BB聽力測試

Shiba-Inu

Hi DaisyWong,

I am an audiologist, but not working in HK now. I used to work with kids and I am very sympathetic to your case. I know at this stage you and your family will have lots of worries, but bit by bit as you understand the problem more and know how to help your kid, things will get better along the way.

I saw your messages both in this forum and the other one, I am sorry about the standard of service u received. I remember u still have a lot of questions in your mind. I hope to help out a little bit here (sorry I don't type Chinese, hope u understand the English term I use)

1. 4 months old is not too young to do ABR, as it has scientific data to support even testing newborn (Western countries are using it to screen newborns' hearing). If there are other complications (eg. premature), that's another story.

2. Audiologists should have done other tests to try to eliminate whether it's conductive loss or not (i.e. problem of outer and middle ear, which can be usually treated medically). For sensorineural hearing loss (i.e. problem of inner ear - cochlea and/ or auditory nerve), there is little that can be done medically, the solution by then will usually be hearing aids/ cochlear implant + suitable habilitation.

3. As mentioned by a ST here, ABR is an objective test, it records the brain waves (up to the brainstem level, not up to the cortex though) elicited by sound stimulation. By about 6 months, 子喬 should be ready for a subjective test called VRA. And that test shows us how the baby makes sense of what he's hearing. Usually intergrating the information of both are more useful when baby is up to the age.

4. "Special Education" section under EMB does not only helps pupils studying in special schools, actually it intends to help ALL pupils with special needs, including those studying in normal schools. And if the kid is able to cope in normal school, intergrating him/ her in normal school is the present trend. 子喬 is still too young to attend school, so EMB will provide test, advice, training now and help in getting the right kind of school when he reaches school age.

5. The kindergarten that Nail mentioned here (Suen Mei) helps hearing impaired kids to learn talking through a habilitation method called "auditory verbal" skills. There are about 3 other KGs out there that train HI kids. EMB will give u more information on that.

6. I worked with lots of kids and many of them suceed in overcoming their hearing problems. Though every case is unique, I believe having supportive parents like u is vital. My last advice is: don't over-react or over-do anything, treat 子喬 as a normal kid and he will grow up well with your love.

7. Here is a good website if u are still hungry for information:

http://www.johntracyclinic.org/

Shiba-Inu

Hi DaisyWong,

Glad to know that u find the information helpful. And nowadays one can get a lot more info from the web than before.

1) per item 2 : 既然耳仔毛病可以有唔同病源，繼而有唔同治療方法，點解個醫生又唔再跟進呢？
--> As I have mentioned, your audiologist should have tried to eliminate outer and middle ear problems, which doctors can handle at this stage. If it's inner ear/ nerve problems, what they can do is limited now. What 子喬 needs now is on one hand, having further age-appropriate tests to better define his hearing loss; on the other hand, putting on hearing aids to help him hear better, and to see if he needs cochlear implant in the future. The two go hand in hand. I think this answers your second Q also.

到現在為止，我仍然未知bb究竟有乜事，同埋成因 (或者個成因巳經唔再重要)
--> correct, the cause is not the most important thing now, rather to work with clinicians and see how to help him. However, if u are suspecting genetic problems, u may try to ask for genetic counselling.

When will 子喬 have the EMB appointment? In HK, EMB is responsible to fit one free hearing aid to a hearing impaired kid. So that will be his first appointment to start "treatment"

Shiba-Inu

Hi bb2005hk,

三個月大時做測試（ＡＢＲ），醫生說有１－２個音聽不到，曲線唔靚
--> ABR is the brainstem (sorry I don't type Chinese here, it's the lower part of the brain) response generated by activating the cochlea in the inner ear in the high-pitch region, not for low-pitch region. So it gives information on the former but not the latter. By saying "１－２個音聽不到", I GUESS he suspected high-pitch hearing loss but not low- and mid- pitches. But that needs further test to confirm.

