DIAGNOSIS OF DEAFNESS IN THE VERY YOUNG CHILD

Congenital aural atresia. A new subclassification and surgical management

The four surgical methods currently in use to improve hearing in patients with congenital aural atresia are (i) fenestration of the lateral semicircular canal, (ii) type III tympanoplasty, (iii) canal plasty and (iv) canal plasty with homograft tympanoplasty. Because the surgery is difficult and the functional results are not always good, the criteria for surgery are also influenced as to whether the anomaly is unilateral or bilateral and what the cosmetic goal is. When aural rehabilitation and cosmetic surgery are contemplated, co-ordinated planning by the otological and plastic surgeon is necessary to attain the best end result. Of the 36 ears with a type II anomaly operated on at the University of Nijmegen between 1972 and 1983 by the technique of canal plasty, the average hearing gain was 20 db, with 18 patients having a 35 dB or better air conduction threshold. The functional results seem to be related to the degree of malformation involved. Classification of the malformations has proved to be useful in discussing the surgical results.

Comparing TROCA and peep-show in testing the hearing of young children

The hearing of 24 normal hearing children ranging in age from 18 to 32 months was tested by TROCA and peep-show, two operant conditioning technique differing only in the type of reward. Children between 18 and 24 months consistently exhibited poorer thresholds (lowest response levels) than children between 25 and 32 months. The older children required fewer trials for threshold determination and took less time in completing testing. Children tested with TROCA exhibited significantly poorer thresholds (although the differences were small) and took significantly longer to complete testing than for peep-show. No differences were found between the two methods for the number of trials to obtain threshold. The results strongly suggest that the type of reward is not an important factor in testing the hearing of young, normal children.

Use of the slide show audiometric technique with mentally retarded children

Because of the apparently high incidence of hearing impairment and difficult to test subjects among the retarded, there is a need to continually strengthen our audiologic assessment armamentarium. This paper (a) discusses the instrumental (or operant) conditioning audiometric technique called the peep show, (b) presents the slide show as an inexpensive means of using this operant technique, (c) considers the use of the slide show technique with mentally retarded children, and (d) compares the slide show to previously reported operant conditioning techniques of this type.

DIFFERENTIAL DIAGNOSIS OF AUDITORY DEFICITS--A REVIEW OF THE LITERATURE

The differential diagnosis of young children with communication disorders is one of the more difficult and germinal tasks confronting speech and hearing personnel today. Audiological assessment should provide quantitative and qualitative information about auditory responses and behavior that can point up other clues to the total diagnosis. A review of the literature reveals that consistency of auditory response is frequently cited as one characteristic that distinguishes children with peripheral hearing loss (reported to be consistent) and children with CNS auditory disorders such as aphasia (reported to be inconsistent).