Does your child seem to be getting confused when you speak? Let's talk about Auditory Neuropathy Spectrum Disorder (ANSD)!

Is your little one not listening properly when you talk? Or do you feel like he or she is getting confused by what you are saying? Sometimes there may be some differences in the way little ones hear sounds. In such cases, a condition called Auditory Neuropathy Spectrum Disorder, or (ANSD) for short, could be the cause. Don't worry, let's talk about this simply.

What is this (Auditory Neuropathy Spectrum Disorder - ANSD)?

Simply put, our ears are what allow us to hear the sounds around us. Then, they convert those sounds into messages that the brain can understand and send them to the brain. However, sometimes these messages get mixed up when they reach the brain, or they don't get there at all. That's what we call Auditory Neuropathy Spectrum Disorder, or (ANSD).

Here are some things that can happen to children with this condition (ANSD):

• It can be difficult to distinguish one sound from another.
• You may not be able to clearly understand what someone is saying.
• It can feel like you hear a sound and then suddenly lose it .
• It may seem like what you hear one day is not what you hear the next day, which means that what you hear changes .

But there is good news. Even children with this condition (ANSD) can improve their language skills and communicate effectively with others through the use of appropriate medical equipment, treatment, and visual communication techniques (i.e., methods of communicating using visual cues).

Why does this (ANSD) occur? What are the causes?

The main cause of this (ANSD) condition is damage somewhere in the auditory nerve , the part of our inner ear called the cochlea (which collects sound and creates messages) and the brain.

Children like these are slightly more likely to develop (ANSD):

• For babies born before their due date (preterm babies).
• If anyone in the family has had this (ANSD) condition before.
• If severe jaundice develops at birth.
• If there is not enough oxygen before or after birth ((low oxygen)) .
• There are some medications that can damage the sensitive parts inside the ear or the auditory nerve. If the child has received such medications .
• If you have certain genetic conditions or neurological conditions , such as Charcot Marie Tooth disease.
• If you have a serious head injury .

How do you know if you have (ANSD)? What are the symptoms?

These symptoms can start at any age. However, most babies are born with this condition (ANSD). Hearing problems can range from mild to severe . Surprisingly, some babies can hear sounds normally, but have difficulty understanding what is being said clearly.

These babies may pass the newborn hearing screening test, but it is only over time that they gradually realize that they have hearing problems.

Take care of these things in your baby's first year.

See if your baby responds well to these hearing milestones in the first year of life. Otherwise, it's a good idea to talk to a doctor.

• Newborn baby : Does he startle or "throw up" when he suddenly hears a loud noise?
• By about 3 months : Does your baby recognize their mother's or father's voice? Does they turn their head in that direction?
• By about 6 months : Does your baby turn his or her eyes or head in that direction when he or she hears a new sound? Does he or she repeat sounds like "uh" and "ah"?
• By about 12 months (one year) : Does your baby make small, meaningless sounds (babbling sounds)? Does your baby respond when you say his or her name? Does your baby try to imitate words? Does your baby say a few words, such as "mama" and "bye-bye"?

When your child gets a little older, see if they have any of these symptoms.

As your child gets older, they may show symptoms like these if they have a hearing problem:

• Speech is limited, unclear, or not spoken at all .
• Do you feel like you're not being listened to or that you're not following instructions ?
• Does he not respond when spoken to normally, or does he give irrelevant answers ?
• Do you get easily distracted when there is a lot of noise around you?
• Do you want to turn up the volume on the TV a lot ?
• Do you have learning disabilities ?

If you have any doubts about your child about something like this, you should definitely talk to a doctor. That's the best thing to do.

How do you know exactly if you have (ANSD) status?

An audiologist is the only person who can accurately diagnose ANSD. He or she is the one who performs special tests and helps people with hearing problems. There are several main tests that can help diagnose ANSD:

What are these tests?

• Otoacoustic emission (OAE) test : This tests how well the part of the inner ear called the cochlea is working. This is done while the baby is sleeping or sitting still. Small earphones are placed in the ear and a gentle sound, such as a clicking sound, is emitted. Then, the response from the inner ear is measured with small stickers called electrodes.
• Auditory brainstem response (ABR) test : This tests how well and clearly the sound coming from the inner ear travels along the auditory nerve to the brainstem. This test shows if the information is not getting to the brain clearly. Usually, if the (OAE) test is normal, but the (ABR) test shows very little or no response, it is thought that there is a high chance of (ANSD).
• Middle ear muscle reflex (MEMR) test : There is a small muscle inside our ear that automatically tightens when we hear a loud sound. That's why it's called (MEMR). In this test, a small rubber tip is inserted into the ear and a loud sound is sent. A machine is used to see how this muscle responds to the sound. In the case of a child with (ANSD), this reaction does not occur to loud sounds, or it takes a much louder sound than a normal person to get the reaction.

