Ear infections

An ear infection (Otitis media) is an infection of the middle ear.

Human ear contains three parts, that is outer, middle and inner ear. Middle ear is a small cavity between tympanic membrane and the opening of the inner ear portions. This cavity is prone for infection. Infection can be a bacteria or a virus. 

These infections can have 2 types,

1) Acute 

2) Chronic

When the infection is not treated it can lead to chronic otitis media.

Mostly otitis media (ear infection) can be seen in children because still their structures are growing and are exposed to recurrent cold.

The main reason for otitis media is because the block of connection between middle ear and throat (Eustachian tube). It’s function is to drain those middle ear fluids and ventilate the middle ear.

In children eustachian tubes narrow and flatten so it has more chances to get infected due to the developmental process.

Sometimes otitis media can occur with fluids (otitis media with effusion) without a infection. When the fluids are inside the middle ear cavity, it will perpetrate the tympanic membrane and come out to ear canal.

A proper antibiotic can prevent the bacterial infection which causes the otitis media.

If it’s not treated it will lead to difficulty in hearing for both adults and children due to the fluids. When it comes to children below two years, it can affect the speech and language learning process of the child due to hearing difficulty .

If you or your child is having above signs, it is better to consult a ENT doctor, they will help if any surgery should be done to remove the fluids, an Audiologist will help to find out the hearing level and comment on middle ear conditions whilst a Speech language pathologist will help to find out the language development of the child.

Simple & Effective Speech activities that every mother should do

Strategies for Indirectly Stimulating Language

Most of the children speak their first meaningful word at the age of 1-1.4 years of age. child's 1st word will be a happy news for all the parents but in some kids utterance of the first word will be delayed, In that case we need to consult a Speech pathologist for more guidance. 

Today I will teach you very basic but more powerful therapy techniques that every parent can try at home while they take  speech therapy from a speech language pathologist. Don't forget that as a parent you will be spending more time with your child than the speech therapist, so use that time effectively at home.

  

Things that you need to keep in mind: it is a child-centered strategies so,

• Do not pressure the child to provide a response 
• Parents have to use simple, short phrases to describe each action/object while interacting with the child

Now you may think what is so special in this method.Yes it is so special, when you are keep speaking to the child, those information will get stored in child's brain.What we have to do as parents is, we have to keep producing  that information (introducing new words). If you are thinking your child's not listening to what you are speaking, you are wrong; your child is always smart, keep that in mind.

As parents,you must have some patience and keep talking/stimulating your child. It is a 100% sure strategy to be used . Now let’s check out the techniques

     1) Self talk

This method is  best used with children of age 1-2 years

Parents/Care-taker have to talk about their own actions as it occurs while the child is listening/watching. It's exactly like a commentary.

Eg: In the kitchen when the mother is cooking she can say " i wash vegetables then cut it and put into pan finally i on the stove 

Likewise parents can use any situation such as bathing,playing...etc.always while keeping in mind that the child doesn't need to engage in a conversation. Adult have to keep talking and give more input.

   2) Parallel talk

Parallel talk is a way of putting speech into action without requiring the child to say anything. This method describes actions 

Talk about every other thing or maybe comment every 10 times or so not every time. Emphasize comment by repeating it by varying the voice. Common prepositions could be emphasized in repetition. Partners have to use simple sentences to make them understandable to the child.Don't worry about the grammar for the time being.

  3) Expansion

Parents have to focus on what the child says and then they need to expand in to a sentence.

Eg: Child says "Mommy Dog"

       Mother says " Yes there is a Dog"

In this method parents need to work on grammar as well.

  4) Extension 

In this method we  expand and add more information about the related topic.

Eg: Child says :"Mommy Dog"

       Mother says : "Yes there is a Big Dog "

With these activities we try to work on the child's vocabulary and try to increase the neural connection in the brain 

Above  techniques will work  for your child if your child have delay speech or not. This method can be used with any child.Parents need be alert and spend more time your child during the age of 1 year to 4 years because that is the Critical time duration which the speech and language development takes place.

Importance of newborn hearing screening for your child

                                                 

                               Most babies are born with normal hearing and experience the beauty of the sound from the beginning. But unfortunately there are babies born  with hearing losses. Those babies can't hear their parents voice, singing or reading to them which delays  the speech and language learning, New born hearing screening identifies babies at risk for hearing  loss so they can be evaluated and treated early.

      What is hearing screening?

