Class 12 Bio Project 182

Biology Investigatory Project
Study Of Causes Of Hearing Loss In Children
Vikram Amar
XII B
Sindhi High School
2023-2024
Biology Investigatory Project 1

Certi icate
This is to certify that that Vikram Amar has satisfactorily completed the
Biology Investigatory project on - Study Of Causes Of Hearing Loss In
Children-prescribed by CBSE for the AISSCE course for the year 2023-2024.
Date:
Signature of internal examiner
Signature of external examiner

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Acknowledgement
I am deeply grateful to my school Sindhi High School Hebbal, Bangalore,

my Principal, Mrs Rachna Sharma and teachers who have given me
opportunity and encouragement to do this project.
I take this opportunity to gratefully acknowledge my Biology teacher Mrs

Nani N and our lab assistant Mrs Anita K for providing valid support, guidance
and advice on planing and executing on this project : Study Of Causes Of
Hearing Loss In Children. I also wish to thank Dr.Ravishankar C, my parents,
friends and above all the Almighty for the smooth completion of this project.
Date:__________________________ Signature:______________________

Index
Introduction: Page 5-12

Aim: Page 13
Materials Required: Page 14
Procedure: Page 15
Observations
General Observations: Page 16-36
Observation Table: Page 37
Statistics: Page 38-39
Results: Page 40
Inference: Page 41
Bibliography: Page 42

Introduction
The normal hearing thresholds of both ears is around 25 dB. A person

who is unable to hear sounds within this threshold is said to have hearing
loss. Hearing loss is very prevalent in our society with about 430 million
people su ering from it globally. Hearing loss can temporary or permanent
and have various cases.Hearing loss can also be of varying degrees with
deafness being absolute hearing loss. Hearing loss amongst children is also
very common with 34 million children su ering hearing loss globally and
around 20,000 children between the age groups 0-6 years su er hearing
loss in Karnataka.
Structure of ear with hearing loss Structure of normal ear
There are many impacts of hearing loss amongst children. It a ects their
literacy, self esteem and social skills. Academic underachievement due to
untreated hearing loss can lead to lesser employment opportunities later in

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life. The social stigma associated with deafness and hearing loss can
adversely a ect the child’s mental and emotional health. It can be a major
cause of depression amongst these children. Parents of such children face
added di iculty in their day to day lives. Therefore it is absolutely essential
for children a ected by hearing loss to undergo immediate treatment.
Hearing loss in Children
Sensorineural Hearing Loss

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Degree Of Hearing Loss
Degree of hearing loss refers to the minimum loudness of sound

required for a person to hear them. It can be classi ied as follows
• Normal 10-15 dB
• Slight 16-25 dB
• Mild 26-40 dB
• Moderate 40-55 dB
• Moderately severe 56-70 dB
• Severe 71-90 dB
• Profound 91+
Deafness occurs when a Pearson is unable to hear sound even in the
presence of ampli ication.
Structure of Ear

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Types Of Deafness
Deafness can be classi ied based on four di erent types of hearing loss
which are
1. Sensorineural hearing loss: Occurs due to problems in inner ear or
sensory organs (cochlea and associated structures) or Vestibulocochlear
nerve.
2. Conductive hearing loss: Occurs when sound waves are not
transferred along the pathway of outer ear, tympanic membrane or
middle ear.
3. Mixed hearing loss: Occurs when conductive hearing loss occurs with
sensorineural hearing loss.
conductive hearing loss

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Causes Of Hearing Loss
There are several causes of hearing loss. A few of them are as follows
• Prenatal factors: Genetic factors, Intrauterine infections etc

• Perinatal factors: Birth asphyxia, Hyperbilirubinemia, Low birth weight
etc
• Chronic ear infections

• Meningitis
• Collection of luids in the ear
• Otosclerosis
• Sensorineural degeneration
• Trauma to ear or head
• Ototoxic chemicals
• Nutrient de iciencies
Amino-glycosides: An Ototoxic Chemical

