6. Summary

School-entry hearing screening is especially important. That screening may actually be the first

Prior to testing, the children's parents were informed of the testing procedures and provided their written consent. The results of the audiometric tests were supplemented by the results of the questionnaire completed by the parents. This questionnaire included questions concerning data on the potential causes of the child's hearing problems, medical history, possible presence

A hearing screening protocol used by a team from the Institute of Physiology and Pathology of Hearing in Kajetany, while screening in different countries includes three steps (Figure 3).

The first step is video-otoscopy. In this test, the specialist otolaryngologist views the middle ear on the monitor. This is the most accurate visual cure repair method and structure of the outer ear. This examination allows the diagnose change in the outer and middle ear such as excessive earwax, acute or chronic otitis media, fungal infection and changes in the tympanic membrane. Second step is otoacoustic emission (OAE). It is an objective method of assessment—technically not a test of hearing but rather a reflection of inner ear mechanism. OAEs are sounds detected in the external ear canal that are generated by the outer hair cells within the cochlea. If the

otoacoustic emission is absent, then we perform the third step—pure-tone audiometry.

Figure 3. Schema of hearing screening protocol in school-age children used in the institute physiology and pathology of

hearing.

point of access to detect childhood hearing impairment.

124 An Excursus into Hearing Loss

of tinnitus, and any presence of learning difficulties.

The positive impact of early identification and intervention for children with hearing loss is well established, and the primary care provider plays a vital role in screening children who require such services. Without prompt intervention, hearing loss in early childhood can cause significant delays in speech development, socioemotional growth, and school achievement.

### Index of technical terms

Acute Otitis Media—painful type of ear infection. It occurs when the area behind the eardrum called the middle ear is inflamed and infected.

Auditory Brainstem Response (ABR)—neurologic test which gives information about the inner ear and brain pathways for hearing. The ABR is performed by pasting electrodes on the head—similar to electrodes placed around the heart when an electrocardiogram is run—and recording brain wave activity in response to sound.

Auditory Neuropathy/Dyssynchrony—hearing disorder in which sound enters the inner ear normally but the transmission of signals from the inner ear to the brain is impaired. People with auditory neuropathy may have normal hearing, or hearing loss ranges from mild to severe but they always have poor speech-perception abilities.

Encephalitis—inflammation of the brain tissue. The most common cause is viral infections. In rare cases, it can be caused by bacteria or even fungi. Symptoms may include headache, fever,

Hearing Screening around the World http://dx.doi.org/10.5772/intechopen.73535 127

Enlarged Vestibular Aqueduct (EVA) Syndrome—a syndromic form of hearing loss, caused by the enlargement of the vestibular aqueduct in the inner ear. It is one of the most common

Evoked Otoacoustic Emission (OAE)—sounds of cochlear origin, which can be recorded by a microphone fitted into the ear canal. They are caused by the motion of the cochlea's sensory

Frequency Pattern Test—an auditory processing disorder test for ages 8 and over using nonverbal stimuli. The frequency pattern test consists of 880 Hz (low) and 1122 Hz (high) tones that are 200 ms in duration and have an interstimulus interval of 150 ms and a 10-ms rise fall time.

Fungal infection—fungal infections occur when an invading fungus takes over an area of the

Gaps in noise—test auditory processing disorder test for ages 7 and older using nonverbal stimuli. It is designed to measure temporal resolution which resolution refers to the ability to detect changes in either the duration of an auditory stimulus and/or the time intervals or gaps of silence embedded within an auditory stimulus. The ability to detect small silent intervals is

Hearing aid—a device designed to improve hearing. Hearing aids are incapable of truly

Influenza—an infectious disease caused by an influenza virus. It is characterized by a sudden onset of fever, cough (usually dry), headache, muscle and joint pain, severe malaise (feeling unwell), sore throat, and a runny nose. The cough can be severe and can last 2 or more weeks. Measles—a highly contagious infection caused by the measles virus. Initial signs and symptoms typically include fever, often greater than 40C (104.0F), cough, runny nose, and inflamed eyes. Two or three days after the start of symptoms, small white spots may form inside the mouth. A red, flat rash which usually starts on the face and then spreads to the rest of the body typically

Medical History—information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information with the aim of obtaining information useful in formulating a diagnosis and providing medical care to the patient. The medically relevant complaints reported by the patient or others familiar with the patient are referred to as symptoms, in contrast with clinical signs, which are ascertained by

Meningitis—an acute inflammation of the protective membranes covering the brain and spinal cord, collectively known as the meninges. The most common symptoms are fever,

inner ear deformities, which results in hearing loss during childhood.

