Hearing Loss in Your Child, What to Do Next?

Hearing Loss in Your Child, What to Do Next?

First series of hearing loss in your child: When parents are told that their child has hearing loss, many a times they are lost about what they should do next. What are the management steps that parents should take to help their child?

 

Knowledge is power

There is nothing more important than finding out every detail of the problem that your child has. Feel free to ask your audiologist or doctor, how they test your child and what is the purpose of each test done. Confirm how reliable were the tests done. Next ask the exact nature of the hearing loss as it would be crucial on deciding what the next step would be.

If it is a conductive hearing loss, whereby the problem is either on the outer ear or the middle ear, the problem might be cured by a medical doctor. If it is a sensorineural hearing loss, determine whether it is a permanent hearing loss or is there a chance of a cure.

The audiologist should be able to advice you on this. Remember, you have the right to have a second opinion. You can ask the audiologist to provide you a copy of all the results, a report for records and also reference if a second opinion is sought.

baby-child

Image Source: Singapore Motherhood

You should also find out the sounds that your child could still hear. Contrary to common perception, it is rare for us to find an individual who does not have any hearing at all. In fact, most children with hearing loss have a degree of residual hearing. Knowing the types of sounds your child can hear as well as the level of loudness is important to help him communicate. Even for temporary hearing loss, it is important to know the communication strategies that you would need in order to help your child through this trying period.

 

Hearing Aids

hearing-aid-child

Image Source: Pinterest

The Malaysian Association of Speech-Language and Hearing (MASH), the professional association for audiologists and speech language pathologists in it’s guideline states that all children with hearing loss of 25dBHL or more should be considered for hearing aid fitting. Various researches worldwide also indicate that a child who receives optimum amplification and rehabilitation early has the potential of developing speech and language that are similar to children with normal hearing levels.

In most cases of permanent hearing loss, your audiologist would recommend that your child should be fitted with hearing aids to help him/her hear. The first thing that we should know about hearing aids are that they help your child to hear by making sounds louder however they will not cure hearing loss. Your child needs to be trained to hear with the hearing aids as amplification alone is not sufficient to help your child understand sounds and language.

Technology in amplification has been improving tremendously. It is important that you know the difference between the various technologies available before deciding on which hearing aids are the best for your child. Most audiologists would recommend digital hearing aids compared to analogue hearing aids for your child. A complete discussion on the differences and benefits of these technologies would require an entire article. Your audiologist would be more than happy to explain to you about them.

 

ear-diagnosis-child

Image Source: Very Well

Another question that you would be asking yourself would be whether one hearing aid is enough or should you get a pair. For children with hearing loss in both ears, the best benefit would be amplification in both ears. This is to maximize their learning potential as well as to ensure that sounds are as natural as they can be. Wearing a single hearing aid when both ears have hearing loss is similar to using a monocle instead of your spectacles. An adult who has acquired speech and language might be able to cope but a child who is learning would struggle with a single hearing aid.

If your child has severe to profound hearing loss and gets insufficient amplification even from the most powerful hearing aids, then a cochlear implant might be beneficial. Again, please remember that a cochlear implant is a device that helps your child to hear and a lot of rehabilitation needs to be carried out before they could listen and understand speech as well as proceed to speak. This is true with both hearing aids and cochlear implants.

Next up on Health Tips by Teleme, the second series on Hearing Loss in Your Child: Communication and Assistive Listening Devices.

 

Source: The Malaysian Association of Speech-Language and Hearing

Download Teleme’s mobile app and consult an Ear, Nose and Throat Surgeon or an Audiologist

 

 

Dr. Shailendra

Dr. Shailendra

Ear, Nose & Throat Surgeon

Mr. Saravanan Selanduray

Mr. Saravanan Selanduray

Audiologist

Your Child’s Vision: Refractive Errors (The Need To Wear Glasses)

Your Child’s Vision: Refractive Errors (The Need To Wear Glasses)

Here we have come to the last part of the series Your Child’s Vision. In this post, we’ll explain about Refractive Errors (the need to wear glasses).