Newborn hearing screening programs can use simple forms of these (OAE) and (ABR) tests. However, to accurately diagnose (ANSD), these tests need to be done in full.

What other tests might be needed?

After being diagnosed with (ANSD), the child may need to undergo several other tests:

• (MRI) test : To see if there is any problem inside the ear and if there are auditory nerves in both ears.
• Genetic testing : To see if this (ANSD) condition is part of a genetic disorder.
• Neurologic testing : Check for other neurological problems.
• Vision testing : Hearing problems and vision problems can often go hand in hand. Therefore, it is very important to see an ophthalmologist if a child with ANSD is diagnosed.

How is the condition (ANSD) treated?

Children with ANSD are treated by a team of specialists . This means that a hearing specialist (audiologist), an ear, nose and throat specialist (ENT doctor), a speech-language therapist (speech-language therapist), and an educational specialist work together to develop the best treatment plan.

Treatment depends on many factors, including the child's age, which part of the auditory nerve is not working properly, and how severe the hearing problem is.

Often, these children benefit greatly from the use of assistive listening devices. Along with these devices, continuing speech-language therapy to improve the child's speaking and listening skills is the best way to achieve results .

What are these helpful devices?

• Frequency modulation (FM) systems : This (FM) system reduces unwanted ambient noise and makes the speaker's (for example, a teacher's) voice heard clearly and loudly. The speaker wears a small microphone and a (transmitter). This (transmitter) sends an electrical signal to a (receiver) that the child wears in their ear or is attached directly to a (hearing aid). This is very useful in classrooms and other noisy places because it can be moved around.
• Hearing aid : This is used to amplify the sound that reaches the ear. Some children with ANSD can benefit from hearing aids, especially when used in conjunction with the FM system mentioned earlier. However, hearing aids alone are not very helpful for children with ANSD , as they only amplify the already muffled sound.
• Cochlear implant : For some children with ANSD, especially those who do not get enough help from hearing aids, a cochlear implant is a good option. This is a device that is surgically implanted in the ear . It bypasses the parts of the ear that are not working properly and directly stimulates the auditory nerve. With good training and ongoing treatment, children with a cochlear implant can learn to hear well and speak clearly.

What else do you want to know?

In addition to using hearing aids, children with ANSD can also learn visual communication skills, which are ways to communicate using what they see with their eyes.

What are these visual communication methods?

• Sign Language : This is a separate language. It has its own grammar, vocabulary, and sentence patterns. It is designed to be used instead of spoken language.
• Cued Speech : This involves the speaker making hand gestures around the mouth. These hand gestures help the listener distinguish between letters that look similar (for example, 'ব' and 'প', or 'ম' and 'ব'). Cued Speech can be used in any language, and is very useful for bilingual families.
• Signing Exact English (SEE) : This is a sign language system that uses the exact same English spoken in the same way, word for word. It also has elements of sign language, but the sentence structure and grammar are borrowed from English.

Cued Speech and SEE both translate what is spoken directly. Both are designed to be used in conjunction with spoken language to help you clearly understand things that lip reading alone cannot.

Parents have a very important role in teaching their children with ANSD to communicate and talk with others. The best results can be achieved by working closely with the medical team.

You can find more information and support on websites like these:

• CDC: Hearing Loss and Your Child (US Centers for Disease Control website)
• Hands and Voices (a network for parents and professionals)

The most important things you need to remember (Take-Home Message)

Okay, so let's remind you of some of the things we've talked about.

• Auditory Neuropathy Spectrum Disorder (ANSD) is a condition in which the sound messages from the ear to the brain are disrupted or do not travel properly.
• It's important to recognize this early . If you suspect that your child has any changes or delays in their hearing, see a doctor immediately.
• This condition can only be accurately diagnosed through special tests such as (OAE) and (ABR).
• Don't worry, devices like (FM) systems, (hearing aids), (cochlear implants), speech therapy, and visual communication methods can improve your child's speaking ability .
• As parents, your interest, dedication, and working together with the medical team are the greatest strength for your child .

Remember, every child is different, so it's important to find the treatment and support that's right for your child.

Auditory Neurological Disorders, ANSD, Hearing Problems, Child Health, Hearing Tests, Cochlear Implants, Speech Therapy