Audiologic Assessment of Children with Down Syndrome

My blog today is not from direct observation. I researched an article titled, "Audiologic Assessment of Children with Down Syndrome." The author, Jack Kile, explains that the diagnosis of hearing loss among children who are affected by Down Syndrome tends to be delayed because the lack of responsiveness is generalized to developmental problems. The author makes note that assessing and treating these clients early is "critical." The hearing loss associated with Down Syndrome can usually be treated or helped with amplification.
Children with Down Syndrome are usually considered difficult to test. This article presents tips associated with testing these children.
The first issue presents with structural abnormalities. In cases of abnormal pinnas, Kile recommends the use of insert earphones to prevent difficulties with placement over the abnormal pinna and to prevent collapsing of the canals. These children also tend to have stenosis of the canal and an abundance of earwax. Concerning the wax, it is recommded that cerumen management be addressed before the client actually comes for a hearing test. The stenosis of the canal will affect tympanometric results. Values may be different for ear canal volumes. Also, skull differences can create issues with the bone conduction trandsducer. The band should be fitted tightly around the head which may be malformed. Kile notes that children with Down Syndrome also typically show a higher prevalence of middle ear disease as shown through Type B tymps. Studies also show that there may be differences in the inner ears of the children shown by ABRs differening from children without Down Syndrome.
The next section of the article dealt with testing modifications based on the child's level of development and their capabilities which can be observed or noted from parental information. The author suggests hands on social interaction to keep these individuals participating. The author also mentions that VRA is a difficult task with those who have Down Syndrome due to their poor sound localization. The clinician should be flexible in working with these children during VRA, especially because behavioral methods are not suggested. It is suggested that more responses could be obtained using rhythmic signals. Children with Down Syndrome tend to be echolalic which can be useful for testing. An audiologist may be able to get the child to repeat the stimuli when it is presented. Also, visual fixation tends to be more lengthy for a child with Down Syndrome. The mother should not be in line of sight and all possible visual distractors not used for testing, should be removed from the testing area. Also, due to a possiblitly of delayed responses, plenty of time should be alotted between presentation of stimuli. Response modes should be as effortless as possible to overcome hypotonia issues. Overall, testing should be adjusted for children with Down Syndrome.
The author then went into detail about how results differ for children with Down Syndrome as compared to children without. Kile noted that there can be a difference of as much as 10dB. He also mentioned that otitis media is the most common problem for children with Down Syndrome but that a sensorineural component is apparent. As an end to this article, Kile explains the need of research to definitively determine the root of the sensorineural loss. He suggests the use of more electrophysiogical methods. I think this article is very intersting and could beneficial to those audiologists who typically test difficult to test clients.

Good site for understanding Down Syndrome:http://www.nlm.nih.gov/medlineplus/downsyndrome.html

Article Citation:
Kile, J. (1996, March). Audiologic assessment of children with Down Syndrome. American
Journal of Audiology, 5, 44-52.