In normal vision, light enters the eye and the image is focused clearly at a single point on the retina (the light sensitive area similar to the film of a camera) at the back of the eye.  Refractive errors result from abnormality of either the length of the eyeball or curvature of the front of the eye called the cornea.

When a refractive error exists, the image is not in focus and 3 situations can arise.

 

1. Myopia (short-sightedness)

Image source: Coolwinks

The image is focused in front of the retina because either the eyeball is too long or the cornea too curved.  The child can see near objects but distant objects appear blurred.  This is the commonest refractive error is Asians and usually manifests between the ages of 6 to 16 years of age.  There is a correlation between short-sightedness and high intelligence, excessive reading, excessive playing of computer or handheld games and not spending enough time outdoors to see distant objects.

 

2. Hyperopia (long-sightedness)

Image source: Coolwinks

The image is focused behind the retina because the eyeball is too short.  Both far and near objects appear blurred although the distant vision is slightly less blurred.

3. Astigmatism

Image source: Coavision

 

The image is focused at 2 points on the retina and objects at all distances appear blurred and distorted. Astigmatism is due to unevenness of the cornea.

A child who develops a refractive error will require spectacle correction to be able to see clearly. This is very important for the child visual development (especially if the child is below the age of 9 years) because not wearing spectacles can lead to amblyopia.

 

When and how often should a child have the eyes checked?

 

It is recommended that children should have their first eye examination at the age of 3 years and again just before the start of school (around 6-7 years old) by either the eye doctor, orthoptist or optomterist.

The eye test should include:

  • Measurement of any refractive errors (shortsighted, longsighted or astigmatism)
  • Eye movement assessment and detection of any squint
  • 3D vision (depth perception) assessment

Risk-free children can have the eyes checked every 2 years while children who wear spectacles should have their eyes checked every year by the optometrist as the prescription may change within this period.

Age No Symptoms & risk-free At risk children
Birth to age 6 years

One check by the age of 6 years. An eye check at age 3 years is optional

One eye check by the age of 1 year & as recommended thereafter

Ages 6 to 18 years Every 2 years Every year
Children who wear glasses Every year Every year

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Download Teleme App and consult a specialist on your child’s vision care and treatment:

 

Ms. Melanie Yeoh

Ms. Melanie Yeoh

Orthoptist (Lazy eye /Squint)

 

Dr. Tsiang Ung

Dr. Tsiang Ung

Ophthalmologist (Paediatric)

 

Your Child’s Vision: Common Eye Problems In Children

Your Child’s Vision: Common Eye Problems In Children

If you’ve read about the 1st part of Your Child’s Vision Series (Your Child’s Visual Milestones). It’s understood that children from 2 years old onwards are the age group that usually manifest common eye problems which we are going to talk about in this post.

The following are common eye problems which can be found in children.

 

A. AMBLYOPIA  (also known as ‘lazy eye’)

Amblyopia occurs because the eye is not able to reach the full potential of its visual development as the eye is not used (in other words, neglected) by the child who prefers to use the other normal eye to see.  This is because the image seen with the affected eye is not as clear as the normal eye and the child prefers to see with the normal eye.

Any disease which blurs or blocks the vision during childhood will result in amblyopia.

Causes include:

  • Refractive errors which have not been corrected with spectacles
  • Squints (the eye which is squinting will be neglected and become amblyopic)
  • Congenital cataract (cataracts which have formed at birth although this is rare)
  • Cornea scarring due to infection or injury (also very rare)

 

In order to reduce the possibility of amblyopia, it is important to diagnose the condition and intervene early. A child with amblyopia may have no visual complaints because the child may be using the other good eye which has normal vision. For this reason, it is absolutely vital a child (who is at risk) must be assessed using appropriate testing techniques and examined by an eye doctor, optometrist or orthoptist to screen for amblyopia.

Amblyopia can be reversed if the situation is detected early during the visual development period (until the age of 9 years).  The earlier amblyopia is detected, the greater is the child’s chance of recovery.  Once a child is diagnosed to have amblyopia, the first plan of action is to treat the underlying cause (if any) such as shortsightedness using spectacles or congenital cataract using surgery before starting amblyopia therapy.

