Pediatric audiology deals with childhood hearing, voice, swallowing, and speech disorders, as well as disorders of speech development. Together with phoniatrics, pediatric audiology forms an independent specialty that was managed as a sub-specialty of otolaryngology (ENT) until 1993. Pediatric audiology, like phoniatrics, has a strong interdisciplinary character because the problems that arise are often not of purely organic origin, but pediatric audiology independently provides diagnoses and therapies across disciplines.
What is pediatric audiology?
Pediatric audiology deals with childhood hearing, voice, swallowing and speech disorders as well as disorders in speech development. Central topics in diagnostics and therapy in pediatric audiology are voice, speech and language development disorders in children, as well as hearing and perception disorders. Swallowing disorders in children also fall within the treatment and diagnostic spectrum of pediatric audiology, because the topics are often causally related. In its diagnostic and therapeutic procedures, pediatric audiology frequently pursues interdisciplinary, holistic approaches beyond the examination and treatment of organic abnormalities. Thus, there are interlockings with the medical specialties ENT, orthodontics, neurology and psychiatry and with non-medical specialties such as psychology, speech therapy, phonetics, pediatrics and many others. Together with phoniatrics, pediatric audiology forms an independent specialty area. The original title was Specialist in Phoniatrics and Pediatric Audiology. As of January 2004, the new title is Specialist in Speech, Voice and Childhood Hearing Disorders. The additional specialist training lasts a total of 5 years and includes specialized further training in child development disorders with regard to hearing, voice, speech, language and swallowing. The interdisciplinary character of this medical specialty was first picked up by Hermann Gutzmann Sr. in his habilitation thesis in 1905. Pediatric audiology in particular received a further boost in 2009 with the introduction of newborn hearing screening. Babies who show abnormalities in hearing screening are referred to pediatric audiology for further treatment.
Treatments and therapies
One of the main concerns of pediatric audiology is to identify causes of child developmental disorders in the area of auditory perception and in voice and speech development in order to apply targeted therapies in a mostly holistic and interdisciplinary approach. The subject area also includes the swallowing act, which is closely linked to voice and speech development and therefore falls within the diagnostic and treatment spectrum of pediatric audiology. Since January 2009, audiometric newborn screening has been performed as a standard procedure to detect congenital, i.e. primarily genetic, hearing disorders so that they can be detected and treated at an early stage. Only methods that allow objective measurement are considered for hearing screening. Hearing disorders can have many causes; the overall spectrum of hearing disorders ranges from obstruction of the external auditory canal by earwax droplets or foreign bodies, to sound conduction problems in the middle ear, to sound perception disorders. While sound conduction problems can usually be traced back to organic-physical reasons, sound perception disorders are problems with the conversion of sound waves into electrical nerve impulses in the cochlea in the inner ear or functional impairments of the auditory nerve (vestibulocochlear nerve) due to lesions or disease or problems in the brain with the further processing of the nervous auditory impulses. Observed abnormalities in childhood speech development may be due to decreased hearing, but are often due to other causes such as voice disorders, which may also be organic in origin, or speech and language fluency disorders such as stuttering, articulation disorders (dyslalia), or a variety of acquired or inherited voice disorders. An example of an absolutely necessary interdisciplinary approach with regard to diagnostics and therapy is selective or total mutism, the partial or complete loss of speech after complete learning of the language although no direct organic causes for the no longer speaking are recognizable.Functional or neurogenic dysphagia or dysphagia following certain surgical procedures also frequently interact with voice and speech formation.
Diagnosis and examination methods
The spectrum of possible developmental disorders that result from acquired or inherited organic abnormalities or from interdisciplinary problems with the processing of sensory impressions and the development of speech is very broad and varied. Equally diverse is the corresponding range of diagnostic procedures, which can be used as a basis for developing efficient and targeted therapies. In the hearing screening for newborns, which has been provided since January 2009, brainstem audiometry and/or procedures using otoacoustic emissions are predominantly used. In the brain stem evoked response audiometry (BERA) method, mild acoustic stimuli are applied to the newborn’s ear and brain waves are measured via a few lead electrodes. These allow conclusions to be drawn about the function of the auditory nerve and the further processing centers in the brain. The examination, which lasts about 20 minutes, is performed during the baby’s normal sleep and does not disturb the child. The other method – called TEOAE (transitory otoacoustic emissions) – takes advantage of the fact that the outer hair cells in the cochlea respond to sound stimuli like an amplifier with their own sound stimuli, which can be measured. For the examination, a tiny probe containing a loudspeaker and microphone is inserted into the external auditory canal. The loudspeaker is used to generate so-called clicks and the microphone is used to measure the sound waves generated by the outer hair cells a few milliseconds later. Both procedures are largely automated, but have the disadvantage that detected abnormalities are not always due to problems in the further processing of sound stimuli or to problems in the conversion of mechanical sound stimuli into electrical nerve impulses. Positive diagnoses therefore require careful further clarification by additional diagnostic procedures. A variety of objective and subjective audiometric procedures are available to measure hearing disorders in children from about 3 years of age and older. Hearing problems can also arise as side effects of certain antibiotics and diuretics (diuretic drugs). For swallowing disorders, fiberendoscopic examination of the swallow (FEES), which allows the nasal and pharyngeal cavities to be inspected via an optical fiber, has become the accepted diagnostic imaging technique. In some cases, FEES must be supplemented by video-assisted VFS.
