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A hearing aid is an  electroacoustic body worn apparatus which typically fits in or behind the  wearer's ear, and is designed to amplify and modulate sound for the wearer. It  is a small electronic device that you wear in or behind your ear. It makes some  sounds louder so that a person with hearing loss can listen, communicate, and  participate more fully in daily activities. A hearing aid can help people hear  more in both quiet and noisy situations. However, only about one out of five  people who would benefit from a hearing aid actually uses one.


A hearing aid has three  basic parts: a microphone, amplifier, and speaker. The hearing aid receives  sound through a microphone, which converts the sound waves to electrical  signals and sends them to an amplifier. The amplifier increases the power of  the signals and then sends them to the ear through a speaker.
                        Types of hearing aids
                        Pocket Model or  Body worn aids
                        This was the first type of hearing aid.These aids  consist of a case containing the components of amplification and an ear mold  connected to the case by a cord. The case is about the size of a pack of  playing cards and is worn in the pocket or on a belt. Because of their large  size, body worn aids are capable of large amounts of amplification and were  once used for profound hearing losses
                        Behind the ear aids  (BTE)
                        Behind-the-ear (BTE) hearing aids consist of a  hard plastic case worn behind the ear and connected to a plastic earmold that  fits inside the outer ear. The electronic parts are held in the case behind the  ear. Sound travels from the hearing aid through the earmold and into the ear.  BTE aids are used by people of all ages for mild to profound hearing loss.
                        A new kind of BTE aid is an open-fit hearing aid.  Small, open-fit aids fit behind the ear completely, with only a narrow tube  inserted into the ear canal, enabling the canal to remain open. For this  reason, open-fit hearing aids may be a good choice for people who experience a  buildup of earwax, since this type of aid is less likely to be damaged by such  substances. In addition, some people may prefer the open-fit hearing aid  because their perception of their voice does not sound “plugged up.”
                        In the ear aids (ITE)
                        In-the-ear (ITE) hearing  aids fit completely inside the outer ear and are used for mild to severe  hearing loss. The case holding the electronic components is made of hard  plastic. Some ITE aids may have certain added features installed, such as a  telecoil. A telecoil is a small magnetic coil that allows users to receive  sound through the circuitry of the hearing aid, rather than through its  microphone. This makes it easier to hear conversations over the telephone. A  telecoil also helps people hear in public facilities that have installed  special sound systems, called induction loop systems. Induction loop systems  can be found in many churches, schools, airports, and auditoriums. ITE aids  usually are not worn by young children because the casings need to be replaced  often as the ear grows.
                        A completely in canal (CIC)
                        Canal aids fit into the ear  canal and are available in two styles. The in-the-canal (ITC) hearing aid is  made to fit the size and shape of a person’s ear canal. A completely-in-canal  (CIC) hearing aid is nearly hidden in the ear canal. Both types are used for  mild to moderately severe hearing loss.
                        Because they are small,  canal aids may be difficult for a person to adjust and remove. In addition,  canal aids have less space available for batteries and additional devices, such  as a telecoil. They usually are not recommended for young children or for  people with severe to profound hearing loss because their reduced size limits  their power and volume.
                        Cochlear Implantation
                        A Cochlear - Implant is a  hearing prosthesis designed to restore or provide a level of auditory sensation  to adults and children who have a severe to profound bilateral Sensory Neural  impairment and who gets limited benefit from hearing aids.
                        A cochlear implant (CI) is  a surgically implanted electronic device that provides a sense of sound to a  person who is profoundly deaf or severely hard of hearing. The cochlear implant  is often referred to as a bionic ear. Unlike hearing aids, the cochlear implant  does not amplify sound, but works by directly stimulating any functioning  auditory nerves inside the cochlea with an electric field. External components  of the cochlear implant include a microphone, speech processor and an RF  transducer or primary headpiece coil. A secondary coil is implanted beneath the  skull's skin and inductively coupled to the primary headpiece coil. The  headpiece coil has a magnet by which it attaches to another magnet placed on  the secondary coil often beside the cochlear implant. The implant relays the  incoming signal to the implanted electrodes in the cochlea. The speech processor  allows an individual to adjust the sensitivity of the device. The implant gives  recipients additional auditory information, which may include sound  discrimination fine enough to understand speech in quiet environments.  Post-implantation rehabilitative therapy is often critical to ensuring  successful outcomes.