And it's true that baby's response pattern (or the doc called 曲線 in your case) does not look as clear as that of adults' until after 18 months after birth, it needs careful interpretation. So repeating ABR by 6 months may just get the same result and same conclusion.

是不是測試成人有可能會有１－２個音聽不到
--> in that case, that adult is described to have hearing loss already, although the degree of loss may be mild or severe, the pitch may be high or low. And depend on all these and other factors, may or may not affect speech perception.

為什麼要１歲再測
--> at one year old, a kid should be able to undergo behaviour testings which give clinicians more information to define his/ her hearing, and see if he/ she needs hearing aids. However, some kids can do the tests at about 6 months old, and there are some other objective tests beside ABR. But I don't know if HK hospitals are offering them at that age or not.  

Shiba-Inu

Hi DaisyWong,

u are welcomed. I love to work with kids last time, they are just cute and it's nice to see them progress.

Kids can be really difficult to test for their hearing, and hearing impairment is sometimes termed a "hidden disability". Fortunately recent years we get advanced technologies like ABR which can detect problems earlier. The earlier we help the kids, the better will be the progress. However, ABR just gives the clinicians a gross idea of what the hearing is like, as 子喬 undergoes more testings as she grows up, her hearing status will unfold graduately.

(Last time I thought 子喬 is a boy, and she's actually a cute girl?)

The descriptions u mentioned are common in ALL kids, because human communication is not only through listening and talking, we still have our body languages. It's important that u still keep on talking to her right now, let her pick up as much cues as she can, but that does not necessarily mean she is picking up the speech sounds. Also, if u want to "observe" her hearing at home, u need to be very careful to take away many other cues. For example, she may just pick up the air vibration when u are clapping hands next to her.

If u don't mind, tell me how she's doing in pedi/ EMB appointment next time.   

Shiba-Inu

Thanks 稚言治語,

I don't type Chinese now. Long long time ago I did, but as I don't use it, I lose it  

Shiba-Inu

Hi Daisy,

Good that u found a reliable pediatrian to talk to. Counceling is really a very important part of a clinical visit!

DaisyWong 寫道:
另外想問除咗EMB，如果想揾私人再做listening tests再reconfirm，有冇渠道？同埋有冇咁嘅需要呢？

It depends on how comfortable u and your family working together with EMB (and the hospital, when will it see 子喬 again? ) There is one thing that's always true (and universal): the gov't service will be there, but it will never give u the best u expected.  

If 子喬 is having her EMB appt next week, maybe u want to go there and decide afterwards... I can pm u some info on private HK audiologists if needed by then.

Shiba-Inu

Hi 稚言治語,

Nice to meet u here too, I guess we have met in some occasions or the others while I was studying/ working in HK.

Audiologists usually just pop up when parents notice really obvious hearing or ear problems. For others, there maybe no such problem (90% of the time, so parents don't know much about us), the problems maybe just mild, or the worst case "hidden".  

Shiba-Inu

Hi 子喬媽媽,

So glad to hear that 子喬 got a good start at EMB!    

其實此類神經性問題是否常見，以及嚴重性會有多大，有否此類資料可提供參考？

神經性失聰 = sensorineural hearing loss I mentioned in previous message. Its incidence rate at birth is about 2-3 in 10000 newborns in developed countries. Although it's not common in newborns, it's a very common (and easily overlooking) problem in the elderly. It's a permanent problem and no medical "cure" for the time being.

嚴重性會有多大 - do u refer to its relationship to baby's health in general? Or other aspects? For the former, if the hearing loss is not a sudden one (ie. hearing first, then lose it), and u and your doctors do not have other suspicions (e.g. tumour, trauma etc...reasons not common in babies ) , the medical problem should only be that of the hearing system.
For other aspects, if babies are not detected and intervented properly in an early age (before 3 the max), their educational, social, emotional development will all be affected.

