Down's syndrome children often suffer from various kinds and various degrees of hearing disturbance. Since patients with Down's syndrome are usually affected by intellectual impairment, it is not easy to carry out appropriate otological management. We performed otological management of 15 Down's syndrome children. Eight of the 15 patients were diagnosed as having hearing disturbance. Otological management is indispensable for development of the patient's language. The importance of otological management should be understood by the personnel responsible for the care of Down's syndrome children. Cooperation between the medical doctor and the people who are engaged in education and welfare is also very important.
In infants with no signs of mental retardation,337 hearing tests were performed for 4 months. This report reveals the recommended methods of testing for specific ages. The results showed that BOA (behavioral observation audiometry) was recommended for infants from birth to 12 months of age, COR (conditioned orientation response audiometry) for infants aged 6 months to 2 years, Peep show testing without headphones for infants aged 3 to 4 years and with headphones for infants aged 4 and a half to 6 and a half years, and air-bone conduction testing for infants aged 6 years. In the case of some infants with severe to profound hearing loss, the results differed from those of normal to mild hearing-impaired infants. A hearing test at any age can help to detect hearing loss. The earlier hearing loss is detected, the sooner a child may be assisted.
A considerable number of prelingually-deafened children with cochlear implants demonstrated discrepancies between their speech perception ability and language development. The difference may be caused partly by the intrapersonal discrepancies among cognitive functions, including visual and auditory cognitive functions. Different clinical outcomes were observed among 3 prelingual deafness cases with cochlear implants and the profiles of their language development and neuropsychological tests were reported here. One case (MW) demonstrated the proper syntactic strategy corresponding to her hearing peers and neuropsychological evaluations revealed that her cognitive functions were well balanced. Two other cases (SN and YH) demonstrated considerable delay in the syntactic strategy for their communication and visual cues were needed to accomplish the interventional goal. It was assumed that the auditory memories of these two cases were affected. Although their medical and educational backgrounds were highly similar, the first outcome and the consequent procedures for intervention were different. Neuropsychological tests can provide crucial information for the optimum interventional approach for implant users.
Additional handicaps with deafness make interventions with cochlear implant difficult and complicated especially among prelingual deafness cases. Attention disorders are well-known risk factors for a poor language prognosis after a cochlear implant. We demonstrated two cases of prelingual deafness patients who showed marked progress in the syntamatic organization of their language skills after short-term intervention although both are combined with ADHD. Visual cues including arrows and texts are first used to focus their attention on the grammatic organization. These visual cues are also effective for better understanding of Japanese Particles (Joshi). These cues are then faded gradually during this interventional period. After 3 months of intervention, both cases can understand and use Japanese Particles even in their voice communication. Management of additional handicaps plays an important role in the intervention for multiply handicapped children with deafness.
Twenty-four children with a cleft palate who were evaluated as veropharyngeally incompetent underwent pharyngeal flap construction because of speech therapy failure. Veropharyngeal competence and general health conditions were assessed more than one year after pharyngeal flap construction in 9 of the 24 children. Their veropharyngeal incompetence had completely healed, and they had no sleep apnea, athough they had exhibited mild snoring postoperatively. Their height and body weight development were not disturbed by pharyngeal flap construction.