Head trauma—any injury that results in trauma to the skull or brain.

correcting a hearing loss; they are an aid to make sounds more accessible.

hair cells as they energetically respond to auditory stimulation.

body and is too much for the immune system to handle.

Hearing deficits—it is a partial or total inability to hear.

an important factor in speech perception.

begins 3–5 days after the start of symptoms.

direct examination on the part of medical personnel.

confusion, a stiff neck, and vomiting.

Behavioral Test–test investigates propensities toward certain kinds of behavior and styles of interaction with others.

Cerumen (Earwax)—brown, gray, or yellowish waxy substance secreted in the ear canal. It protects the skin of the human ear canal, assists in cleaning and lubrication, and also provides some protection against bacteria, fungi, insects, and water.

Chickenpox (Varicella)—a virus infection, commonly of children, caused by the varicella zoster virus and characterized by mild headache and fever, malaise, and eruption of blisters on the skin and mucous membranes.

Chronic Otitis Media—a long-standing, persistently draining perforation of the eardrum.

Cochlea—the auditory portion of the inner ear situated in the temporal bone. The cochlea interacts with the middle ear via two holes that are closed by membranes: the oval window, which is located at the base of the scala vestibuli and which undergoes pressure from the stapes, and the round window, which seals the base of the tympanic membrane and is used to relieve pressure. The cochlea is filled with a watery liquid, the perilymph, which moves in response to the vibrations coming from the middle ear via the oval window.

Cochlear Implant—a device that provides direct electrical stimulation to the auditory (hearing) nerve in the inner ear. Children and adults with a severe-to-profound sensorineural hearing loss who cannot be helped with hearing aids may be helped with cochlear implants. Cochlear implants have external (outside) parts and internal (surgically implanted) parts that work together to allow the user to perceive sound.

Congenital Hearing Impairment—it means that the hearing impairment is present at birth. Congenital hearing loss can be caused by genetic or nongenetic factors.

Connexin—structurally related transmembrane proteins that assemble to form vertebrate gap junctions.

Dichotic Listening Test—a psychological test commonly used to investigate selective attention within the auditory. Specifically, it is used as a behavioral test for hemispheric lateralization of speech sound perception. During a standard dichotic listening test, a participant is presented with two different auditory stimuli simultaneously (usually speech). The different stimuli are directed into different ears over headphones.

Duration Pattern Test—standard version is an auditory processing disorder test for ages 11 and over using nonverbal stimuli. The duration patterns are composed of three 1000-Hz tones and two 300-ms intertone intervals.

Ear Canal—it is a tube running from the outer ear to the middle ear. The adult human ear canal extends from the pinna to the eardrum and is about 2.5 cm (1 in) in length and 0.7 cm (0.3 in) in diameter.

Encephalitis—inflammation of the brain tissue. The most common cause is viral infections. In rare cases, it can be caused by bacteria or even fungi. Symptoms may include headache, fever, confusion, a stiff neck, and vomiting.

Enlarged Vestibular Aqueduct (EVA) Syndrome—a syndromic form of hearing loss, caused by the enlargement of the vestibular aqueduct in the inner ear. It is one of the most common inner ear deformities, which results in hearing loss during childhood.

Evoked Otoacoustic Emission (OAE)—sounds of cochlear origin, which can be recorded by a microphone fitted into the ear canal. They are caused by the motion of the cochlea's sensory hair cells as they energetically respond to auditory stimulation.

Frequency Pattern Test—an auditory processing disorder test for ages 8 and over using nonverbal stimuli. The frequency pattern test consists of 880 Hz (low) and 1122 Hz (high) tones that are 200 ms in duration and have an interstimulus interval of 150 ms and a 10-ms rise fall time.

Fungal infection—fungal infections occur when an invading fungus takes over an area of the body and is too much for the immune system to handle.