That's why I said 子喬 has a good start: she was detected early, intervented early and gets supportive parents!

人工耳蝸手術費用若干？

US$ 3 to 40000 as done in HK (including the surgery, device and rehab). Three public hospitals in HK get funding to do it, so parents just need to pay for a small portion.

...轉介讀學師跟進語言訓練...

讀學師    Do u mean inspectors (督學) in EMB?  

Shiba-Inu

子喬 is growing bigger and prettier, lots of hair. I will not mistaken "her" as "him" anymore!      

Shiba-Inu

稚言治語 寫道:
何先生？是何賜德嗎？瘦瘦哋，戴眼鏡的？我同學嚟ga，都幾熟添﹗佢好有心機，放心啦﹗

Hi 稚言治語 ,
Haha.... then I know which year u graduated from HKU la!    As far as I know, Chelton Ho is working for Student Health Services under DH, the 何先生 in EMB is also 瘦瘦哋，戴眼鏡 but much older than Chelton! I believe both of them are 有心機 in treating their patients!  

Shiba-Inu

DaisyWong 寫道:
想知人工耳蝸手術邊3家政府醫院可以做。暫時我想專注係EMB跟進BB情況，唔想overdo住，免得sidetrack個治療，你哋有乜意見呢？不過我都想你可以email D private audiologists (in case 有需要)比我

Hi Daisy,
Cochlear implant (or we call CI in short) can be done in 3 major hospitals: Queen Mary, Prince of Wales and QE. Don't worry if 子喬 is not seen by the ENT in these hospitals for the time being. If the need of CI is confirmed in the future, your doctor will refer u to one. I think the earliest age to do such a surgery in HK is about 1 yr old. On the other hand, we all want to confirm if babies really have that need by trying hearing aids first, right?

I agree that babies should not be overtested in such a young age. However, does EMB suggest one or two hearing aids for 子喬? If the test results suggest problem in both ears (usually they do), start her with two rather than one will be better. Since EMB only offer one free hearing aid, u need to buy another one by yourself, usually as referred by EMB.

And I don't have the list with me now, can I email to u one/ two days later? I will try to give u some who have experience with kids. Maybe u can get 稚言治語's list first if urgent.

Typo is common, don't worry, just for fun!  

Shiba-Inu

Hi 稚言治語,
" 畀人發現我有幾老添﹗" Don't worry, I am the same generation as u!  - That mean both of us are still young!    Whether u know me or not, I really don't know! However, I know Chelton because there are only a handful of audiologists in HK, we basically know each other (and the background, and the reputation... so frightening!)

"有時我都唔明，佢個位係點搞出嚟" - well, about 6-7 years ago, ED knew that it got a bulky structure and wanted to shut down the students' screening to eliminate some staff from the special education section. So it "sold" that part of the service to DH, which at that time wanted to expand its student services (why it had the $$   ) - duplicate service? YES!

Shiba-Inu

Hi loveyanpig ,

Don't worry too much for the time being. OAE is not a 100% accurate test (in fact, it's the first step of testing babies only), and there are a lot of things we can do nowaday to help hearing impaired kids. I have posted some information here and there in BK to response to other worried BK moms, see if the following links help you to relieve some of your worries:

A forum talking about middle ear infection (click here)

A forum talking about failing OAE test (click here)

Chatting with other parents with similar situation helps too!   

Shiba-Inu

Hi 子喬媽媽,

Please check email.

"子喬宜家refer咗去特殊教育跟進(唔洗担心，係audio，not mental 嘅特殊教育)"
--- that's an interesting comment! It remains me of a Chinese saying that "naming is so important to a person's life". Seems it's important to an organization too!

"子喬前幾日再去醫院做ABR test，結果都好confuse，有時OK又有時唔OK咁"
--- I have to give that hospital some         too.... I wonder which hospital is that?

"頭先子喬瞓瞓吓覺，比個電話嘈醒呀"
--- that's a very good sign! Does it happen everytime the phone rings, or just for this time?

