audiological diagnosis after newborn screeningaudiological diagnosis after newborn screening pr hung...
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![Page 1: Audiological Diagnosis after Newborn ScreeningAudiological Diagnosis after Newborn Screening Pr Hung THAI-VAN, M.D., Ph.D. President of the French Society of Audiology Department of](https://reader036.vdocuments.mx/reader036/viewer/2022070802/5f02decc7e708231d4066b5e/html5/thumbnails/1.jpg)
Ifos World Course on Hearing Rehabilitation Dubai, 29 march 2019
Audiological Diagnosis after Newborn Screening Pr Hung THAI-VAN, M.D., Ph.D. President of the French Society of Audiology Department of Audiology & Otoneurological Evaluation (Head) Lyon University Hospital France
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Universal Newborn Hearing Screening (UNHS): What’s next?
UNHS
Diagnosis Intervention
0 –1 month 3 months 6 months
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Objective measures: what is children- specific?
Behavioral Audiometry: when and how
Diagnostic strategy
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Principles of Behavioral Audiometry
Deliver stimuli
Take stimuli
Building a circular path between the clinician and the
child
Take reactions
Deliver reactions
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Principles of Behavioral Audiometry
Deliver stimuli Take reactions
Take stimuli Deliver reactions
Building a circular path between the clinician and the child
Adapt your testing to the child age (neurodevelopmental, not chronological)
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Principles of Behavioral Audiometry
Deliver stimuli Take reactions
Take stimuli Deliver reactions
Building a circular path between the clinician and the child
Adapt your testing to the child age (neurodevelopmental, not chronological)
Always use the parents as partners when testing
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Before 6 months: Behavioral Observation
Audiometry (BOA)
Take your time and look for the infant reflexive
behaviors to auditory stimuli: i.e., eye blink/widening,
modification of cardiac rhythm, startle responses (Moro
reflex)…
Bias 1: can be elicited by a wide range of intensity
levels
Bias 2: babies can get bored very quickly
Bias 3: observer experience-dependent
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Objective measures: what is child specific?
Behavioral Audiometry: when and how
Diagnostic strategy
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TARGETTING…
Middle Ear
Inner Ear
Afferent pathway & beyond
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Tympanometry (Otto Metz, 1946; Jerger, 1970)
P - P + 0
Impedance : type B
G V
Otitis with middle ear effusion
glu
0 atm
P1 = 0 atm
Adapted from Van Den Abbeele et al.
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Effect of ear canal volume
Consensus statement: Eriksholm workshop on wideband absorbance measures of the middle ear. Feeney MP et al., Ear Hear. 2013
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3D wideband tympanometry
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TARGETTING…
Middle Ear
Inner Ear
Afferent pathway & beyond
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Principle
Transient evoked otoacoustic emissions
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Otoacoustic emissions
Assessing OHCs in vivo
Transient evoked otoacoustic emissions
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Distorsion Product 0toacoustic emissions
Objective Audiometry:
DPOAEs are back!
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Distorsion Products
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Distorsion Products
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Distorsion Products
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TARGETTING…
Middle Ear
Inner Ear
Afferent pathway & beyond
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Click, Chirp, Tone Burst
+
-
ground ABR
Auditory Brainstem Response
> 80 Hz
3000 trials
fs = 7 à 50 kHz
Why « brainstem » ?
Early activity (< 20 ms) > 80 Hz
AUDITORY BRAINSTEM RESPONSES
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Auditory Evoked Potentials (AEP)
I) CLICK ABRs
II) FREQUENCY-SPECIFIC DIAGNOSIS
III) HOW TO GET RID OF CONDUCTIVE HL
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Normal ABRs (20 dB-threshold)
Start at 70 dB then diminish stim level
(10-20 dB steps)
ABR RECIPE IN YOUNG CHILDREN
Looking for objective hearing threshold
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Well-defined waveforms CNS maturity Topodiagnosis in conjunction with TEOAEs Auditory neuropathy diagnosis
ABR information
What does it tell you?
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Auditory Neuropathy Diagnosis
TOAEs are present
ABRs are absent
Cochlear microphonic potential (CMP)
must be looked for
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Cochlear Microphonic Potential (CMP)
Low amplitude response just a
few msec after the click
Latency does not change with
intensity level
Receptor potential of hair cells
Follow stimulus polarity (either
rarefaction or condensation
click)
(Starr et al., 1996 ; Starr et al.,
2001 ; Buchman et al, 2006 ;
Berlin et al., 2010) Figure extraite de Hood, 2015
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Case Report – 2 month-old
preterm birth (36 weeks)
OEA present OEA absent
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Case Report – 2 month-old
preterm birth (36 weeks)
ABR present Alternating Polarity click
ABR absent Alternating Polarity click
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Case Report – 2 month-old
preterm birth (36 weeks)
CMP present Rarefaction / Condensation clicks
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Auditory Evoked Potentials (AEP)
I) CLICK ABRs
II) FREQUENCY-SPECIFIC DIAGNOSIS
III) HOW TO GET RID OF CONDUCTIVE HL
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Tone-Burst ABRs
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Tone-Burst ABR
Ribeiro, 2003
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Tone-Burst ABR
Ribeiro FM, Carvallo, RM; 2007
Global neurodevelopment delay No collaboration at behavioral audiometry Need for frequency specific diagnosis
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Auditory steady state response (ASSR)
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Carrier: e.g. 2000 Hz
Modulation 90 Hz
FM +/-AM
signal
Auditory steady state response (ASSR)
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Carrier Frequencies (FP) : 500, 1000, 2000, 4000 Hz
Modulation Frequencies (FM) : 40 Hz (awake adult, sleep-sensitive)
vs 90 Hz (children)
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Testing 4 frequencies in both ears at a time!
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ASSR provide objective audiogram
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Click-ABR vs ASSR threshold
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Rance & Rickards, 2002- JAAA vol.13(5), 236-245.
500 Hz 1000 Hz
.96 .97
2000 Hz 4000 Hz
.98 .97
AU
DIO
MET
RY
PTA vs ASSR threshold
ASSR
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Auditory Evoked Potentials (AEP)
I) CLICK ABR
II) FREQUENCY-SPECIFIC DIAGNOSIS
III) HOW TO GET RID OF CONDUCTIVE HL
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BC
40 dB HL
BC ABR
With permission from Ribeiro & Chapchap, Hospital Sao Luiz - Sao Paulo
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Objective measures: what is child specific?
Behavioral Audiometry: when and how
Diagnostic strategy
![Page 44: Audiological Diagnosis after Newborn ScreeningAudiological Diagnosis after Newborn Screening Pr Hung THAI-VAN, M.D., Ph.D. President of the French Society of Audiology Department of](https://reader036.vdocuments.mx/reader036/viewer/2022070802/5f02decc7e708231d4066b5e/html5/thumbnails/44.jpg)
TAKE HOME MESSAGES
Combine otoscopic, endocochlear and afferent
auditory pathway examination
It’s always nice to see the ABR traces
If you can’t get a precise idea of middle ear status, go
for Bone conduction testing
Frequency-specific diagnosis can be done during
follow-up
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Thank you!