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Year : 2014  |  Volume : 20  |  Issue : 4  |  Page : 166-168

Audiological assessment modalities in children with multiple handicaps and parents' perception

1 Department of Audiology, C U Shah Institute of Audiology and Speech Therapy, Surendranagar, India
2 Department of Audiology, Ali Yavar Jung National Institute For The Hearing Handicapped, Mumbai, Maharashtra, India
3 Department of ENT and Head and Neck Surgery, M P Shah Government Medical College, Jamnagar, Gujarat, India

Date of Web Publication13-Dec-2014

Correspondence Address:
Noorain Alam
C U Shah Institute of Audiology and Speech Therapy, Surendranagar, Gujarat
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0971-7749.146931

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Aim: Children with multiple disabilities have combination of various disabilities. Accurate hearing evaluation is difficult in this population. Audiologists, generally employ a test battery approach, which includes combining findings of parent impression with behavior observation audiometry (BOA) as well as auditory brainstem evoked responses (ABR) findings. This study was carried out to find if there exists a correlation among various steps in the test battery for children with multiple handicaps as well as to find out, which disability is the most common among this population. Methodology: A total of 103 numbers of children with multiple handicaps were chosen at random who were referred to C U Shah Institute of Audiology and Speech Therapy for audiological assessment. The three steps involved in assessment that is parental impression, BOA and ABR findings were taken into account. The relationship was obtained using data analysis. Results: It was found that among children with multiple handicaps referred for audiological assessment, mental retardation was the most common (32.03%). Furthermore, it was found that there were more contradictory findings between parent impression and ABR (48%) when compared with parent impression with BOA (38%). In between BOA and ABR contradictory findings were found in 41% of cases. Conclusion: There are wide contradictions among various steps involved in assessment of children with multiple handicaps. Implication: Audiologist should use a test battery approach to assess hearing ability of this population and audiologists should interpret findings carefully at each level.

Keywords: Audiological assessment, Auditory brainstem response, Behavior observation audiometry, Multiple handicaps

How to cite this article:
Alam N, Ansari S, Gurnani D, Sinha V, Sharma PK, Jindal S. Audiological assessment modalities in children with multiple handicaps and parents' perception. Indian J Otol 2014;20:166-8

How to cite this URL:
Alam N, Ansari S, Gurnani D, Sinha V, Sharma PK, Jindal S. Audiological assessment modalities in children with multiple handicaps and parents' perception. Indian J Otol [serial online] 2014 [cited 2022 Oct 6];20:166-8. Available from: https://www.indianjotol.org/text.asp?2014/20/4/166/146931

  Introduction Top

Children with multiple disabilities have a combination of various disabilities that may include: speech, physical mobility, learning, mental retardation (MR), visual, hearing, brain injury, and possibly others. Along with multiple disabilities, they can also exhibit sensory losses and behavior and or social problems. Children with multiple disabilities - also referred to as multiple exceptionalities vary in severity and characteristics.

The judgment by the clinician makes on children's hearing abilities often necessarily involve a differential evaluation. Accurate hearing evaluations are difficult in children with multiple disabilities.

Approximately 25-33% of children with hearing loss have multiple potentially disabling conditions (Holden-Pitt and Diaz, 1998 [1] ; McCracken, 1994 [2] ; Moeller et al., 1990 [3] ). This population requires modifications of diagnostic protocols as they are considered as difficult to test population.

Different steps involved in assessing the multiple handicapped children can be summarized as:

  • Parental impression about the auditory status of the child
  • Behavior observation audiometry (BOA)/visual reinforcement audiometry (VRA)
  • Brain-stem evoked response audiometry.

To come to a proper diagnosis the audiologist needs to correlate all the information obtained from each modality of tests given above.

As parents observe children closely and are able to judge hearing status formally hence, their impression about the hearing is important. However, with children with multiple handicaps they may relate lack of response to auditory stimuli to hearing loss, which may be actually due to associated handicap.

A skilled audiologist will decide the hearing status on BOA/VRA based on subjective response of the client and this test shows poor test-retest reliability, and high inter- and intra-subject variability (Bench et al, 1976 [4] ; Weber 1969 [5] ; Wilson and Thompson, 1984 [6] ).

In ABR, under good recording conditions, visual detection levels of wave V are usually within 10 dB of behavioral audiometric thresholds for click stimuli. Sometimes due to neuromaturational delay abnormal ABR recordings may be obtained.

Whole test battery, thus may show poor correlation among the different test modalities.