Shiba-Inu

Hi Nail,

Actually I have not "talked" to you, but I do think you are a very good sharing partner!      

Shiba-Inu

Yanyan's 肥豬腳 really look yummy!!!  

Daisy and mdoip,

Usually the sequence of testing newborn baby's hearing is as follow:

OAE (for univeral screening of all babies' hearing, first gatekeeper) -> ABR  (objective test, does not need any response from the babies, but need sedation) -> other behaviour test e.g. VRA  (subjective test, needs babies' response and needs to be age- & ability- appropriate)

As babies' hearing is so difficult to test, audiologists usually do all (we call "battery of test") to obtain more information. So there is nothing as one method being better than the other, the most important thing is how the audiologists intergrate all the information together to get a clearer picture of  babies' hearing.

Shiba-Inu

mdoip 寫道:
So , I want to ask is he mild loss or severe loss his hearing?
Is there any case that  failed in OAE but pass in ARB test ?

mdoip,

OAE cannot tell the degree of hearing loss. It's just a test of pass or fail.

Yes, as I have explained in the other forums (please see the links in my previous message), OAE fail a small portion of normal hearing babies as well. So there's a possibility of failing OAE and then get normal results in ABR.

mdoip 寫道:
The 聽力學家 refer him to do the ARB test. However, we must wait for the appointment until august.

If u and your family want a peace of mind and get ABR results before Aug, there is just a few private hearing aid company/ hospital (?) out there that can do ABR on babies. I may email u the phone no. of these places, but mind u two things:
1. Your son needs to be sedated to do the test.
2. Price maybe around thousands.

On the other hand, if your son is 6 months or older, and have enough support for the nect to turn and trace subjects visually, u can self-refer yourself to EMB and try to see if he can do VRA (what test the audiologist can do depend on the condition of your son on that day though).

Shiba-Inu

DaisyWong 寫道:
子喬剛做完VRA test，結果話有residual hearing，何故咁confuse，因為ABR test話hearing lost

Daisy,

ABR test is not frequency specific, and it tells the part of the story mainly on the high-frequencies part. So the report usually says somethings like "at least severe hearing loss in the high freq for both ears".
However, audiologist can try different freq on the babies when tested with VRA. It's quite common for hearing loss to be worse in the high freq than low and middle freq, and at diff freq they may have diff degree of loss. e.g. "moderate loss at low freq sloping to profound loss at high freq" - then the baby is described as having "residual hearing" at the low freq.

Shiba-Inu

Hi mdoip,

I don't have your email address. I will pm you the list of institutes in HK which are experienced in testing children. If you don't receive it, try giving me your email address, OK?

For that list, try to phone those with an asterisk to check with them the price of doing ABR. Some of them may suggest "ASSR" instead of "ABR" which is used to test babies' hearing too. However, ASSR will tell you a little bit more information: it will give you the degree of hearing loss from low to high frequencies, while ABR tells you the degree mainly at the high frequencies region. For the time being, I will say that ABR is good enough.

Be sure to tell the institutes that you have done OAE already, so no need to repeat it again.

For any of the tests, if hearing loss is ever detected, further tests will be necessary to learn more about babies' hearing so as to figure out the most appropriate way to help them.

Good luck!  

Shiba-Inu

Hi loveyanpig,

In MCH, if your baby was tested by an equipment and the nurse put an eartip into his/ her ears, that's the OAE (otoacoustic emissison) test.

If you are referred to see the audiologists in the ENT department of an hospital, most probably they will do the ABR in that appointment. However, doing which test subjected to the condition of your baby on that day and the decision of the audiologist.

If your baby is going to be tested with ABR, he/ she will firstly be given a very mild dose of sedation to put him/ her to sleep. Then the audiologist will put on the headphones and some electrodes on his/ her head in order to record the "brain waves"  when sound is presented.