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 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 1  |  Issue : 2  |  Page : 80-83

A study of audiological profile of children with cerebral palsy


1 Department of Audiology, Ali Yavar Jung National Institute for the Hearing Handicapped, K. C. Marg, Mumbai, Maharashtra, India
2 Department of Physiology, Grant Medical College and Sir J. J. Group of Hospitals, Mumbai, Maharashtra, India

Date of Web Publication7-Jan-2016

Correspondence Address:
Mohammad Shamim Ansari
Lecturer (Speech & Hearing), Department of Audiology, Ali Yavar Jung National Institute for the Hearing Handicapped, K. C. Marg, Bandra (W), Mumbai - 400 050, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2395-4264.173436

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  Abstract 

Background: Hearing is critical for the full development of language skills. Even a mild hearing impairment can interfere with speech and language development. Hearing impairment has the highest incidence rate for any pediatric disability, since several risk factors in infants with cerebral palsy (CP) are the same risk factors to develop hearing impairment. Thus, it should come as no surprise that hearing impairment occurs more frequently among children with cerebral palsy than in the general population. Recent studies have shown that up to 25% of children with cerebral palsy also suffer from a hearing impairment. However, no data of hearing impairment in cerebral palsy is available in India.
Objective: The goal of this study was to determine the frequency and profile of hearing impairment in children with cerebral palsy.
Methodology: This was a retrospective study involving 117 children of 2-10 years of age of both genders who were diagnosed with cerebral palsy. The audiometry, tympanometry, otoacoustic emission, and auditory brain stem response hearing tests were employed to categorize the hearing impairment.
Results: Hearing impairment was observed in 39% of children. Sensorineural, conductive, and mixed hearing impairment was present in 48%, 41%, and 31% of the children, respectively. Among them, there was mild, moderate, and severe degree of hearing impairment in 52%, 26%, and 22% of the children with cerebral palsy, respectively.
Conclusions: Prevalence of hearing impairment in children with cerebral palsy is alarming. This warrants early identification and diagnosis of hearing impairment, especially for medically treatable forms of hearing impairment such as secretory otitis media, Eustachian tube dysfunction, and presence of wax. This early identification may facilitate better development of speech and language as well as positive outcomes. Therefore audiological assessment should be incorporated into the diagnostic and therapeutic plan of all children with cerebral palsy.

Keywords: Additional impairment, audiometry, auditory brainstem response, cerebral palsy, hearing impairment, immittance audiometry


How to cite this article:
Ansari MS, Hafiz Ansari M A. A study of audiological profile of children with cerebral palsy. Indian J Cereb Palsy 2015;1:80-3

How to cite this URL:
Ansari MS, Hafiz Ansari M A. A study of audiological profile of children with cerebral palsy. Indian J Cereb Palsy [serial online] 2015 [cited 2017 Apr 24];1:80-3. Available from: http://www.ijcpjournal.org/text.asp?2015/1/2/80/173436


  Introduction Top


Children with CP have an organic complication in the peripheral and central nervous systems. [1],[2],[3] Therefore, CP is often accompanied by other disorders and problems of cerebral function, in particular speech and language impairment, intellectual impairment, disorders of vision and hearing, attention, vigilance, and behavior. [4],[5] Consequently, the majority of the affected individuals cannot participate and find their place in normal society. [6],[7],[8]

Advances in treatment of perinatal infections and improved medical facilities for neonatal care have resulted in more surviving infants, but with complications that may include hearing impairment. In particular, reduced mortality rates of premature babies with very low birth weight are responsible for more infants with complications may be of hearing impairment. [6] Recent studies have shown that hearing impairment occurs in 4-25% of children with cerebral palsy. [6] Hearing impairment is most common in children with very low birth weight or severe hypoxic-ischemic insults. [7],[11],[12]

Existence of hearing problems with unique motor problem in CP, present a range of special educational and psychological needs, to an even greater degree than for children with single disability. [11],[12],[13] Untreated reduced hearing acuity during infancy and early childhood compounded with additional disability may have more deleterious effect on communication abilities, speech and language, and cognitive development that can severely interfere with their psycho, difficulties in parent-child and peer-child interactions, low self-esteem, linguistic, auditory perceptual, and educational development. [7],[11],[12]

However, the effects of hearing impairment are amenable to the technological treatment and rehabilitation strategies if identified at an early age and effective intervention program is initiated.[11-13] Thus, overall future and success of a child can be improved and reducing the complications of hidden hearing impairment. [14],[15],[16]

However, there is no data with regards to prevalence, degree, and type of hearing impairment in CP is available in the Indian context. Hence, we propose to study the presence of hearing impairment in children with CP. Our aim is to increase the awareness of possible correctable audiological impairment that hinder development and learning in children with CP.