Gaps in noise—test auditory processing disorder test for ages 7 and older using nonverbal stimuli. It is designed to measure temporal resolution which resolution refers to the ability to detect changes in either the duration of an auditory stimulus and/or the time intervals or gaps of silence embedded within an auditory stimulus. The ability to detect small silent intervals is an important factor in speech perception.

Head trauma—any injury that results in trauma to the skull or brain.

Hearing aid—a device designed to improve hearing. Hearing aids are incapable of truly correcting a hearing loss; they are an aid to make sounds more accessible.

Hearing deficits—it is a partial or total inability to hear.

Auditory Neuropathy/Dyssynchrony—hearing disorder in which sound enters the inner ear normally but the transmission of signals from the inner ear to the brain is impaired. People with auditory neuropathy may have normal hearing, or hearing loss ranges from mild to

Behavioral Test–test investigates propensities toward certain kinds of behavior and styles of

Cerumen (Earwax)—brown, gray, or yellowish waxy substance secreted in the ear canal. It protects the skin of the human ear canal, assists in cleaning and lubrication, and also provides

Chickenpox (Varicella)—a virus infection, commonly of children, caused by the varicella zoster virus and characterized by mild headache and fever, malaise, and eruption of blisters

Chronic Otitis Media—a long-standing, persistently draining perforation of the eardrum.

response to the vibrations coming from the middle ear via the oval window.

Congenital hearing loss can be caused by genetic or nongenetic factors.

Cochlea—the auditory portion of the inner ear situated in the temporal bone. The cochlea interacts with the middle ear via two holes that are closed by membranes: the oval window, which is located at the base of the scala vestibuli and which undergoes pressure from the stapes, and the round window, which seals the base of the tympanic membrane and is used to relieve pressure. The cochlea is filled with a watery liquid, the perilymph, which moves in

Cochlear Implant—a device that provides direct electrical stimulation to the auditory (hearing) nerve in the inner ear. Children and adults with a severe-to-profound sensorineural hearing loss who cannot be helped with hearing aids may be helped with cochlear implants. Cochlear implants have external (outside) parts and internal (surgically implanted) parts that

Congenital Hearing Impairment—it means that the hearing impairment is present at birth.

Connexin—structurally related transmembrane proteins that assemble to form vertebrate gap

Dichotic Listening Test—a psychological test commonly used to investigate selective attention within the auditory. Specifically, it is used as a behavioral test for hemispheric lateralization of speech sound perception. During a standard dichotic listening test, a participant is presented with two different auditory stimuli simultaneously (usually speech). The different

Duration Pattern Test—standard version is an auditory processing disorder test for ages 11 and over using nonverbal stimuli. The duration patterns are composed of three 1000-Hz

Ear Canal—it is a tube running from the outer ear to the middle ear. The adult human ear canal extends from the pinna to the eardrum and is about 2.5 cm (1 in) in length and 0.7 cm

severe but they always have poor speech-perception abilities.

some protection against bacteria, fungi, insects, and water.

work together to allow the user to perceive sound.

stimuli are directed into different ears over headphones.

tones and two 300-ms intertone intervals.

interaction with others.

126 An Excursus into Hearing Loss

junctions.

(0.3 in) in diameter.

on the skin and mucous membranes.

Influenza—an infectious disease caused by an influenza virus. It is characterized by a sudden onset of fever, cough (usually dry), headache, muscle and joint pain, severe malaise (feeling unwell), sore throat, and a runny nose. The cough can be severe and can last 2 or more weeks.

Measles—a highly contagious infection caused by the measles virus. Initial signs and symptoms typically include fever, often greater than 40C (104.0F), cough, runny nose, and inflamed eyes. Two or three days after the start of symptoms, small white spots may form inside the mouth. A red, flat rash which usually starts on the face and then spreads to the rest of the body typically begins 3–5 days after the start of symptoms.

Medical History—information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information with the aim of obtaining information useful in formulating a diagnosis and providing medical care to the patient. The medically relevant complaints reported by the patient or others familiar with the patient are referred to as symptoms, in contrast with clinical signs, which are ascertained by direct examination on the part of medical personnel.