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Treatment Of Hearing Loss
Hearing loss can be treated by the following methods
• Medical treatment: This includes treatment by surgery or medications

like antibiotic in case of bacterial infection of middle ear.
• Hearing aids: It is a small electronic device which ampli ies sounds. It

is usually worn in or behind the ear. It consists of three main parts i.e a
microphone, an ampli ier and a speaker. Sound is received via the
microphone which converts audio input to electrical signals. These signals
are sent to the ampli ier where the power of the signals are increased and
sent to the ear via the speaker.
Hearing aid
• Cochlear implant: It is a small electronic device mainly used by those

with strong or irreversible hearing loss

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• Assistive listening, Hearing enhancement and alerting devices:
These devices are designed to enhance sound received by the ear and
assist hearing some of them are as follow:
a)Large area listening systems
b)Television Listening systems
c)Conference microphones
d)Personal FM systems
e)Ampli ied telephones
• Signalling and text display systems: These convert speech and sound
into text or lashing lights. Some examples are as follows:
a) Signalling and warning systems
b) TV closed captioning
• Aural rehabilitation and listening and auditory rehabilitation

enhancement: This training is aimed to maximise the hearing ability of
those with hearing. The trining may include the following
c) Audiologic rehabilitation classes
d) Establishing guidelines for communicating with
those around you
e) Learning good listening strategies
Cochlear Implant

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Prevention Of Hearing Loss
It is estimated that 60% of hearing loss occurring in children under the

age of 15 is preventable. There are several methods to prevent hearing loss
I.e
• Immunisation against Rubella, H. In luenza and S. pneumoniae which

prevents against meningitis, Congenital rubella syndrome , etc.
• Immunisation against measles, mumps and meningitis and prevention

of premature birth are also recommended by WHO.
• Avoidance of certain types of medication as well as exposure to

ototoxic chemicals.
• Avoiding exposure to loud noises in school, workplace etc

Neonatal hearing screening helps identify infants who are a ected by
hearing loss. It helps detect permanent congenital hearing loss. This has
become very popular amongst parents as it reduces the age of detection of
hearing loss, which allows early intervention for diagnosed children.
Infant undergoing neonatal hearing screening

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Aim
To study the causes of hearing loss in children through the
ages of 3 to 10 years with the help of case studies

Materials Required
• Radiological MRI
• Prescription
• Diagnostic reports
• CT scan
• Family History and genetic information
• Auditory Brainstem Response (ABR) reports
• Otoacoustic emission (OAE) reports
• Impedance Audiometry test reports
• Compliance Reports
• Type of hearing aid/cochlear implant used

Procedure
Selection of topic
I selected the given topic as hearing loss and deafness were very
common disabilities which a ected a large number of people including
children. I therefore set out to determine the causes of hearing loss amongst
children.
I decided to ask my uncle Dr. Ravishankar C., Professor & Head,
Department of ENT, Bowring and Lady Curzon Hospital, Shri Atal Bihari
Vajpayee Medical College to ind out more about these issues.
Procedure followed in the hospital
Day 1: Patients sex and age were noted. They were screened for risk
factors and the results were noted. Several investigations were conducted to
determine type and degree of hearing loss. Also patient compliance was
noted.
Day 2: Patients underwent surgery or were given hearing aids depending
on the type and degree of Hearing loss. Their compliance for various
procedures were noted.
Day 3: The observations were tabulated and results and inferences were
noted.

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Observations
Based on procedure the following observation have been noted
• Number of male and female cases were roughly equal.

• The mean age of patients was approximately 6 years old.
• Parents were the irst to notice in most cases.,however screening
helped to identify some cases.
• Most cases have undergone radiological MRI as investigation

• All cases have undergone ABR / OAE / Impedance Audiometry
investigations.
• Distraction Techniques were used in almost all the cases for

investigation
• All patients showed good compliance during tests and procedures
Meeting Dr Ravishankar C at home clinic Shri Atal Bihari Vajpayee

Medical College & Research
Institute
The following case studies reveal speci ic characters

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Case 1
Patient Age: 6 Years

Patient Sex: Male
Consanguineous Marriage: Cousin
Maternal Cause: No
Perinatal Cause: No
Type of Hearing Loss: Severe
Degree of Hearing Loss: 85 dB
Side of Hearing Aid/Cochlear Implant insertion: Behind the ear
Type Of Hearing Aid/Cochlear Implant: Widex
Problems Faced: Speech Delay

