Ms. Kibby received her master's degree in Audiology with honors from California State University, Long Beach, and is currently pursuing her doctorate at the University of Florida. She completed her clinical fellowship and spent seven years at Texas Children's Hospital in Houston, where she trained for her pediatric specialty.
Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.
Dr. Bredenkamp recieved his medical degree from the University of California, San Francisco School of Medicine. He then went on to serve a six year residency at the University of California, Los Angeles School of Medicine in the department of Surgery.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
How can hearing be assessed in a child who is unable to cooperate?
Some children are unable to cooperate for hearing evaluations, either due to
their age or to a developmental delay (for example, a child with severe mental
retardation). Currently, there are two different types
of tests that are utilized for children who are unable to cooperate. The first
is the frequency-specific auditory brainstem response (ABR) evaluation. An ABR
is a physiological measure of the brainstem's response to sound. It tests the
integrity of the hearing system from the ear to the brainstem. The test is
performed by placing four to five electrodes on the child's head, after which
a variety of sounds are presented to the child through small earphones. As the
hearing nerve fires, the sound stimulus travels up to the brain. The electrical
activity generated by the nerve can be recorded by the electrodes and presented
as waveforms on a computer screen. The audiologist can then present different
loudness levels of each sound and determine the softest levels at which the
child can hear. The child can be tested using all the sounds of a conventional
hearing evaluation (adult hearing evaluation).
The limitation of the ABR is the need for the child to be quiet and still.
The electrical potential the computer is recording from the auditory nerve is
very small. Any muscle movement, including something as small as an eye blink,
can obliterate the hearing response; therefore, the infant or child must be
sleeping during the test. Infants less than 3 months old can be tested
during natural sleep. Children older than 3 months are typically sedated for
about one hour (under the supervision of a physician) during the test. The most
common oral sedative used is chloral hydrate.
The second type of test to objectively evaluate children is the otoacoustic emission (OAE) test. This test can be done as a supplement to
the ABR or as an initial screen of hearing. An otoacoustic emission test
measures an acoustic response produced by the inner ear (cochlea). The acoustic
response measured is in essence the response produced by the inner ear as it
bounces back out of the ear in response to a sound stimulus. The test is
performed by placing a small probe that contains a microphone and speaker into
the child's ear.
As the child sits or rests quietly, sounds are generated in the probe and
responses that come back from the cochlea are recorded. Once the cochlea
processes the sound, an electrical stimulus is sent to the brainstem, but in
addition, there is a second and separate sound that does not travel up the
nerve but comes back out into the child's ear canal. This
"byproduct" is the otoacoustic emission. The emission is then recorded
with the microphone probe and represented pictorially on a computer screen. The
audiologist can tell which sounds yielded a response/emission and the strength
of those responses. If there is an emission present for those sounds critical to
speech comprehension, then the child has "passed" the hearing screen.
As a supplement to the ABR, the OAE serves as a crosscheck to either confirm
normal hearing or verify the site-of-lesion for the hearing loss as the inner
ear. OAE tests the integrity of the hearing organ for sound (the cochlea),
but it does not evaluate the hearing beyond the cochlea. That is why the OAE is
often paired with the ABR or with a behavioral test that can evaluate a child's
responsiveness to sound.
The results from an ABR and an OAE evaluation can predict the child's
hearing, determine if there is a loss, determine the type of hearing loss, and
help with decisions regarding intervention. Intervention can include medical
treatment, surgery, or hearing aids and therapy.
There are many symptoms involved in the 1st, 2nd and 3rd trimesters of pregnancy. The first early pregnancy symptom is typically a missed period, but others include breast swelling and tenderness, nausea and sometimes vomiting, fatigue and bloating. Second trimester symptoms include backache, weight gain, itching, and possible stretch marks. Third trimester symptoms are additional weight gain, heartburn, hemorrhoids, swelling of the ankles, fingers, and face, breast tenderness, and trouble sleeping. Read more to learn about recommended procedures and tests for each stage of a healthy pregnancy.
Jaundice is a yellowish staining of the skin and whites of the eyes (sclerae) with bilirubin, the pigment found in bile. Jaundice can be an indicator of liver or gallbladder disease, or it may result from the rupture of red blood cells (hemolysis).
Down syndrome is a chromosomal disorder that results in the presence of an additional third chromosome 21, also referred to as trisomy 21. Most individuals with Down syndrome have widely recognizable physical characteristics. The severity of Down syndrome ranges from mild to severe. Diagnostic testing for Down syndrome include amniocentesis, chorionic villus sampling, and percutaneous umbilical cord sampling. The most common risk factor for Down syndrome is a woman's age.