Meningitis—an acute inflammation of the protective membranes covering the brain and spinal cord, collectively known as the meninges. The most common symptoms are fever, headache, and neck stiffness. The inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and less commonly by certain drugs.

adolescents and adults. The device is built on the basis of an advanced central computer system and a portable computer equipped with additional accessories enabling the test.

Hearing Screening around the World http://dx.doi.org/10.5772/intechopen.73535 129

Play Audiometry—it allows an audiologist to test the hearing of very young toddlers and preschoolers. CPA uses behavioral conditioning to get kids to respond to sounds. It is designed for children usually between 2 and 5 years of age. It measures hearing sensitivity to determine both a child's type and degree of hearing loss, if any. The audiologist can then refer

Pure Tone Audiometry (PTA)—the key hearing test used to identify hearing threshold levels of an individual, enabling determination of the degree, type and configuration of a hearing loss, thus providing the basis for diagnosis and management. PTA is a subjective, behavioral measurement of hearing threshold, as it relies on patient response to pure tone stimuli. Therefore, PTA is used on adults and children old enough to cooperate with the test procedure.

Questionnaire—a research instrument consisting of a series of questions (or other types of prompts) for the purpose of gathering information from respondents. Although questionnaires

Rubella—is an infection caused by the rubella virus. This disease is often mild with half of people not realizing that they are sick. A rash may start around 2 weeks after exposure and last for 3 days. Complications may include bleeding problems, testicular swelling, and inflammation of nerves. Infection during early pregnancy may result in a child born with congenital

Sensitivity—the ability of an organism or organ to respond to external stimuli. For example, auditory hypersensitivity occurs when a person has a collapsed tolerance to normal environ-

Sound-source location—a listener's ability to identify the location or origin of a detected sound in direction and distance. The auditory system uses several cues for sound source localization, including time and level differences (or intensity-difference) between both ears, spectral infor-

Specificity—In medicine, it means the extent to which a diagnostic test is specific for a particular

Sudden Idiopathic Hearing Loss—defined as greater than 30 dB hearing reduction, over at least three contiguous frequencies, occurring over a period of 72 h or less. Some patients describe that the hearing loss was noticed instantaneously in the morning, and others report that it rapidly developed over a period of hours or days. Only one ear is usually affected. About half of people recover some or all of their hearing spontaneously, and some people need

System of Integrated Communication Operations "SZOK"®—a world-class solution—is a revolution in the creation of IT infrastructure and data management. The project's innovativeness is based on the use of a system supporting patient diagnosis at a distance and the transfer of research results to the health services sector. Integrating patient data into the

are often designed for statistical analysis of the responses, this is not always the case.

mental sound. The term commonly used to describe this condition is "hyperacusis."

mation, timing analysis, correlation analysis, and pattern matching.

parents to another specialist, if necessary.

rubella syndrome (CRS) or miscarriage.

condition, trait, and so on.

a treatment from an otolaryngologist.

Middle Ear—the portion of the ear internal to the eardrum, and external to the oval window of the inner ear. The mammalian middle ear contains three ossicles, which transfer the vibrations of the eardrum into waves in the fluid and membranes of the inner ear. It joins the tympanic cavity with the nasal cavity, allowing pressure to equalize between the middle ear and throat. The hollow space of the middle ear is also known as the tympanic cavity. The primary function of the middle ear is to efficiently transfer acoustic energy from compression waves in air to fluid-membrane waves within the cochlea.

Mitochondrial Hearing Loss—nonsyndromic deafness caused by mutations in both nuclear and mitochondrial genes. Nonsyndromic mitochondrial hearing loss is characterized by moderate to profound hearing loss, and a maternally inherited mutation in either the MTRNR1 or MTTS1 gene.

Mumps—a viral disease caused by the mumps virus. Initial signs and symptoms often include fever, muscle pain, headache, and feeling tired. This is then usually followed by painful swelling of one or both parotid salivary glands. Symptoms typically occur 16—18 days after exposure and resolve after 7–10 days. Symptoms in adults are often more severe than those in children. Complications may include meningitis, pancreatitis, permanent deafness, and testicular inflammation, which uncommonly results in infertility.