 Image source: huffingtonpost

The amblyopia therapy involves patching the good (i.e: normal) eye so that the amblyopic eye will be used by the child and hence stops it from being neglected.  The duration for patching the normal eye varies between 1 to 6 hours per day depending on the regime used and the severity of the amblyopia. It is important to use the lazy eye during the patching period by doing hand-eye exercises such as drawing, copying and colouring.

 

Compliance with therapy is the single most important factor determining a successful outcome.  It requires full cooperation of the child and parents as well as strict supervision of the eye doctor or orthoptist to ensure good results.  Visual improvement can sometimes be measured after only 1 month of therapy.  Patching can be stopped when the vision has improved to almost normal (the lazy eye can never reach 100% normal so at best 90% of normal can be considered excellent result), or when there is no further visual improvement especially when the child has reached 9 years of age.

 

B. SQUINTS (also known as ‘cock-eye)

Image source: Allaboutvision

Humans possess two eyes which give us binocular vision and hence the ability to judge depth and distance in 3-dimension. In the normal person, the 2 eyes are parallel to each other and move together when we look from one object to another.

Image source: SightMD

A squint is present when the 2 eyes are not aligned parallel to each other. When looking ahead, the squinting eye (or cock eye) is either deviated inwards or outwards and is known as a convergent or divergent squint respectively.

When a child has a squint, the vision in the squinting eye will be suppressed and the child will prefer to use the normal eye all the time. This will lead to amblyopia (lazy eye) in the squinting eye. Squints usually appear between the ages of 1-3 years.

Treatment of squints involves patching the normal eye to reverse the amblyopia (see treatment of lazy eye above) and then plan to perform squint surgery to align the eyes so that they become parallel again. Some squints do not need surgery and eye fusion exercises together with spectacles will be sufficient to treat the squint.

Successful treatment will allow the child to look normal (so that he/she will not be teased at school) and restore some degree of binocular vision for the child.

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Download Teleme App for FREE and consult a specialist today on your child’s vision care and treatment:

 

 

Ms. Melanie Yeoh

Ms. Melanie Yeoh

Orthoptist (Lazy eye /Squint)

 

Dr. Tsiang Ung

Dr. Tsiang Ung

Ophthalmologist (Paediatric)

 

 Dr. Lee Mun Wai

Dr. Lee Mun Wai

Ophthalmologist (Retina)

 

Your Child’s Vision: Your Child’s Visual Milestones

Your Child’s Vision: Your Child’s Visual Milestones

At birth, the infant’s visual function is not fully developed but continues to develop in the first few years of life.  It is therefore important to monitor your child’s vision as he/she grows so that any abnormalities can be detected and treated early.

The visual milestones (see Table below) are a useful guide to monitor your child’s visual development. If the child does not appear to follow the milestones or if you have any concern, do consult an eye doctor, optometrist or orthoptist for a more thorough eye examination.

Children’s Visual Milestones

Age Visual ability
0-3 months At birth, the vision is poor (only in the range of hand movements or count fingers).  The newborn infant will initially choose to look at light sources such as a torch and only begin to develop eye contact with adults from around the age of 6-8 weeks.  The infant will soon be able to follow large objects which move slowly within his/her environment.
3-6 months The child will now begin to reach objects with his/her hands especially brightly coloured and larger objects.  The eyes will begin to move more widely and with less head movement.  The child will also be learning to grasp with his/her hands and also watch the parent’s face when being talked to.
6-12 months The child is now able to see smaller objects such as ‘100s and 1000s’, bread crumbs or sweets.  The child will try to pick them up and place them in his/her mouth!  The child can also interact with the parents as he/she will be interested in simple pictures in books or drawn for him/her.  He/she will be able to fixate and follow objects of interest such as his/her favourite toy.
12-18 months The child is able to recognize people’s faces and pictures. As the child begins to crawl, he/she is able to know the way around the house.  At this age, the child’s vision can be estimated by putting ‘100s and 1000s’ in your palm and watching the child reach for them.
18-24 months The child now becomes interested in picture or cartoon books, and may even recognize them as representations of real objects.  The child’s vision can be estimated by rolling STYCAR balls of decreasing sizes at around 3 m in front of the child and the child should be able to follow the balls movements.  The vision corresponds to the smallest ball that the child is able to see moving.  The child’s vision can also be assessed using Forced Preferential Teller Acuity Cards or Cardiff picture cards if the child is cooperative.
2 years onwards The child’s vision is almost at its peak development but continues to improve until the age of 7-9 years old. The vision can now be tested accurately using picture recognition and matching technique with Kay or Cardiff picture cards.  All children should be screened by the age of 3 years because squints and amblyopia (lazy eye) usually manifest by this age group.