                        As of 2009, approximately  150,000 people worldwide had received cochlear implants; in the United States, about 30,000 adults and over 30,000 children are  recipients.The vast majority are in developed countries due to the high  cost of the device, surgery and post-implantation therapy. A small but growing  segment of recipients have bilateral implants (one implant in each cochlea).
                        There is disagreement  whether providing cochlear implants to children is ethically justifiable,  renewing a century-old debate about models of deafness that often pits hearing  parents of deaf children against the Deaf community.
                        Counselling for CI
                        Facility for total  audiological work up for CI
                        Auditory - Verbal Therapy  (AVT)


Hearing Loss
                        Hearing loss is the total  or partial inability to hear sound in one or both ears.                     To understand hearing loss  it is important to understand how normal hearing takes place. There are 2  different pathways by which sound waves produce the sensation of hearing: air  conduction and bone conduction.
                    In air conduction, sound  waves move through the air in the external auditory canal (the "ear  canal" between the outside air and your eardrum). The sound waves hit the  tympanic membrane (eardrum) and cause the tympanic membrane to move.
                    The bones in the middle ear  are connected to the tympanic membrane. When the tympanic membrane moves, this  movement is transmitted to the bones. These 3 bones are called the malleus, the  incus, and the stapes. Movement of the stapes causes pressure waves in the  fluid-filled inner ear.
                    The cochlea is an inner ear  structure surrounded by fluid. It contains multiple small hairs. Pressure waves  in the fluid cause the hairs to move. This movement stimulates the auditory  nerve. Different frequencies of noises stimulate different hairs on the  cochlea, which translate to the sensation of sounds of different pitch.
                    Hearing by bone conduction  occurs when a sound wave or other source of vibration causes the bones of the  skull to vibrate. These vibrations are transmitted to the fluid surrounding the  cochlea and hearing results.
                                        Mental retardation
                    Mental retardation is a  generalized disorder, characterized by significantly impaired cognitive  functioning and deficits in two or more adaptive behaviors with onset before  the age of 18. Once focused almost entirely on cognition, the definition now  includes both a component relating to mental functioning and one relating to  individuals' functional skills in their environment.
                    Mental retardation is a  condition diagnosed before age 18 that includes below-average general  intellectual function, and a lack of the skills necessary for daily living.  Mental retardation affects about 1 - 3% of the  population. There are many causes of mental retardation, but doctors find a  specific reason in only 25% of cases.
                    A family may suspect mental  retardation if the child's motor skills, language skills, and self-help skills  do not seem to be developing, or are developing at a far slower rate than the  child's peers. Failure to adapt (adjust to new situations) normally and grow  intellectually may become apparent early in a child's life. In the case of mild  retardation, these failures may not become recognizable until school age or  later.
                    Autism is a brain  development disorder characterized by impaired social interaction and  communication, and by restricted and repetitive behavior. These signs all begin  before a child is three years old. Autism involves many parts of the brain; how  this occurs is not well understood. The two other autism spectrum disorders  (ASD) are Asperger syndrome, which lacks delays in cognitive development and  language, and PDD-NOS, diagnosed when full criteria for the other two disorders  are not met.
                    Autism causes kids to  experience the world differently from the way most other kids do. It's hard for  kids with autism to talk with other people and express themselves using words.  Kids who have autism usually keep to themselves and many can't communicate  without special help.
                    They also may react to  what's going on around them in unusual ways. Normal sounds may really bother  someone with autism — so much so that the person covers his or her ears. Being  touched, even in a gentle way, may feel uncomfortable.