Noise-induced Hearing Loss—hearing impairment resulting from exposure to loud sound. People may have a loss of perception of a narrow range of frequencies, impaired cognitive perception of sound, or other impairment, including sensitivity to sound or ringing in the ears. Hearing may deteriorate gradually from chronic and repeated noise exposure or suddenly from a short high intensity noise. In both types, loud sound overstimulates delicate hearing cells, leading to the permanent injury or death of the cells.

Otitis Media with Effusion—when there is thick or sticky fluid behind the eardrum in the middle ear, but there is no ear infection. Normally, the Eustachian tube drains fluid from your ears to the back of your throat. If it clogs, otitis media with effusion (OME) can occur. This condition most often affects children. Muffled hearing is a common symptom.

Ototoxic Drugs—medications which can damage the ear, resulting in hearing loss, ringing in the ear, or balance disorders. The effects of ototoxicity can be reversible and temporary, or irreversible and permanent. Ototoxic drugs include, for example, antibiotics (gentamicin), loop diuretics (furosemide), and platinum-based hemotherapy (cisplatin). Outer hair cells.

Outer Hair Cells—called acoustical preamplifiers. In mammalian outer hair cells, the receptor potential triggers active vibrations of the cell body. This mechanical response to electrical signals is termed somatic electromotility and drives oscillations in the cell's length, which occur at the frequency of the incoming sound and provide mechanical feedback amplification. They also improve frequency selectivity.

Platform for Sense Examination—a portable device for screening hearing, sight and speech and hearing and speech rehabilitation in children (also with special educational needs), adolescents and adults. The device is built on the basis of an advanced central computer system and a portable computer equipped with additional accessories enabling the test.

headache, and neck stiffness. The inflammation may be caused by infection with viruses,

Middle Ear—the portion of the ear internal to the eardrum, and external to the oval window of the inner ear. The mammalian middle ear contains three ossicles, which transfer the vibrations of the eardrum into waves in the fluid and membranes of the inner ear. It joins the tympanic cavity with the nasal cavity, allowing pressure to equalize between the middle ear and throat. The hollow space of the middle ear is also known as the tympanic cavity. The primary function of the middle ear is to efficiently transfer acoustic energy from compression waves in air to

Mitochondrial Hearing Loss—nonsyndromic deafness caused by mutations in both nuclear and mitochondrial genes. Nonsyndromic mitochondrial hearing loss is characterized by moderate to profound hearing loss, and a maternally inherited mutation in either the MTRNR1 or

Mumps—a viral disease caused by the mumps virus. Initial signs and symptoms often include fever, muscle pain, headache, and feeling tired. This is then usually followed by painful swelling of one or both parotid salivary glands. Symptoms typically occur 16—18 days after exposure and resolve after 7–10 days. Symptoms in adults are often more severe than those in children. Complications may include meningitis, pancreatitis, permanent deafness, and testic-

Noise-induced Hearing Loss—hearing impairment resulting from exposure to loud sound. People may have a loss of perception of a narrow range of frequencies, impaired cognitive perception of sound, or other impairment, including sensitivity to sound or ringing in the ears. Hearing may deteriorate gradually from chronic and repeated noise exposure or suddenly from a short high intensity noise. In both types, loud sound overstimulates delicate hearing

Otitis Media with Effusion—when there is thick or sticky fluid behind the eardrum in the middle ear, but there is no ear infection. Normally, the Eustachian tube drains fluid from your ears to the back of your throat. If it clogs, otitis media with effusion (OME) can occur. This

Ototoxic Drugs—medications which can damage the ear, resulting in hearing loss, ringing in the ear, or balance disorders. The effects of ototoxicity can be reversible and temporary, or irreversible and permanent. Ototoxic drugs include, for example, antibiotics (gentamicin), loop

Outer Hair Cells—called acoustical preamplifiers. In mammalian outer hair cells, the receptor potential triggers active vibrations of the cell body. This mechanical response to electrical signals is termed somatic electromotility and drives oscillations in the cell's length, which occur at the frequency of the incoming sound and provide mechanical feedback amplification.