A study was conducted by Kitagawa et al., 2003, [7] demonstrated coincidence between a secular change in auditory brainstem evoked responses (ABRs) and the conditioned orientation reflex (COR) audiometry in 229 multiply handicapped children with motor disorders. Improvement in behavioral hearing testing minimum response level, including mental and physical development, was observed in 111 cases. There were 92 cases of ABR, and in 37 of them there was no correlation between the ABR and COR findings. The initial diagnosis in 44 patients was moderate to severe hearing loss, and a secular change was observed in 37 of them. The ABR thresholds and the COR minimum reaction level decreased in 11 patients, whereas in 17 patients, ABR thresholds remained unchanged and only the COR values decreased. The final diagnosis was moderate to severe hearing loss in 18 patients. The study shows the need of correlating different test modalities repeated over the duration of time.

This study focused on the correlation of findings of different steps involved in the initial hearing assessment of children with multiple handicaps.

Aim of the study

The aim of this study is to provide evidence if three steps of the tests, that is, parent impression, BOA/VRA, and ABR have a similar or contradictory findings.

  Methodology Top

A total of 103 children with multiple handicaps <3 years of age, were selected, who were referred to C U Shah Institute of Audiology and Speech Therapy, Surendranagar for audiological assessment. The findings of all the steps involved in diagnosis of such population mainly parent impression, BOA/VRA, and ABR were correlated. Descriptive data analysis was performed.

  Result and Discussion Top

  1. Findings indicate that among children with multiple handicaps who were referred for audiological assessment, MR is the most common disability (32.03%, when combined with Downs syndrome), while vision, heart and others (Cleft Lip and Palate (CLP) and HERNIA) are the least (1.94% each) [Graph 1].

  2. When parents' impression is correlated with the findings on BOA and ABR we got following results:
    • Parents suspected hearing loss: 56,
    • Parents didn't suspect hearing loss: 47,
    • BOA confirmed hearing loss: 75,
    • BOA rejected hearing loss: 28,
    • ABR confirmed hearing loss: 56,
    • ABR rejected hearing loss: 47.

Findings on different tests showed following pattern:

Behavior observation audiometry versus ABR

Both of these tests have shown similar findings on 61 cases, while they have contradictory findings on 42 (41%) cases out of which on 31 (73%) of cases demonstrated to have no hearing loss on ABR test, while they fail BOA test.

Parent impression versus behavior observation audiometry

Both of these cases have shown similar findings on 64 cases, but have contradictory findings on 39 (38%) of cases out of which in 28 (71.8%) cases parent did not suspect hearing loss in their wards, but BOA test fail them.

Parent impression versus ABR

Both of these cases have shown similar findings on 55 cases, but have contradictory findings on 48 (46.6%) of cases out of which in 24 (50%) cases parent did not suspect hearing loss in their wards, but hearing loss was confirmed in them.

  Conclusion Top

The findings clearly show in multiple handicap population, there is more number of children with MR and various steps involved in audiological assessment of this population show wide contradiction.

  Implication Top

The study point out that in children with multiple handicap need to be assessed thoroughly and the outcome may not be in correlation with each other.

  References Top

Holden-Pitt L, and Diaz JA (1998). Thirty years of the annual survey of deaf and hard of hearing children and youth: A glance over the decades. American Annals of the Deaf, 143:72-6.  Back to cited text no. 1
McCracken W (1994). Deaf children with complex needs: A piece of the puzzle. Journal of the British Association of Teachers of the Deaf, 18:54-60.  Back to cited text no. 2
Moeller MP, Coufal K, and Hixson P (1990). The efficacy of speech-language pathology intervention: Hearing-impaired children. Seminars in Speech and Language, 11:227-40.  Back to cited text no. 3
Bench J, Collyer Y, Mentz L and Wilson I. (1976). Studies in infant behavioral audiometry). Studies in infant behavioral audiometry. I. Neonates Audiology, 15:85-105.  Back to cited text no. 4
Weber BA. (1969). Validation of observer judgments in behavior observation audiometry. Journal of Speech and Hearing Disorders, 34:350-4.  Back to cited text no. 5
Thompson G, Wilson W. (1984). Clinical application of visual reinforcement audiometry. Semin Hear, 5:85-99.  Back to cited text no. 6
Kitagawa K, Go I, Shintani T, Himi T. Assessment of hearing in children with multiple disabilities and motor disorders. Audiol Jpn 2003;46:268-74.  Back to cited text no. 7

This article has been cited by
1 Review of International Studies on Multiple Disabilities
Sakarya University Journal of Education. 2020; : 532
[Pubmed] | [DOI]


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