Children at risk

In most cases, the child’s vision develops without any problems. However, in some children, there may be problems during the early development of their vision and this may affect the development of the child’s other milestones such as speech (as the child cannot see words to learn) or motor development (as the child does not have the confidence to see where he/she is crawling or walking).  The child may also have difficulty bonding with the mother as he/she may not be able to see the mother’s facial expressions.

Baby image created by Yanalya – Freepik.com

Children at risk include those:

  • Who have someone in the family with eye diseases such as congenital cataract, squints or high refractive errors which may be hereditary in nature
  • Born to mothers who were ill during pregnancy (especially during the 1st trimester) with infections such as rubella, cytomegalovirus or herpes virus
  • Born prematurely (especially less than 32 weeks gestation)
  • With low birth weight (especially less than 1.5kgs)
  • Who have Down’s syndrome or are educationally subnormal

Download Teleme App and consult a specialist today on your child’s vision care and treatment:

 

 

Ms. Melanie Yeoh

Ms. Melanie Yeoh

Orthoptist (lazy eye /squint)

 

Dr. Tsiang Ung

Dr. Tsiang Ung

Ophthalmologist (paediatric)

 

 Dr. Manoharan Shunmugam

Dr. Manoharan Shunmugam

Ophthalmologist (retina)

 

Things You Should Know About Diabetic Retinopathy

Things You Should Know About Diabetic Retinopathy

What is Diabetic Retinopathy?

Diabetic retinopathy (DR) is a complication of diabetes mellitus (DM) and is an important cause of avoidable blindness worldwide. Over time, diabetes causes damage to many organs in your body, including the retina. Your retina helps you see by acting as the film projector in the back of your eye, projecting the image to your brain.

Diabetes damages the tiny blood vessels that nourish the retina. In the early stages, known as non-proliferative or background retinopathy, the vessels in the retina weaken and begin to leak, forming small, dots of bleeding. When retinopathy advances, the decreased blood circulation deprives areas of the retina of oxygen.

Diabetic retinopathy can lead to severe visual loss or blindness in 2 ways. The first is when it affects your macula, the central part of your retina that provides you with sharp, central vision. When this part becomes swollen, it is called diabetic maculopathy.

At the same time, blood vessels can also become blocked or closed, and parts of the retina die. New, abnormal, blood vessels may then start to grow along the retina and surface of the vitreous (the transparent gel that fills the inner part of the eye).

Unfortunately, these delicate vessels can bleed easily. Blood may leak into the retina and vitreous, causing “floaters” (spots that appear to drift in front of the eyes), along with decreased vision. This is called proliferative diabetic retinopathy, and it can even cause scar tissue which can pull off the retina, causing what’s called a tractional retinal detachment (TRD).

In the later phases of the disease, continued abnormal vessel growth and scar tissue may cause a total retinal detachment and glaucoma. The result of either problem, if left untreated, is loss of sight and potentially blindness.

Signs of leakage and bleeding in DR
Figure 1: Signs of leakage and bleeding in DR

Symptoms of Diabetic Retinopathy

You may not be aware the symptoms of DR in the initial stages of the condition, unless it progresses quickly to the more severe stages. The symptoms of DR include:

• Blurred vision
• Sudden loss of vision in one eye
• Seeing rings around lights
• Dark spots or flashing lights

The symptoms described above may not necessarily mean that you have diabetic retinopathy. However, if you experience one or more of these symptoms, contact your ophthalmologist for a comprehensive eye examination.

The following are the risk factors for accelerating DR:

• Poorly-controlled diabetes
• A long duration of diabetes
• High blood pressure
• Elevated blood cholesterol levels
• Sleep apnea
• Gestational diabetes (diabetes during pregnancy)

Tests for Diabetic Retinopathy

A dilated retinal examination will be recommended by your ophthalmologist to examine the retina and detect the presence of any diabetic changes in the eye.

