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Department of Otolaryngology (ENT)
- Head & Neck Surgery

Common Conditions:

Allergic Rhinitis / Nasal Allergy

Sinusitis

Ear (Otology) & Dizziness

Snoring & Obstructive Sleep Apnoea

Head & Neck Cancers

Swallowing Problem

Hearing & Language

Thyroid Problem

Paediatric (Kids) ENT

Tonsillitis

Nasal Polyps

 

Hearing & Language

 

 

Doctors

 

Senior Consultant

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What causes it

Genetic Causes of Hearing Loss
One or more children out of five with unknown cause of sensorineural hearing loss may have genetic hearing loss. Genetic hearing loss is the leading known cause of hearing loss currently, more so than infections or injury. A blood sample is needed for the test. Without testing, the diagnosis can be missed as parents are usually both with normal hearing, and the patients look normal without any other syndromic features.

 

Testing allows families to obtain a definitive diagnosis such as the cause of hearing loss, plan for the child’s treatment (certain mutations are related to certain expected severity of hearing loss eventually), prognosticate success outcomes of cochlear implantation, assess the risk of hearing loss in future siblings, and avoids further tedious and expensive testing. This test is currently done free for Singaporeans under a BMRC-ASTAR grant. For patients who do not wish to join the study, or for foreigners seeking genetic testing for hearing loss, a clinical genetic testing service is also available.

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About the condition

Hearing loss is a hidden handicap that is often ignored. It can be detected through formal assessment. The incidence increases with age and affects 1/3 of those above 65 years of age. Three in 1000 babies born in Singapore have significant hearing impairment. Often, their parents have normal hearing. These children are at risk of delays in speech, language, intellectual, social and emotional development.

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Diagnosis and Treatment Options

Every hearing impaired child should have a comprehensive hearing test and early intervention to ensure integration into the mainstream society.

 

Audiological Evaluation

  • Acoustic Reflex Threshold
  • Acoustic Reflex Decay
  • Auditory Brainstem Response (ABR)
  • Central Auditory Processing Disorder (CAPD)
  • Cochlear Implant Evaluation
  • Eustachian Tube Function Test
  • Hearing Aid Fitting
  • Hearing Screening
  • Otoacoustic Emissions (OAE's)
  • Play Audiometry
  • Pure Tone Audiometry
  • Speech Audiometry
  • Steady State Evoked Potential (SSEP)
  • Tympanometry
  • Visual Reinforcement Audiometry (VRA)

 

Audiological Evaluation

  • Hearing Screening
  • Pure Tone Audiometry
  • Tympanometry
  • Eustachian Tube Function Test
  • Otoacoustic Emissions (OAE's)
  • Visual Reinforcement Audiometry (VRA)
  • Acoustic Reflex Threshold
  • Acoustic Reflex Decay
  • Central Auditory Processing Disorder (CAPD)
  • Speech Test
  • Tone Decay
  • Auditory Brainstem Response (ABR)
  • Steady State Evoked Potential (SSEP)

 

Universal Newborn Hearing Screening Programme

Hearing loss is the most frequent birth defect. The year 1999 saw the birth of the screening programme in the Department of Neonatology, NUH. In the initial stages, the tests were carried out only on the high-risk group of babies. But this identified only about 50% of affected children. Failure to identify all of them resulted in diagnosis and intervention at an unacceptably late age. Universal Newborn Hearing Screening programme (UNHS) has therefore become an important part of our standard medical care. This programme is run in collaboration with the ENT department. With a national UNHS programme in place since April 2002, more hearing-impaired children in Singapore are now expected to integrate into mainstream education.

 

A year’s study in Singapore (June 2002 to May 2003) showed that there is a clear need for an early detection and intervention programme. The incidence of hearing loss was found to be 5.2 in a 1000 and those with severe to profound impairment was 3 in a 1000.

 

The aim of the programme is to diagnose and intervene early so that children may acquire normal speech & language thereby reducing communication disabilities, achieve positive outcomes in academic performance and also enjoy normal social development. This also enhances opportunities for the hearing impaired child to be a part of the hearing world right from infant stage and subsequently receive formal education just like their hearing p eers.

 

For most children with a significant hearing loss, amplification with appropriate counselling and habilitative therapy may be the method of intervention.

 

Auditory Verbal Therapy

Aural habilitation is aimed at maximising the function of a hearing-impaired individual’s hearing in order to listen and acquire spoken language. All children who have been identified with hearing loss are strongly recommended to undergo therapy because listening and talking skills are not automatic after hearing aid fitting or cochlear implantation.