Middle ear infection or inflammation (otitis media) is inflammation fo the middle ear. There are two types of otitis media, acute and chronic. Acute otitis media is generally short in duration, and chronic otitis media generally lasts several weeks. Seventy-five percent of children in the U.S. suffer from otitis media at some point. Treatment depends upon the type (chronic or acute).
Hydrocephalus is an abnormal buildup of cerebrospinal fluid (CSF) in the ventricles of the brain. The fluid is often under increased pressure and can compress and damage the brain. Symptoms of hydrocephalus vary with age, progression of the disease, and individual tolerance to the condition. Hydrocephalus is most often treated by surgery in which a shunt system is inserted.
Measles (rubeola) is a highly contagious disease that's caused by a virus. Symptoms include a rash, high fever, cough, runny nose, and red eyes. Treatment focuses on symptom relief. The disease can be prevented with the measles, mumps, and rubella vaccine.
Encephalitis is a brain inflammation that causes sudden fever, vomiting, headache, light sensitivity, stiff neck and back, drowsiness, and irritability. Meningitis is an infection that causes inflammation of the meninges that surround the brain and spinal cord. Symptoms of meningitis include high fever, headache, nausea, vomiting, and stiff neck.
Autism in children and adults is a developmental disorder, characterized by impaired development in communication, social interaction, and behavior. Autism is classified as a pervasive developmental disorder (PDD), which is part of a broad spectrum of developmental disorders affecting young children and adults. There are numerous theories and studies about the cause of autism. The treatment model for autism is an educational program that is suitable to an individual's developmental level of performance. There is no "cure" for autism.
Learning disabilities can cause an individual to have trouble learning and using skills such as reading, listening, writing, reading, speaking, reasoning, and performing mathematics. There is no cure for learning disabilities. Parents and teachers working together to properly diagnose learning disabilities can properly plan a course of education. For some, medication may be appropriate as complimentary treatment.
Ear was is a natural substance secreted by special glands in the skin on the outer part of the ear canal. It repels water, and traps dust and sand particles. Usually a small amount of wax accumulates, dries up, and then falls out of the ear canal carrying with it unwanted particles. Under ideal circumstances, you should never have to clean your ear canals. The absence of ear wax may result in dry, itchy ears, and even infection. Ear wax may accumulate in the ear for a variety of reasons including; narrowing of the ear canal, production of less ear wax due to aging, or an overproduction of ear wax in response to trauma or blockage within the ear canal.
Swimmer's ear (external otitis) is an infection of the skin that covers the outer ear canal. Causes of swimmer's ear include excessive water exposure that leads to trapped bacteria in the ear canal. Symptoms include a feeling of fullness in the ear, itching, and ear pain. Chronic swimmer's ear may be caused by eczema, seborrhea, fungus, chronic irritation, and other conditions. Common treatment includes antibiotic ear drops.
Pervasive development disorders (PPDs) are conditions involving developmental delays in children. There are five types of PDDs: autism, Asperger's syndrome, childhood disintegrative disorder, Rett's syndrome, and pervasive development disorders not otherwise specified (PDDNOS).
German measles is a disease that's caused by a virus. Symptoms include rash and fever for two to three days. The MMR (measles, mumps, and rubella) vaccine prevents this disease.
Noise-induced hearing loss may be an acoustic trauma (temporary hearing loss), or permanent due to an acute acoustic trauma. Experts agree that continual exposure to more then 85 dBs (decibels) is dangerous to the ears. Ear plugs and ear muffs can help prevent noise-induced hearing loss as well as decreasing exposure to loud noises.
Children's health is focused on the well-being of children from conception through adolescence. There are many aspects of children's health, including growth and development, illnesses, injuries, behavior, mental illness, family health and community health.
Hearing loss (deafness) may be present at birth or it may manifest later in life. Deafness may be genetic or due to damage from noise. Treatment of deafness depends upon its cause.
Jaundice in infants occur when the baby's liver may not be developed enough to efficiently rid the body of bilirubin. Symptoms of jaundice include yellowish colored eyes, and yellowing of the skin. Some babies are more at risk to develop jaundice. Kernicterus is a type of brain damage that occurs when a baby has jaundice and is not treated. Treatment of infant jaundice is generally with phototherapy so that kernicterus should not develop.
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