In addition to this, your ophthalmologist may also recommend certain diagnostic procedures such as a fundus fluorescein angiogram (FFA) or optical coherence tomography (OCT) to assess the severity of DR and to determine the best mode of treatment.

The angiogram test involves the injection of fluorescein (a yellow dye) into your arm. The dye can then be seen coursing through the blood vessels in your retina and photos are taken.

Normal, healthy blood vessels do no leak, however, damaged blood vessels like in DR do, thus helping to target treatment. An OCT scan uses reflected light to build a cross sectional image of the retina. Maculaedema is noted when areas of your retina are shown to contain spaces filled with fluid.

Treatment of Diabetic Retinopathy

In mild cases, treatment is not necessary. Regular eye exams are critical for monitoring progression of the disease. Strict control of blood sugar and blood pressure levels can greatly reduce or prevent DR. In more advanced cases, treatment is recommended to stop the damage of DR, prevent vision loss, and potentially restore vision.

Treatment options include:

1. Intravitreal Anti-VEGF injections
Anti-VEGF therapy involves the injection of the medication into the back (vitreous cavity) of your eye. The medication is an antibody designed to bind to and remove the excess VEGF (vascular endothelial growth factor) present in the eye that is causing the disease.

2. Laser Therapy

Laser retinal treatment is often helpful in treat- ing DR. To reduce macularedema, a laser is focused on the damaged retina to seal leak- ing retinal vessels. For abnormal blood vessel growth (neovascularization), the laser treatment is targeted over the peripheral retina (Panretinal Photocoagulation). The small laser scars that result will reduce abnormal blood vessel growth. Laser retinal therapy may be performed in outpatient clinic and greatly reduces the chance of severe visual impairment.

3. Vitrectomy

A vitrectomy may be recommended in advanced proliferative diabetic retinopathy. During this microsurgical procedure that is performed in the operating room, the vitreous is removed and replaced with a clear solution. Your ophthalmologist may wait several weeks to see if the blood will clear on its own before going ahead with surgery. In addition to a vitrectomy, retinal repair may be necessary if scar tissue has detached the retina from the back of your eye. Severe loss of vision or even blind- ness can result if surgery is not performed to reattach the retina.

Proliferation of new blood vessels with scar tissue forming on the retina and in the vitreous

Figure 2. Proliferation of new blood vessels with scar tis- sue forming on the retina and in the vitreous

How to Prevent Diabetic Retinopathy

• Visit your ophthalmologist or optometrist at least once a year. You may be recommended to visit more or less frequently depending on your situation.
Maintain optimal blood glucose levels, blood pressure and blood cholesterol.
• Know your HbA1c (a test of your average blood glucose level over three months). Most people with diabetes should aim for a target of lower than 7%. Talk to your healthcare team about what your target should be.

Who should be screened

All individuals with either Type I or Type II diabetes should be screened annually.
• The interval for follow-up assessments should be tailored according to the severity of the retinopathy. In those with no or minimal retinopathy, the recommended interval is one to two years.
Women with type I or type II diabetes or women who plan to become pregnant should be screened before conception, during the first trimester, as needed during pregnancy and within the first year postpartum

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Dr. Manoharan

Dr. Manoharan

Ophthalmologist (Retina)

Dr. Kenneth Fong

Dr. Kenneth Fong

Ophthalmologist (Retina)

Dr. Alan Ang

Dr. Alan Ang

Ophthalmologist (Retina)

I underwent Lasik surgery in Malaysia and I was able to attend follow-up consultations because I currently live in New Zealand. However, upon returning to New Zealand, I managed to consult my doctor through TeleMe’s online video consultation platform and it went smoothly. I highly recommend TeleMe’s service to everyone !

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Dr. Manoharan

Dr. Manoharan

Ophthalmologist (Retina)

Dr. Kenneth Fong

Dr. Kenneth Fong

Ophthalmologist (Retina)

Dr. Alan Ang

Dr. Alan Ang

Ophthalmologist (Retina)

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