 

Sessions are conducted weekly each time, or as recommended by our therapists. The caregiver is present with the child at each session and is taught the various techniques to encourage the child to listen, react, respond and subsequently comprehend. The goal of each session is to arm the child’s caregiver with skills that can be used during daily interactions with the child. All sessions are individualised based on the needs of the child and mainly take the form of play activities including singing and reading activities. Areas such as listening, language comprehension, language expression, speech, cognition and social skills are included in the goals of these activities in accordance to the child’s needs. These are then taught to parents so that they can continue working on the relevant goals during play at home. Therapy is aimed at integrating each child into the demands of our listening society as far as possible.

 

We work closely with the caregiver and the rest of the child’s family members to ensure that the child’s lifestyle at home is that of an auditory verbal one. The aim is to equip each family with the appropriate education, guidance, advocacy and support. Home and school visits are made regularly to ensure that the child is integrating well in the listening world. Close contact is maintained with teachers, principals and other school staff. Therapy is also appropriate for adults who have had hearing loss since childhood and would like to learn to listen and speak better after being equipped with current amplification devices (hearing aids or cochlear implants) recommended by the doctors and audiologists.

 

For further information on our Auditory Verbal Therapy service, please contact: Tel: 6772 4477

 

Treatment Options

Cochlear Implant (CI)

Cochlear Implant (CI) programme is a part of Centre for Hearing Intervention and Language Development (CHILD) at NUH, a programme which conducts assessments to determine whether hearing-impaired children/adults are suitable candidates for CI surgery. We provide the surgery and coordinate post-operative services for these patients.

 

Patients interested in the CI programme are advised to submit relevant information regarding their child's medical and hearing history for evaluation and selection. Based on the information received, they will then be advised as to whether they should undergo a more comprehensive assessment, such as the Auditory Performance Evaluation (APE).

 

A qualified audiologist and therapist will conduct specific speech and language assessments as deemed suitable, and provide the post-implant habilitation.

 

Cochlear Implant Investigations and Therapy

  • MAPping
  • Neural Response Telemetry (NRT)
  • Auditory Performance Evaluation (APE)
  • Auditory Verbal Therapy (AVT)

 

In order to be accepted as a candidate for a cochlear implant, the family is required to attend recommended assessments before the final evaluation can be made. They must also be committed to the clinic's approach. All implantees must undergo regular post-operative assessments.

 

Common FAQs on Cochlear Implant Surgery

  1. What is the surgery about?
    Before a cochlear implant is considered, a series of tests such as ear examination, hearing evaluation, radiologic (x-ray, MRI) examination, and AVT are necessary.

    Cochlear implant surgery is performed by the Otolaryngologist (ENT Specialists) under general anaesthesia and lasts from two to three hours. An incision is made just behind the ear to access the mastoid cavity that leads to the middle and inner ears. An x-ray is taken after surgery to confirm the position of the implant. Generally, the patient stays for one or two days after the surgery.
  2. What happens after the surgery?
    About one month after surgery, the cochlear implant team will ‘switch on’ the implant. They will teach the parents how to look after the system. The patient will probably be asked to return for a few visits for regular checkups, and readjustments of the speech processor are needed.
  3. What can I expect from the surgery?
    Cochlear implants do not restore normal hearing and the benefits vary from one individual to another. There are many factors that contribute to the degree of benefit a user receives from a cochlear implant, including:
    • The period/amount of time the patient had been deaf. 
    • The number of surviving auditory nerve fibers.
    • The patient’s and family’s motivation to learn to hear and speak.

 

Hearing Aids

Digital, Programmable, and multi-channel Behind-The-Ear (BTE) hearing aids of all styles are available in the market. These aids are suitable for all types of hearing losses, that is, from mild to profound. There are also different types and models of custom hearing instruments: Completely-In-The-Canal (CIC), In-The-Canal (ITC), as well as In-The-Ear (ITE). All are worn in the ear to take advantage of the natural hearing process. They are inconspicuous and represent the "elegant" cosmetic solution.

 

At Centre for Hearing Intervention and Language Development (CHILD), the audiologists offer a wide range of hearing products and services. We exercise flexibility in fitting babies, young children to adults with any type and degree of hearing loss.

 

Services

  • Hearing Aid Evaluation and Fitting
  • Test/Repair Hearing Aid
  • FM System
  • Tinnitus Masker
  • Custom-Made Ear Mould
  • Custom-Made Swimming Mould
  • Family Guidance Counselling

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