                                    Hearing "Screening" is not the same as diagnosis. The main purpose of hearing screening is to separate among apparently healthy individuals from those who are great risk for hearing loss and to refer them for diagnostic testing and guidance. Screening tests divides the populations as “pass group” and “refer group”

Persons with positive(refer) or suspicious findings must be referred to their physicians for diagnosis and necessary treatment.

 The audiological screening may cover different aspects such as,

•         impairment

•         hearing disability

•         middle ear disorders

•         Oto-neurological disorders.

The purpose of this write up is to focus on screening impairment for different age groups and accordingly we can classify as

•         Neonatal screening 

•         School screening

•         Industrial screening

•         Others like monitoring in special occasions (epidemic or mass poisoning)

Today we mainly talk about neonatal (less than 4 weeks old) screening, because that is the time duration that we can find out a hearing impairment at the earliest. Usually hearing impairment is a not a visible disability, as normal children may not begin talking until 1.5 to 2 years of age so a new born hearing play a major role in diagnosing a persons with hearing loss.

           Universal Newborn Hearing screening (UNHS)

       In 1994, The National institute of health Consensus Development Conference on early identification of  Hearing impairment in infants and in children recommended UNHS. 

       The joint committee on infant hearing(JCIH) issued similar guidelines in 1995 and again in 2000. UNHS is also recommended by the American of Pediatrics, by the centers for disease control and prevention and in healthy people, 2010.

           UNHS is now performed worldwide compulsorily on all new born because of the significant harm of unidentified permanent congenital hearing loss. These hearing screening programs have shown benefits for newborns and JCIH has renewed up-to-date guidelines for hearing screening which have yielded successful results.

However children with risk factors should be screened not only at birth but also through childhood. The JCIH recommends continued surveillance of these children because they may be at risk of progressive hearing loss. 

This recommendation includes audiologic testing every six months until 3 yrs of age. In Low-risk children, a repeat hearing screening is recommended before entry into the kindergarten.

 The joint committee on infant hearing(JCIH) Guidelines 

This  included a list of risk indicators for two groups of age. Firstly, birth through 28 days which consisted of 5 risk indicators. And secondly, 29 days through 2 yrs which includes 10 risk indicators.

1) Birth through 28 days

•         Illness or condition requiring admission of 48 hrs of more in NICU.

•         Stigma or other associated findings assiociated with hearing losss.

•         Family history of permanent hearing loss

•         Craniofacial anomalies, including pinna and ear canal.

2) 29 days through 2 yrs

•         Parental or caregiver concern regarding speech, language and hearing or developmental delay.

•         Stigma or other associated findings associated with hearing loss.

•         Family history of permanent childhood hearing loss.

•         Postnatal infections associated with sensorineural hearing loss .

•         In Utero Infections.

•         Neonatal indicators: Hyperbilirubinemia requiring exchange transfusion, persistent pulmonary hypertension associated with mechanical ventilation

•         Syndromes associated with progressive hearing loss

•         Neurodegenerative or sensory motor neuropathies

•         Head trauma

•         Recent or persistent otitis media with effusion for 3 months or more.

        Test to administer?

• Otoacoustic emissions (OAE)
• Automated auditory brainstem response (aABR)

        Tips for parents

• Ask your Doctor/Audiologist for New born screening  test. it is available in most of the hospital  
• When the screening says "Refer" make sure to meet your audiologist after 3 months of duration.
• Parents should not be afraid of the results "Refer" it can be due to amniotic fluid in the ear also,to clear cut it to the screening test again after 3.
• Earlier the diagnosis, Earlier the management.

       So don't lose hope! 

It's nothing to be ashamed of to have a stutter

Introduction

Stuttering (Stammering) is a speech fluency disorder in which the normal flow of speech is frequently disrupted by the repetitions, pauses and prolongations that differ both in frequency and severity from normally fluent individuals.The emotional state of the individual that stutters in response to the stuttering often constitutes the most difficult aspect of the disorder.,

In other words the person knows what he or she wants to say, but has to strain to say it. People with significant speech difficulty often don’t stutter when singing, talking to animals,reading to small children or when they are alone talking to themselves. (VANRIPER 1982).

Speech fluency consists of three variables:

1. Continuity : Refers to speech that flows without hesitation or stoppage                                                
2. Rate: The speed in which the words are spoken. English-speaking adults, the mean overall speaking rate is 170 words per minute (w/m), substantially quicker than the approximately 120 w/m that stutterers produce.                                                                                                                           
3. Ease of speaking : Amount of effort being expended to produce speech. Fluent speakers put very little muscular or physical effort into the act of speaking, while stutterers exert a relatively large amount of muscular effort to produce the same speech.

