KidsAudiologist

Posts Tagged ‘lip reading

Just occasionally paediatric audiologists, particularly those who work in cochlear implant programmes, will meet a child who has been born without cochlea or auditory nerves, or other abnormality of the inner ear that makes a hearing aid or cochlear implant useless. This diagnosis has just been given to the parents of a 4 month old boy and other parents in the same situation have shared their experiences on the NDCS Parent Place forum. This must be devastating for parents who have held out hope for a technological miracle that will help their little one access hearing and speech. Some parents have been researching the option of an auditory brainstem implant (ABI).

An ABI works in a similar way to a cochlear implant and in fact the external parts look just like a cochlear implant. But instead of electrodes inserted into the cochlea, the electrodes stimulate the auditory brainstem directly, bypassing the ear and auditory nerve. This makes the procedure more invasive than that for a cochlear implant.

ABI’s are used most often for adults who have suffered trauma to their hearing nerve which means that it is no longer useful and Manchester Cochlear Implant Programme have implanted more than 50 adolescents and adults in this group. Trauma usually occurs during surgery to remove a tumour from the hearing nerve. Once the hearing nerve has been damaged in this way the person would not benefit from hearing aids or a cochlear implant because the sounds could not transfer from the ear to the brain along the nerve. ABI has only been used for adults who have previously had hearing and use speech to communicate. Where a cochlear implant stimulates different points corresponding to different frequencies along the cochlea, the brainstem does not have this separation of frequencies so the ABI cannot separately stimulate different groups of nerves corresponding to distinct frequency ranges. The ABI therefore provides a sensation of hearing that can help aid lip-reading and provide other clues used in spoken communication (for example rhythm and speed of speech) but these adults are unable to use the ABI alone to hear speech without the additional help of lip-reading etc.

Although ABI’s have been available in the UK for the last decade only a handful of children have had the procedure here. The outcomes for children are more variable than for children who use a cochlear implant – they may only offer access to louder and environmental sounds although some are accessing speech. Like cochlear implants the emerging evidence is that the earlier implantation takes place, the better the outcomes for the child. ABI’s have been used in cases when there is no cochlea (and therefore nothing to implant with a cochlear implant), when the cochlea has suffered extensive damage (such as following meningitis) and an electrode can’t be inserted into the cochlea, and when there is no auditory nerve.

It is understandable that most hearing parents opt for cochlear implants for their deaf child – opening up options for their child to develop spoken language as well as BSL and potentially other languages too. For parents of children in the ABI candidature group it appears that most have instead been opting to concentrate on developing British Sign Language as their child’s first language without technological intervention but there is increasing interest in the option of an ABI.

Further information on auditory brainstem implants including further reading links and research go to the NDCS webpage.

Updates and family stories

Hope for Hearing is a trust that was set up to raise funds for 22 month old Evie’s ABI which was implanted in Italy in June 2012. You can read more about her story and her family’s experiences of the assessment and surgery etc.

amazing amelia had her ABI at 2 years 8 months. Read her blog and watch videos of her progress.

The Fight for Finn is a trust that was set up to raise funds for 18 month old Finn’s ABI which was implanted in Italy in July 2012. You can read more about his story and his family’s experiences of the assessment and surgery etc.

Read Oliver Bosche’s story on the MailOnline on watch him on STV “Deaf toddler hears for the first time after pioneering treatment” in April 2013

Read Danny Pickards story on the MailOnline from February 2014 and his website Help me Hear

Christmas is that time of year when we traditionally eat too much, exchange presents, and get extended family and friends together. Whilst I’m not going to attempt any dietary or present buying advice, there may be readers who are going to be joining family or friends with a deaf or hearing impaired child in the family. You may not normally get to spend a lot of time with them or maybe they were very tiny the last time you saw them. The following tips will help make communication easier and more enjoyable for you both…

  • Most children who have hearing difficulty will use all kinds of visual clues to help them make sense of what is being said. They will watch your facial expressions and body language, and they may be watching your lips closely (lip-reading). So it’s really important to make sure you have the child’s attention before starting to talk, keep facing the child and try to maintain good eye contact. Try to get down on the same level as them so that they don’t have to look up to you all the time. And if you’re playing together allow some space so that they can see your face clearly. At Christmas the fairy lights can be very pretty and atmospheric but if a child has a hearing loss they won’t easily be able to follow what’s being said in a dark room so try to keep the lights on when you’re talking. And try not to stand with your back to a window as this creates shadow and makes it difficult to read your facial expressions or lipread.
  • Santa may be a lovely fellow who brings some great presents but with that bushy white beard he’s impossible to lip-read. If you’re sporting facial hair consider a festive trim. And don’t try to talk to the child at the same time as munching your way through the mince pies and Quality Street, or when hiding behind the Christmas edition of the Radio Times.
  • Background noise makes it really hard for a hearing impaired child to follow your speech and conversation in groups can be impossible. Since there’s probably going to be lots of conversation  going on around the dinner table try to make sure that any background noise that can be turned off, such as the looped CD of Christmas songs, is.  Make sure members of the group speak one at a time and visually indicate when a different person is speaking so that the child can keep up.
  • When you’re talking there’s no need to shout. This will distort your lip patterns but more importantly appear to the child that you are angry with them, potentially setting up yet another generation of traditional Christmas family feuding. So speak clearly, naturally and at a normal pace.
  • Mostly though, don’t give up! They may not know all the words you use so try a different word with the same meaning and use gestures to show what you mean. Encourage them to tell you if they don’t  understand.

However you celebrate, I wish you a very enjoyable festive period and happy New Year!

If you’re reading this after Christmas, why not contact the NDCS for a copy of their flyer or poster of tips Communicating with deaf children without references to slightly dysfunctional family dynamics (which may have more to do with the authors own rather than widespread experiences).

 

 


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