  Aim of the study Top


The goal of the study was to determine the frequency and type of hearing impairment in children with CP.


  Methodolgy Top


Research design

The study uses simple retrospective survey design. The required data were abstracted from the medical reports and files of the subjects to fulfil the need of the study.

Subjects selection

A total of 117 children (77 boys and 40 girls) in the age range of 2-12 years with mean age of 7.6 years and standard deviation of 2.8 years diagnosed with CP were selected for the study. The subjects were either referred to our institute from the various hospitals for hearing evaluation or visited as follow-up during October 2011 and April 2013. The parental interview was conducted to obtain demographic information. The risk factors for CP were identified through case history and reports.

Complete audiological diagnostic test involving behavioral observation audiometry/visual reinforced audiometry, play or conditioned audiometry, immittance audiometry, otoacoustic emission, and auditory brainstem evoked tests was performed to identify and categorize the hearing impairment in children with CP.

Statistical analysis

Descriptive analysis of demographics and audiological test findings was carried out to determine the prevalence and to categorize the different types and degree of hearing impairment.


  Results Top


Children with CP of various types, subtypes, and severity visited or referred in our clinic are elucidated in [Table 1].
Table 1: Distribution of types and subtypes and severity of children with cerebral palsy


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Out of 117 subjects of CP, 73 (63%) had spasticity, 25 (21%) were with choreoathetotic, and 19 (16%) suffered with hypo tonicity of extra pyramidal type. The CP of mild, moderate, and severe degree was noted in 14%, 43%, and 43% of subjects, respectively.

Hearing impairment was observed in 46 (39%) of subjects. To identify and categorize the hearing impairment, various audiological tests were employed. The results of audiological tests in CP are depicted in [Table 2] and types of hearing impairment are elucidated in [Table 3].
Table 2: Depicting results of PTA, tympanometry, OAE and ABR in study group


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Table 3: Elucidating types of hearing impairment found in different types of cerebral palsy


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[Table 2] demonstrates the results of audiological tests. Owing to the mental retardation, myoskeletal and other associated behavioral disturbances including short attention span, impulsivity, tantrum, self-stimulatory, and distractibility in about 79% of CP audiometry could be done only in 25 (21%) of subjects.

On the other hand, the results of electrophysiological tests such as otoacoustic emissions revealed gross peripheral hearing abnormality in 76 (65%), tympanometry indicated  Eustachian tube More Details dysfunction, wax collection, serous, and secretary otitis media that resulted in conductive type hearing impairment in 52 (45%) of children [Table 3].

Auditory brain stem response revealed mild sensorineural hearing impairment in spastic and hypotonic type, moderate hearing impairment in spastic, athetoid and hypotonic type, and severe hearing impairment mostly in spastic and athetoid.

From [Table 2], it can be seen that most frequently occurring type of hearing impairment is sensorineural 22 (48%) followed by mixed 19 (41%) and 14 (31%) conductive in the studied group.

From [Table 3], it can be observed that most frequently occurring degree of hearing impairment is moderate 24 (52%) followed by severe 12 (26%) and 10 (22%) of mild level children with cerebral palsy.


  Discussion Top


CP consists of a heterogeneous group of nonprogressive clinical syndromes that are characterized by motor and postural dysfunction due to the damage to developing brain. A concomitant disability such as hearing impairment often exits with CP. The coexistence of unidentified hearing impairment can affect the treatment plan and long-term outcome of CP. Therefore, an understanding of the interaction of the motor components and associated deficits in children with CP is necessary for setting comprehensive and realistic goals and better outcomes. [2],[6],[7]

We studied 117 cases of CP to examine the types and degree of hearing impairment in CP. The study found 46 (39%) out of 117 children with hearing impairment along with CP. The results of pure tone audiometry, tympanometry, otoacoustic emission, and auditory brain stem responses have recorded hearing impairment in 46 (39%) out of 117 subjects.

Our data differ from Morales et al. who stated prevalence of 60% hearing impairment among CP, whereas odding and Roebroech Hendrik reported 25% incidence of hearing impairment in cerebral-palsied population. The differences in frequency of hearing impairment in CP in these studies may due to the variations in types of CP in each case study and/or the variable causes of CP in these cases.