Platform for Sense Examination—a portable device for screening hearing, sight and speech and hearing and speech rehabilitation in children (also with special educational needs),

condition most often affects children. Muffled hearing is a common symptom.

diuretics (furosemide), and platinum-based hemotherapy (cisplatin). Outer hair cells.

bacteria, or other microorganisms, and less commonly by certain drugs.

fluid-membrane waves within the cochlea.

ular inflammation, which uncommonly results in infertility.

cells, leading to the permanent injury or death of the cells.

They also improve frequency selectivity.

MTTS1 gene.

128 An Excursus into Hearing Loss

Play Audiometry—it allows an audiologist to test the hearing of very young toddlers and preschoolers. CPA uses behavioral conditioning to get kids to respond to sounds. It is designed for children usually between 2 and 5 years of age. It measures hearing sensitivity to determine both a child's type and degree of hearing loss, if any. The audiologist can then refer parents to another specialist, if necessary.

Pure Tone Audiometry (PTA)—the key hearing test used to identify hearing threshold levels of an individual, enabling determination of the degree, type and configuration of a hearing loss, thus providing the basis for diagnosis and management. PTA is a subjective, behavioral measurement of hearing threshold, as it relies on patient response to pure tone stimuli. Therefore, PTA is used on adults and children old enough to cooperate with the test procedure.

Questionnaire—a research instrument consisting of a series of questions (or other types of prompts) for the purpose of gathering information from respondents. Although questionnaires are often designed for statistical analysis of the responses, this is not always the case.

Rubella—is an infection caused by the rubella virus. This disease is often mild with half of people not realizing that they are sick. A rash may start around 2 weeks after exposure and last for 3 days. Complications may include bleeding problems, testicular swelling, and inflammation of nerves. Infection during early pregnancy may result in a child born with congenital rubella syndrome (CRS) or miscarriage.

Sensitivity—the ability of an organism or organ to respond to external stimuli. For example, auditory hypersensitivity occurs when a person has a collapsed tolerance to normal environmental sound. The term commonly used to describe this condition is "hyperacusis."

Sound-source location—a listener's ability to identify the location or origin of a detected sound in direction and distance. The auditory system uses several cues for sound source localization, including time and level differences (or intensity-difference) between both ears, spectral information, timing analysis, correlation analysis, and pattern matching.

Specificity—In medicine, it means the extent to which a diagnostic test is specific for a particular condition, trait, and so on.

Sudden Idiopathic Hearing Loss—defined as greater than 30 dB hearing reduction, over at least three contiguous frequencies, occurring over a period of 72 h or less. Some patients describe that the hearing loss was noticed instantaneously in the morning, and others report that it rapidly developed over a period of hours or days. Only one ear is usually affected. About half of people recover some or all of their hearing spontaneously, and some people need a treatment from an otolaryngologist.

System of Integrated Communication Operations "SZOK"®—a world-class solution—is a revolution in the creation of IT infrastructure and data management. The project's innovativeness is based on the use of a system supporting patient diagnosis at a distance and the transfer of research results to the health services sector. Integrating patient data into the

system platform will allow for better and faster service and will reduce patient waiting times for visits to an institute.

Author details

Poland

References

Piotr Henryk Skarżyński1,2,3,4\* and Maciej Ludwikowski1

\*Address all correspondence to: p.skarzynski@medincus.pl

4 Center of Hearing and Speech, MEDINCUS, Kajetany, Poland

International Advanced Otology. 2011;7(2):194-200

Teleaudiology, Kajetany/Warsaw, Poland

2 Institute of Sensory Organs, Kajetany, Poland

1 World Hearing Center, Institute of Physiology and Pathology of Hearing, Department of

Hearing Screening around the World http://dx.doi.org/10.5772/intechopen.73535 131

3 Heart Failure and Cardiac Rehabilitation, Department of the Medical University of Warsaw,

[1] Skarżyński PH, Kochanek K, Skarżyński H, Senderski A, Wysocki J, Szkiełkowska A. Hearing screening program in school-age children in western Poland. The Journal of

[2] Skarżyński PH, Świerniak W, Piłka A, Skarżyńska MB, Włodarczyk AW, Kholmatov, et al. A hearing screening program for children in primary schools in Tajikistan: A telemedicine

[3] Anderson KL. http://successforkidswithhearingloss.com. 2012. Retrieved from Supporting Success for Children with Hearing Loss: https://successforkidswithhearingloss.com/wp-