                    Kids with autism often  can't make connections that other kids make easily. For example, when someone  smiles, you know the smiling person is happy or being friendly. But a kid with  autism may have trouble connecting that smile with the person's happy feelings.
                    Autism has a strong genetic  basis, although the genetics of autism are complex and it is unclear whether  ASD is explained more by rare mutations, or by rare combinations of common  genetic variants. In rare cases, autism is strongly associated with agents that  cause birth defects. Controversies surround other proposed environmental  causes, such as heavy metals, pesticides or childhood vaccines; the vaccine  hypotheses are biologically implausible and lack convincing scientific  evidence. The prevalence of ASD is about 6 per 1,000 people, with about four  times as many males as females. The number of people known to have autism has  increased dramatically since the 1980s, partly due to changes in diagnostic  practice; the question of whether actual prevalence has increased is unresolved.
                    What is autism?
                    Autism spectrum disorder  (ASD) is a range of complex neurodevelopment disorders, characterized by social  impairments, communication difficulties, and restricted, repetitive, and  stereotyped patterns of behavior.  Autistic  disorder, sometimes called autism or classical ASD, is the most severe form of  ASD, while other conditions along the spectrum include a milder form known as  Asperger syndrome, the rare condition called Rett syndrome, and childhood  disintegrative disorder and pervasive developmental disorder not otherwise  specified (usually referred to as PDD-NOS).   Although ASD varies significantly in character and severity, it occurs  in all ethnic and socioeconomic groups and affects every age group.  Experts estimate that three to six children  out of every 1,000 will have ASD.  Males  are four times more likely to have ASD than females.
                    ADHD - Attention-deficit hyperactivity disorder
                    Attention-deficit  hyperactivity disorder (ADHD or AD/HD) is a neurobehaviora developmental  disorder. ADHD is primarily characterized by "the co-existence of  attentional problems and hyperactivity, with each behavior occurring  infrequently alone." While signs may appear to be innocent and merely  annoying nuisances to observers, "if left untreated, the persistent and  pervasive effects of ADHD signs can insidiously and severely interfere with  one's ability to get the most out of education, fulfill one's potential in the  workplace, establish and maintain interpersonal relationships, and maintain a  generally positive sense of self.


Attention deficit  hyperactivity disorder (ADHD) is one of the most common childhood disorders and  can continue through adolescence and adulthood. Symptoms include difficulty  staying focused and paying attention, difficulty controlling behavior, and  hyperactivity (over-activity).
                    ADHD has three subtypes:
                    Predominantly  hyperactive-impulsive
                    Most symptoms (six or more)  are in the hyperactivity-impulsivity categories.                    Fewer than six symptoms of  inattention are present, although inattention may still be present to some  degree.
                    Predominantly inattentive
                    The majority of symptoms  (six or more) are in the inattention category and fewer than six symptoms of  hyperactivity-impulsivity are present, although hyperactivity-impulsivity may  still be present to some degree.
                    Children with this subtype  are less likely to act out or have difficulties getting along with other  children. They may sit quietly, but they are not paying attention to what they  are doing. Therefore, the child may be overlooked, and parents and teachers may  not notice that he or she has ADHD.
                    Combined  hyperactive-impulsive and inattentive
                    Six or more symptoms of  inattention and six or more symptoms of hyperactivity-impulsivity are present.
                    Most children have the  combined type of ADHD.
                    Treatments can relieve many  of the disorder's symptoms, but there is no cure. With treatment, most people  with ADHD can be successful in school and lead productive lives. Researchers  are developing more effective treatments and interventions, and using new tools  such as brain imaging, to better understand ADHD and to find more effective  ways to treat and prevent it.