The highest number of children with CP found to have sensorineural hearing impairment followed by conductive and mixed type of hearing impairment that can be accounted for damage to the growing brain and compounded with the associated problems such as poor body growth, oral-aural hygiene, and frequent cold and cough. All children who have hearing impairment exhibited defective speech and language skills. Defective speech has been observed in 63% of studied population.


  Conclusion Top


CP is often accompanied by other disorders of cerebral function. Auditory disorders are very frequent in this population. Hence, hearing evaluation should be incorporated in the diagnostic work up of cerebral-palsied child. This will allow us to understand and consider the coexisting morbidities in delineation and setting up the therapeutic goals. Identification of hearing impairment may also help in providing better counseling and suggestion to the parents and setting up the realistic intervention goals.

The identification of hearing impairment also important as disorders of hearing is amenable and manageable with wide range of medical, rehabilitative devices, and therapeutic techniques. Therefore, the identification of hearing impairment in children with CP may suggest appropriate line of management and can provide important prognostic information.

Acknowledgment

We would like to express our thanks and gratitude to participants and parents of the participants in the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Morris C. Definition and classification of cerebral palsy: A historical perspective. Dev Med Child Neurol Suppl 2007;109:3-7.  Back to cited text no. 1
    
2.
Surveillance of Cerebral Palsy in Europe. Surveillance of cerebral palsy in Europe: A collaboration of cerebral palsy surveys and registers. Surveillance of Cerebral Palsy in Europe (SCPE). Dev Med Child Neurol 2000;42:816-24.  Back to cited text no. 2
    
3.
Ghai OP, editor. Central nervous system. In: Essentials Pediatrics. 6 th ed. New Delhi: CBS Publishers; 2004. p. 540.  Back to cited text no. 3
    
4.
Odding EM, Hendrik R. The epidemiology of cerebral palsy, incidence, impairment and risk factors. Disabil Rehabil 2006;28:183-91.  Back to cited text no. 4
    
5.
Rosenbaum P. A report: The definition and classification of cerebral palsy. Dev Med Child Neurol 2007;49:480.  Back to cited text no. 5
    
6.
Streppel M, Richling F, Roth B, Walger M, von Wedel H, Eckel HE. Epidemiology and etiology of acquired hearing disorders in childhood in the Cologne area. Int J Pediatr Otorhinolaryngol 1998;44:235-43.  Back to cited text no. 6
    
7.
Saigal S, Rosenbaum P, Stoskopf B, Hoult L, Furlong W, Feeny D, et al. Comprehensive assessment of the health status of extremely low birth weight children at eight years of age: Comparison with a reference group. J Pediatr 1994;125:411-7.  Back to cited text no. 7
    
8.
Joint Committee on Infant Hearing. Year 2007 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs. Suppl Audiology Today, November-December, 1-29, 2007.  Back to cited text no. 8
    
9.
Sano M, Kaga K, Kitazumi E, Kodama K. Sensorineural hearing loss in patients with cerebral palsy after asphyxia and hyperbilirubinemia. Int J Pediatr Otorhinolaryngol 2005;69:1211-7.  Back to cited text no. 9
    
10.
Mueller MP. Early intervention and language development in children who are deaf and hard of hearing. Pediatrics 2000;101:144-56.  Back to cited text no. 10
    
11.
Northern JL, Downs MP. Hearing in Children. 5 th ed. Philadelphia: Lippincott, Williams, and Wilkins; 2002.  Back to cited text no. 11
    
12.
McDermott S, Nagle R, Wright HH, Swann S, Leonhardt T, Wuori D. Consultation in paediatric rehabilitation for behaviour problems in young children with cerebral palsy and/or developmental delay. Pediatr Rehabil 2002;5:99-106.  Back to cited text no. 12
    
13.
O'Shea TM. Diagnosis, treatment, and prevention of cerebral palsy. Clin Obstet Gynecol 2008;51:816-28.  Back to cited text no. 13
    
14.
Zafeiriou DI, Andreou A, Karasavidou K. Utility of brainstem auditory evoked potentials in children with spastic cerebral palsy. Acta Paediatr 2000;89:194-7.  Back to cited text no. 14
    
15.
Kolker IA. Hearing function and auditory evoked potentials in children with spastic forms of cerebral palsy. Neurophysiology 2004;36:270-5.  Back to cited text no. 15
    
16.
Morales Angulo C, Azuara Blanco N, Gallo Terán J, González Aledo A, Rama Quintela J. Sensorineural hearing loss in cerebral palsy patients. Acta Otorrinolaringol Esp 2006;57:300-2.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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  In this article
Abstract
Introduction
Aim of the study
Methodolgy
Results
Discussion
Conclusion
References
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