an older deaf child should assume that sign language will be the child’s primary communication method and should assess their own and their community’s resources to support this, particularly the opportunity to interact with other Deaf people and the availability of appropriate educational opportunities.


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Resources:
American Society for Deaf Children
American Speech-Language-Hearing Association
Hands & Voices
National Association of the Deaf
Adopting a Child With Hearing Loss
ASL as a First Language
Ear Community
Cochlear
Gallaudet University
Signs for Hope

 

Read blog posts about Hearing Loss on No Hands But Ours.


Vision Issues

Visit the blogs of families who have adopted children with vision issues:

A Full Quiver
And Jada Makes Seven
Elizabeth Mei
Love Like Crazy
Through Gabe’s Eyes

Strabismus (crossed eyes)

Strabismus is the condition where the eyes are misaligned. Different types of strabismus include crossed eyes (esotropia, the most common type in children), out-turned eyes (exotropia), or vertical misalignment (hyper or hypotropia). The problem may be present intermittently or constantly. Treatment options depend upon the type of strabismus, and may include glasses, prism lenses, and/or surgery.To read more about strabismus, go here.

Amblyopia (lazy eye)

Amblyopia, commonly known as lazy eye, is the eye condition noted by reduced vision not correctable by glasses or contact lenses and is not due to any eye disease. The brain, for some reason, does not fully acknowledge the images seen by the amblyopic eye. This almost always affects only one eye but may manifest with reduction of vision in both eyes. It is estimated that three percent of children under six have some form of amblyopia.

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Glaucoma

Glaucoma is a disease caused by increased intraocular pressure (IOP) resulting either from a malformation or malfunction of the eye’s drainage structures. Left untreated, an elevated IOP causes irreversible damage the optic nerve and retinal fibers resulting in a progressive, permanent loss of vision. However, early detection and treatment can slow, or even halt the progression of the disease.

glaucomasight

left: shows a normal range of vision, unaffected by glaucoma
right: the same view with advanced vision loss from glaucoma

glaucoma diagram and above photos available through the Creative Commons license, courtesy of Wikipedia

Cataracts

Congenital cataract is a lens opacity that is present at birth or shortly after birth.

Congenital cataracts may be sporadic, or they may be caused by chromosomal anomalies, metabolic disease (eg, galactosemia), or intrauterine infection (eg, rubella) or other maternal disease during pregnancy. Cataracts may be located in the center of the lens (nuclear), or they may involve the lens material underneath the anterior or posterior lens capsule (subcapsular or cortical). They may be unilateral or bilateral. They may not be noticed unless the red reflex is checked or unless ophthalmoscopy is done at birth. As with other cataracts, the lens opacity obscures vision. Cataracts may obscure the view of the optic disk and vessels and should always be evaluated by an ophthalmologist.

Removal of a cataract within 17 wk after birth permits the development of vision and cortical visual pathways. Cataracts are removed by aspirating them through a small incision. In many children, an intraocular lens may be implanted. Postoperative visual correction with eyeglasses, contact lenses, or both is usually required to achieve the best outcome.

After a unilateral cataract is removed, the quality of the image in the treated eye is inferior to that of the other eye (assuming the other eye is normal). Because the better eye is preferred, the brain suppresses the poorer-quality image, and amblyopia develops. Thus, effective amblyopia therapy is necessary for the treated eye to develop normal sight. Some children are unable to attain good visual acuity because of accompanying structural defects. In contrast, children with bilateral cataract removal in which image quality is similar in both eyes more frequently develop equal vision in both eyes.

Some cataracts are partial (posterior lenticonus) and opacify during the 1st decade of life. Eyes with partial cataracts will have a better visual outcome.

Nystagmus

Nystagmus is a vision condition in which the eyes make repetitive, uncontrolled movements, often resulting in reduced vision. These involuntary eye movements can occur from side to side, up and down, or in a circular pattern. As a result, both eyes are unable to hold steady on objects being viewed. Nystagmus may be accompanied by unusual head positions and head nodding in an attempt to compensate for the condition. Nystagmus can be inherited and appear in early childhood or develop later in life due to an accident or illness. Generally, nystagmus is a symptom of some other underlying eye or medical problem, however, the exact cause is often unknown. Persons with nystagmus may experience reduced visual acuity. They may also have problems with depth perception that can affect their balance and coordination. Nystagmus can be aggravated by fatigue and stress.

The forms of nystagmus include:

Congenital – most often develops by 2 to 3 months of age. The eyes tend to move in a horizontal swinging fashion. It is often associated with other conditions such as albinism, congenital absence of the iris (the colored part of the eye), underdeveloped optic nerves, and congenital cataract.

Spasmus nutans – usually occurs between 6 months and 3 years of age and resolves spontaneously between 2 and 8 years of age. Children with this form of nystagmus often display head nodding and a head tilt. Their eyes may move in any direction. This type of nystagmus usually does not require treatment.

Acquired – develops later in childhood or adulthood. The cause is often unknown, but it may be due to central nervous system and metabolic disorders or alcohol and drug toxicity.

Nystagmus can not be cured. While eyeglasses and contact lenses do not correct nystagmus, they can help to correct other vision problems such as nearsightedness, farsightedness or astigmatism. Some types of nystagmus improve throughout childhood. In addition, vision may be enhanced with prisms and special glasses. The use of large-print books, magnifying devices and increased lighting can also be helpful. Treatment for other underlying eye or medical problems may help to improve or reduce nystagmus.

Resources:
American Association for Pediatric Ophthalmology and Strabismus
Amblyopia – MedlinePlus
What is Lazy Eye (Amblyopia)?
Glaucoma – St. Luke’s
Glaucoma – National Eye Institute
Congenital Glaucoma
Congenital Cataracts
Cataracts – St. Luke’s
Strabismus
Strabismus – MedlinePlus
What is Strabismus?
American Nystagmus Network
Nystagmus
Nystagmus – MedlinePlus
AOA Nystagmus
Yahoo! Group – China Adoption Eye Sight
Irelen
Vision Therapy

 

Read more about Vision Issues on No Hands But Ours.


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