                    Cerebral Palsy
                    The term cerebral palsy  refers to any one of a number of neurological disorders that appear in infancy  or early childhood and permanently affect body movement and muscle coordination  but don’t worsen over time. Even though cerebral palsy affects muscle movement,  it isn’t caused by problems in the muscles or nerves.  It is caused by abnormalities in parts of the  brain that control muscle movements.  The  majority of children with cerebral palsy are born with it, although it may not  be detected until months or years later. The early signs of cerebral palsy  usually appear before a child reaches 3 years of age.  The most common are a lack of muscle  coordination when performing voluntary movements (ataxia); stiff or tight  muscles and exaggerated reflexes (spasticity); walking with one foot or leg  dragging; walking on the toes, a crouched gait, or a “scissored” gait; and  muscle tone that is either too stiff or too floppy.  A small number of children have cerebral  palsy as the result of brain damage in the first few months or years of life,  brain infections such as bacterial meningitis or viral encephalitis, or head  injury from a motor vehicle accident, a fall, or child abuse.
                    We do not know the cause of  most cases of cerebral palsy. That is, we are unable to determine what caused  cerebral palsy in most children who have congenital CP. We do know that the  child who is at highest risk for developing CP is the premature, very small  baby who does not cry in the first five minutes after delivery, who needs to be  on a ventilator for over four weeks, and who has bleeding in his brain. Babies  who have congenital malformations in systems such as the heart, kidneys, or  spine are also more likely to develop CP, probably because they also have  malformations in the brain. Seizures in a newborn also increase the risk of CP.  There is no combination of factors which always results in an abnormally  functioning individual. That is, even the small premature infant has a better  than 90 percent chance of not having cerebral palsy. There are a surprising  number of babies who have very stormy courses in the newborn period and go on  to do very well. In contrast, some infants who have rather benign beginnings  are eventually found to have severe mental retardation or learning  disabilities.
                    Cleft lip and palate
                    If the cleft does not  affect the palate structure of the mouth it is referred to as cleft lip. Cleft  lip is formed in the top of the lip as either a small gap or an indentation in  the lip (partial or incomplete cleft) or it continues into the nose (complete  cleft). Lip cleft can occur as a one sided (unilateral) or two sided (bilateral).  It is due to the failure of fusion of the maxillary and medial nasal processes  (formation of the primary palate). A mild form of a cleft lip is a microform  cleft. A microform cleft can appear as small as a little dent in the red part  of the lip or look like a scar from the lip up to the nostril. In some cases  muscle tissue in the lip underneath the scar is affected and might require  reconstructive surgery. It is advised to have newborn infants with a microform  cleft checked with a craniofacial team as soon as possible to determine the  severity of the cleft.
                    Stuttering is a speech  disorder in which sounds, syllables, or words are repeated or prolonged,  disrupting the normal flow of speech. These speech disruptions may be  accompanied by struggling behaviors, such as rapid eye blinks or tremors of the  lips. Stuttering can make it difficult to communicate with other people, which  often affects a person’s quality of life.
                    Symptoms of stuttering can  vary significantly throughout a person’s day. In general, speaking before a  group or talking on the telephone may make a person’s stuttering more severe,  while singing, reading, or speaking in unison may temporarily reduce  stuttering.
                    Stuttering is sometimes  referred to as stammering and by a broader term, disfluent speech.
                    Stuttering (alalia  syllabaris), also known as stammering (alalia literalis or anarthria  literalis), is a speech disorder in which the flow of speech is disrupted by  involuntary repetitions and prolongations of sounds, syllables, words or  phrases, and involuntary silent pauses or blocks in which the stutterer is  unable to produce sounds. 'Verbal non-fluency' is the accepted[citation needed]  umbrella term for such speech impediments. The term stuttering is most commonly  associated with involuntary sound repetition, but it also encompasses the  abnormal hesitation or pausing before speech, referred to by stutterers as  blocks, and the prolongation of certain sounds, usually vowels and semi-vowels.  The term "stuttering", as popularly used, covers a wide spectrum of  severity: it may encompass individuals with barely perceptible impediments, for  whom the disorder is largely cosmetic, as well as others with extremely severe  symptoms, for whom the problem can effectively prevent most oral communication.  The impact of stuttering on a person's functioning and emotional state can be  severe. Much of this goes unnoticed by the listener, and may include fears of  having to enunciate specific vowels or consonants, fears of being caught  stuttering in social situations, self-imposed isolation, anxiety, stress,  shame, or a feeling of "loss of control" during speech. Stuttering is  sometimes popularly associated with anxiety or low intelligence, but there is  actually no such correlation (though as mentioned social anxiety may actually  result in individuals as a result of their stuttering). Despite popular  perceptions to the contrary, stuttering does not affect and has no bearing  on intelligence.