Characteristic of stuttering

l   Repetitions of sound, syllable, phrase & word (Beginning of word)

Examples of repetition for a phrase would be 

"I want.. I want.. to go.. I want to go to the store,"

"I want to go to the - I want to go to the store."

 A word repetition would often resemble,

 "I want to-to-to go to the store,"

 Syllable or sound repetition being, 

"I wa-wa-want to go to the store," or, "I w-w-want to g-go to the store."

l  Sound prolongations.

             Example : “Aaaaaaask her if I can come."
                               "Pu-------put it back!"
                               "Is that y------yours?"
                               "Mmmm-me too."

l  Interjections.

      Examples : Ahh!,Ah!

l  Broken words.

l  Blocking that is audible or silent.

l  Circumlocutions (substitutions to avoid words hard to pronounce).

l  Words spoken with excessive physical tension.

l  Physical concomitants

         Distracting sounds:Noisy breathing,whistling,clicking sound, blowing..

         Facial grimaces : lip pressing, jaw jerking, jaw muscle tense 

         Head movement : Back , forward, poor eye contact

         Movement of the extremities : face movement,swinging, leg ,torso movement

How to diagnose?

Diagnosing stuttering requires the skill of qualified Speech language pathologist (SLP) because Identifying a person with stuttering is determined  by the type of disfluencies he or she have.

During an evaluation, a SLP will use different tests to identify the number and types of disfluencies a person produce in different situations

For young children it’s very important to consult a SLP to diagnose stuttering, an inappropriate diagnosis may leads to have a stuttering which is not actually present. So it is always recommended to have a SLP consulation before diagnose  by your own as a parent .

Treatment

Treatment is based on the symptoms that the patient exhibits. A SLP teach people who stutter to control/monitor the rate at which they speak, so a person with stuttering can use techniques such as

·         Reduced the rate of speech (speak in slow manner)

·         Relaxation techniques (Breathing exercises )

·         Delay auditory feed back

NOTE: For stuttering there is no medicine or pills. It’s mainly a behavioral change that needs to be done by the speech language pathologist  

Celebrities who stutter

 Ed sheeran                        Elvis Presley                                  Marc Anthony

 

                               

       Bruce Willis                  Bhathiya Jayakody                                 Hirithik Roshan               

    Winston Churchhill                             King Deorge VI                                 Tiger woods                           

                                           

Sign this online petition to ensure people with stuttering are portrayed with sensitivity in Indian cinema

 Click here to sign the petition

Dizziness or Vertigo

Vertigo/Dizziness is the sensation of spinning ,swaying.That is the feeling of you or your environment moving.Also you may feel loss of balance.

Vertigo can be experienced mostly during morning and night,specially when you getup from the bed while turning your head,due to change in the vestibular system.

Vestibular system is mainly responsible for balancing our body.When we shift our head form one position to another usually the particles in the vestibular system also move,and it will stimulate our brain regarding our body/head position.

When there is an issue with those particles in the vestibular system,you may experience dizziness or vertigo. 

Vertigo is a symptom rather than a medical condition. Other symptoms that can accompany vertigo includes: 

• Hearing loss
• Tinnitus (Ringing sensation in the ear), 
• Nausea, vomiting 
• Feeling of fullness in the ear
• Loss of balance 

This rotational dizziness have two main causes: disturbance in either,

•       The balance organs of the inner ear (Peripheral vertigo)
•        Parts of the brain or sensory nerve pathways (Central vertigo).

PERIPHERAL VERTIGO

The inner ear causes include 

1) Labyrinthitis - This is the inflammation of the inner ear labyrinth; a structure that contains the organs of the senses of hearing and equilibrium.

  2) Vestibular Neuronitis - An infection of the vestibular nerve in the inner ear which causes the vestibular nerve to be inflamed, disrupting the sense of balance.

3) Meniere’s disease - Vertigo caused due to the high pressure of a fluid in a compartment of the inner    ear.

      4)  B.P.P.V - Benign paroxysmal positional vertigo occurs when micro-sized calcium crystals on the       utricle of the inner ear gets displaced which creates a false signal to the brain causing vertigo.

CENTRAL VERTIGO

It involves the central nervous system due to a disturbance in one of the following areas

1.      Parts of the brain (brainstem or cerebellum) that deals with the interaction between the senses of vision and balance.

