the ear group, antwerp, belgium the landmarks towards hearing paul j govaerts, md, ms, phd k...

the ear group, Antwerp, Belgium

The landmarks towards hearingThe landmarks towards hearing

Paul J Govaerts, MD, MS, PhD

K Daemers, G De Ceulaer, M Yperman, C De Beukelaer

the eargroup

Antwerp-Deurne (Belgium)


BELGIUMBELGIUM

Flanders 60% of population approx 60.000 newborns

Antwerp 1993 pilot study European concerted actions (Grandori)

1995 Well Baby Organization


Flanders UNHS 2003Flanders UNHS 2003

Flanders approx 60.000 newborns since 1999: universal screening (ALGO) coverage: 94-96% 5.7 %0 retested >> 2 %0 referred>> 0.9 %0 of population with bilateral loss


1 month: screening • + referral

• + expert counseling

• + setting out the time line

Congenital SNHLCongenital SNHLthe landmarks towards hearing …the landmarks towards hearing …





3 months: diagnostic work-up



Congenital SNHLCongenital SNHLDiagnostic work-up Diagnostic work-up

Confirmation of hearing loss

Excluding other pathologies (syndromes)

Looking for the etiology



Confirmation of hearing loss• ABR under anaesthesia

• After paracenthesis

• With air and bone conduction

Excluding other pathologies (syndromes)




Confirmation of hearing loss• ABR under anaesthesia

• After paracenthesis

• With air and bone conduction

Excluding other pathologies (syndromes)• Clinical examination

• Ophtalmologic examination

• Ultrasound kidneys, urine

• ECG

• Chromosomal analysis



Congenital SNHLCongenital SNHLdiagnostic work-updiagnostic work-up

10 years ago: only diagnosis is 15% Now: diagnosis in 75%

Unknown 25 %

Genetic

connexin-26 25 %

other 10 %

Labyrinthine malformation 20 %

Acquired 20 %

Blood exam !

MRI / CT scan !





3 months: diagnostic work-up






3 months: diagnostic work-up 3-6 months: hearing aid fitting + rehab






3 months: diagnostic work-up 3-6 months: hearing aid fitting + rehab 9-12 months: evaluate hearing aids


Cochlear function- amplification (detection)- discrimination

Audiometry??

HA evaluationCI candidacy selectionCI evaluation + programming


*.wav files*.wav files


A§EA§E

Boy 11 monthsConnexin-26 deafnessHearing aids from age 3 months


A§EA§E

CI @16 mos





3 months: diagnostic work-up 3-6 months: hearing aid fitting + rehab 9-12 months: evaluate hearing aids


http:/www.eargroup.net

Cochlear implantbefore 18 months

ContinuHearing aids


Age at implantationAge at implantationCAP: CAP: follow-up 2 yearsfollow-up 2 years

response to spoken language

language discrimination

telephone

22 10 17 9 96


Age at implantationAge at implantationbabblingbabbling


Receptive language Receptive language development (Reynell)development (Reynell)

0

10

20

30

40

50

60

70

80

1 2 3 4 5 6 7 8

age (years)

raw

sco

re

gemiddelde

min 2 SD

TD

KM

SA

LT

JV

SW

BB

Courtesy of Leo De Raeve, KIDS, Hasselt, Belgium)


Expressive language Expressive language development (Reynell)development (Reynell)

0

10

20

30

40

50

60

70

80

1 2 3 4 5 6 7 8

age(years)

raw

sco

re

gemiddelde

min 2 SD

TD

KM

SA

LT

JV

SW

BB

Courtesy of Leo De Raeve, KIDS, Hasselt, Belgium)


Age at implantationAge at implantationmainstream integrationmainstream integration

89

6354

33

140

102030405060708090

integration (%)

0 1 2 3 4 5

age of implantation (y)


ConclusionConclusionthe road towards hearing…the road towards hearing…

http://eargroup.net

[email protected]

1 month: screening 3 months: diagnostic work-up < 6 months: hearing aid fitting + rehab < 12 months: evaluate hearing aids < 18 months: hearing restoration

the ear group, antwerp, belgium the landmarks towards hearing paul j govaerts, md, ms, phd k...

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