                    Disorders of the quality of  speech characterized by the substitution, omission, distortion, and addition of  phonemes.
                    Mispronunciation or  pronunciation error, technically known as misarticulation, is a common speech  problem. A Speech Language Pathologist can teach her to produce the /ra/ sound,  by conducting the necessary evaluations before starting therapy.
                    Aphasia is a disorder that  results from damage to portions of the brain that are responsible for language.  For most people, these are areas on the left side (hemisphere) of the brain.  Aphasia usually occurs suddenly, often as the result of a stroke or head  injury, but it may also develop slowly, as in the case of a brain tumor, an  infection, or dementia. The disorder impairs the expression and understanding  of language as well as reading and writing. Aphasia may co-occur with speech  disorders such as dysarthria or apraxia of speech, which also result from brain  damage.
                    Aphasia is a disorder  caused by damage to the parts of the brain that control language. It can make  it hard for you to read, write and say what you mean to say. It is most common  in adults who have had a stroke. Brain tumors, infections, injuries and  dementia can also cause it. The type of problem you have and how bad it is  depends on which part of your brain is damaged and how much damage there is.
                    There are four main types:
                    Expressive aphasia :                     you  know what you want to say, but you have trouble saying or writing what you mean
                                       Receptive aphasia :                    you  hear the voice or see the print, but you can't make sense of the words
                    Anomic aphasia :                    you have  trouble using the correct word for objects, places or events
                    Global aphasia :                    you can't  speak, understand speech, read or write.
                    Some people recover from  aphasia without treatment. Most, however, need language therapy as soon as  possible.
                    Dysarthria is a speech  disorder that is due to a weakness or incoordination of the speech muscles.  Speech is slow, weak, imprecise or uncoordinated. It can affect both children  and adults. "Childhood dysarthria" can be congenital or acquired. It  is often a symptom of a disease, such as cerebral palsy, Duchenne muscular  dystrophy, myotonic dystrophy, Bell palsy. In both adults and children, it can result  from head injury.
                    In adults, dysarthria is  can be caused by stroke, degenerative disease (Parkinson's, Huntington's,  amyotrophic lateral sclerosis, multiple sclerosis, myasthenia gravis),  infections (meningitis), brain tumours, and toxins (drug or alcohol abuse, lead  poisoning, carbon monoxide, etc.).
                    In order for speech to be  clear, a number of subsystems must work together. A weakness in any one of the  systems can result in dysarthria. So can an incoordination between systems. The  lungs (respiratory subsystem) supply the air necessary to power the speech  system. The voice box or larynx (laryngeal) sets the air vibrating and creates  voice. The soft palate (velopharyngeal) acts a door between the oral and nasal  cavities and channels air to one or both cavities resulting in different sound  quality. The lips, tongue, teeth, and jaw (articulatory) move to further  channel and shape the sounds into the various vowels and consonants.
                    Dysarthria is a motor  speech disorder resulting from neurological injury, characterised by poor  articulation (cf. aphasia: a disorder of the content of speech). Any of the  speech subsystems (respiration, phonation, resonance, prosody, articulation and  movements of jaw and tongue) can be affected.
                    Dysarthric speech is due to  some disorder in the nervous system, which in turn hinders control over, for example,  the tongue, throat, lips or lungs. Swallowing problems (dysphagia) are often  present.



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