[4] Skarżyński PH, Piłka A, Ludwikowski M, Skarżyńska MB. Comparison of the frequency of positive hearing screening outcomes in schoolchildren from Poland and other countries of Europe, Central Asia, and Africa. Journal of Hearing Science. 2015, February;51-58

[5] Tharpe AM, Sladen DP. Causation of permanent unilateral and mild bilateral hearing loss

[6] Ross DS, Holstrum WJ, Gaffney M, Green D, Oyler RF, Gravel JS. Hearing screening and diagnostic evaluation of children with unilateral and mild bilateral hearing loss. Trends in

[7] Liu XZ, Pandya A, Angeli S, Telischi FF, Arnos KS, Nance, et al. Audiological features of

[8] Marazita G, Ploughman LM, Rawlings B, Remington E, Arnos KS, Nance WE. Genetic epidemiological studies of early-onset deafness in the U.S. school-age population. Amer-

[9] Arjamand EM, Webber A. Audiometric findings in children with a large vestibular aqueduct. Archives of Otolaryngology - Head & Neck Surgery. 2004, October;130(10):1169-1174

GJB2 (connexin 26) deafness. Ear and Hearing. 2005, June;26(3):361-369

model. Medical Science Monitor. 2016;22:2424-2430. DOI: 10.12659/MSM.895967

content/uploads/2011/12/Handout-Hearing-Screening-in-Early-Childhood.pdf

in children. Trends in Amplification. 2008, March;12(1):17-25

ican Journal of Medicine Genetics. 1993, June 15;46(5):486-491

Amplification. 2008, March;12(1):27-34

Teleaudiology—it is the utilization of telehealth to provide audiological services and may include the full scope of audiological practice. The innovation that is currently being developed broadens teleaudiology and hearing care practice to virtual care modalities such as clinical video telehealth, store-and-forward telehealth, home telehealth, mobile health applications, secure messaging, and electronic consults.

Telemedicine—the use of telecommunication and information technology to provide clinical healthcare from a distance. It has been used to overcome distance barriers and to improve access to medical services that would often not be consistently available in distant rural communities. It is also used to save lives in critical care and emergency situations.

Tinnitus—the hearing of sound when no external sound is present. While often described as a ringing, it may also sound like a clicking, hiss, or roaring. Rarely, unclear voices or music are heard. The sound may be soft or loud, low pitched or high pitched and appear to be coming from one ear or both. Most of the time, it comes on gradually. In some people, the sound causes depression or anxiety and can interfere with concentration.

Tympanic Membrane—a thin, cone-shaped membrane that separates the external ear from the middle ear. Its function is to transmit sound from the air to the ossicles inside the middle ear and then to the oval window in the fluid-filled cochlea. Hence, it ultimately converts and amplifies vibration in air to vibration in fluid. Rupture or perforation of the eardrum can lead to conductive hearing loss.

Unilateral Hearing Loss (UHL)—a type of hearing impairment where there is normal hearing in one ear and impaired hearing in the other ear. Patients with unilateral hearing loss have difficulty in hearing conversation on their impaired side, localizing sound, understanding speech in the presence of background noise, interpersonal and social relations. Using for example CROS hearing aids or BAHA implant can help to resist better hearing functioning.

Universal Screening Protocol—it is the largest preventive health program in Poland. Its primary goal is to examine each newborn baby to except possible hearing impairment and to analyze risk factors that predispose to hearing loss.

Vernix—the waxy or cheese-like white substance found coating the skin of newborn human babies. It is produced by dedicated cells and is thought to have some protective roles during fetal development and for a few hours after birth. Vernix is theorized to serve several purposes, including moisturizing the infant's skin, and facilitating passage through the bacteria. It serves to conserve heat and protect the delicate newborn skin from environmental stress.

Video-otoscopy—video-otoscopy is the use of an otoscope (this is an instrument used to look in the ears) that has a very tiny video camera that transmits images to a television screen. These scopes use fiber optics to transmit a very bright light that illuminates the ear canal. The video otoscope allows the doctor to see in the ear much better than a traditional handheld otoscope. With the irrigating function, debris can be cleaned deep within the ear that would be impossible to remove any other way.