2.      Sensory messages to and from the thalamus (part of the brain).

TREATMENT

Epley Maneuver

If your vertigo comes from your left ear and side:

1.      Sit on the edge of your bed. Turn your head 45 degrees to the left (not as far as your left shoulder). Place a pillow under you so when you lie down, it rests between your shoulders rather than under your head.

2.      Quickly lie down on your back, with your head on the bed (still at the 45-degree angle). The pillow should be under your shoulders. Wait 30 seconds (for any vertigo to stop).

3.      Turn your head halfway (90 degrees) to the right without raising it. Wait 30 seconds.

4.      Turn your head and body on its side to the right, so you're looking at the floor. Wait 30 seconds.

5.      Slowly sit up, but remain on the bed a few minutes.

If the vertigo comes from your right ear, reverse these instructions. Sit on your bed, turn your head 45 degrees to the right, and so on.

Do these movements three times before going to bed each night, until you've gone 24 hours without dizziness.

Semont Maneuver

For dizziness from the left ear and side:

1. Sit on the edge of your bed. Turn your head 45 degrees to the right.
2. Quickly lie down on your left side. Stay there for 30 seconds.
3.  Quickly move to lie down on the opposite end of your bed. Don't change the direction of your head. 
4. Keep it at a 45-degree angle and lie for 30 seconds. Look at the floor.
5.   Return slowly to sitting and wait a few minutes.
6. Reverse these moves for the right ear. 
7. Again, do these moves three times a day until you go 24 hours without vertigo.

Half-Somersault or Foster Maneuver

Some people find this maneuver easier to do:

1. Kneel down and look up at the ceiling for a few seconds.
2. Touch the floor with your head, tucking your chin so your head goes toward your knees. Wait for any vertigo to stop (about 30 seconds).
3. Turn your head in the direction of your affected ear (i.e. if you feel dizzy on your left side, turn to face your left elbow). Wait 30 seconds.
4. Quickly raise your head so it's level with your back while you're on all fours. Keep your head at that 45-degree angle. Wait 30 seconds.
5. Quickly raise your head so it's fully upright, but keep your head turned to the shoulder of the side you're working on. Then slowly stand up.

You may have to repeat this a few times for relief. After the first round, rest 15 minutes before trying a second time.

Brandt-Daroff Exercise

Here’s what you need to do for this exercise:

1. Start in an upright, seated position on your bed.
2. Tilt your head around a 45-degree angle away from the side causing your vertigo. Move into the lying position on one side with your nose pointed up.
3. Stay in this position for about 30 seconds or until the vertigo eases off, whichever is longer. Then move back to the seated position.
4. Repeat on the other side.

You should do these movements from three to five times in a session. You should have three sessions a day for up to 2 weeks, or until the vertigo is gone for 2 days.

Note:

• Reduce your salt intake
• For the rest of the day after doing any of these exercises, try not to tilt your head too far up or down. 
• If you don't feel better after a week of trying these moves, talk to your doctor/audiologist again, and ask him/her what he/she wants you to do next.
• You might not be doing the exercises right, or something else might be the cause of your dizziness.

                                                           Special thanks to 

                                                                Rhiya Grace

                                        ( Speech Language pathologist and Audiologist )

Puberphonia (Mutational falsetto)

Isn't it an interesting question to probe why some boy's end up having girls voices?Have you ever met some one like that? 

It is one of the most intriguing yet a highly confusing voice disorder which takes place during adolescence that many of you might not be aware of it.It happens as a consequence of boys larynx not achieving the expected adult dimensions during puberty.A patient with puberphonia will have their pre-pubertal voice after adolescences.

During puberty,vocal fold length and mass will increase and pitch decrease but few of them are unable to switch to the new low pitch,Therefore,we call this  condition as puberphonia

Voice characteristic

1. High pitch 
2. Breathy
3. Hoarse

It is mostly seen in boys.Usually males have a low pitch females have a high pitch.However,in this case males will have a high pitch which is similar to a female voice.

This can we vise-versa but it won't effect much in females because they have high pitch in nature.

The Social consequences for males who exhibits Puberphonia are many.

• Often though of as being effeminate,passive and immature and frequently endure much teasing from friends,schoolmates,co-workers...  

• Sexual confusing over the phone (Caller may mistakenly identify person with puberphonia as his mother or sister)

• Distress at the failure to develop a mature voice because of the social consequences 

How to over come Puberphonia??? 

worry not,In most of the cases Puberphonia can be easily treated by voice therapy given by a professional speech language pathologist.