Case 2

Patient Sex: Male
Consanguineous Marriage: No
Maternal Cause: No
Perinatal Cause: No
Side of Hearing Aid/Cochlear Implant insertion: Behind The Ear
Problems Faced: No

Case 3

Patient Sex: Female
Maternal Cause: No
Perinatal Cause: No
Type Of Hearing Aid/Cochlear Implant:Widex
Problems Faced: Not much improvement

Case 4
Patient Age: 5 years

Patient Sex: Female
Consanguineous Marriage: Maternal Uncle
Maternal Cause: No
Perinatal Cause: No
Type of Hearing Loss: Sensorineural Hearing Loss
Degree of Hearing Loss: 90-95 dB
Problems Faced: Nil

Case 5

Patient Sex: Male
Consanguineous Marriage: Second degree
Maternal Cause: No
Perinatal Cause: No
Degree of Hearing Loss: 80-85 dB
Problems Faced: No

Case 6

Patient Sex: Female
Maternal Cause: Hypertension
Perinatal Cause: Low Birth Weight, Prematurity
Type of Hearing Loss: Profound
Side of Hearing Aid/Cochlear Implant insertion: In the ear
Type Of Hearing Aid/Cochlear Implant: CP 802
Problems Faced: Nil

Case 7

Patient Sex: Male
Maternal Cause: No
Perinatal Cause: Low Birth Weight, Prematurity
Side of Hearing Aid/Cochlear Implant insertion: N/A
Type Of Hearing Aid/Cochlear Implant: N/A
Problems Faced: N/A

Case 8
Patient Age: 3.5

Patient Sex: Male
Consanguineous Marriage: Cousin
Maternal Cause: No
Perinatal Cause: No
Type of Hearing Loss: Moderately severe
Degree of Hearing Loss: Right 70 dB, Left 60 dB
Side of Hearing Aid/Cochlear Implant insertion: Bilateral
Problems Faced: Nil
Widex Hearing Aid

Case 9

Patient Sex: Female
Consanguineous Marriage: Third degree
Maternal Cause: Fever, Thyroid Disease, Anaemia
Perinatal Cause: No
Side of Hearing Aid/Cochlear Implant insertion: Right Implant, Left
Hearing Aid
Type Of Hearing Aid/Cochlear Implant: Behind the ear (hearing aid), In
the ear (implant)
Problems Faced: Nil

Case 10

Patient Sex: Male
Maternal Cause: No
Perinatal Cause: Jaundice
Degree of Hearing Loss: Right 75, Left 80
Type Of Hearing Aid/Cochlear Implant: Resound Company
Problems Faced: Nil
Resound Company Hearing Aids

Case 11

Patient Sex: Male
Maternal Cause: No
Perinatal Cause: Prematurity
Degree of Hearing Loss: 90
Problems Faced: Nil

Case 12

Patient Sex: Female
Maternal Cause: No
Perinatal Cause: No
Side of Hearing Aid/Cochlear Implant insertion:Behind the ear (hearing
aid), In the ear (implant)
Type Of Hearing Aid/Cochlear Implant: Left CP 802, Right Implant
Problems Faced: Nil

Case 13

Patient Sex: Male
Maternal Cause: Fever, Thyroid Disease
Perinatal Cause: NICU Admission
Problems Faced: Nil
CP Cochlear implant

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2
Case 14

Patient Sex: Female
Maternal Cause: Thyroid Disease
Type of Hearing Loss: Severe Profound
Side of Hearing Aid/Cochlear Implant insertion: N/A
Type Of Hearing Aid/Cochlear Implant: N/A
Problems Faced: N/A

Case 15

Patient Sex: Male
Consanguineous Marriage: Third Degree
Maternal Cause: Thyroid disease
Type Of Hearing Aid/Cochlear Implant: Medel
Problems Faced: Nil

Case 16

Patient Sex: Male
Maternal Cause: No
Perinatal Cause: No
Problems Faced: Speech Delay

Case 17

Patient Sex: Female
Consanguineous Marriage: Second Degree
Maternal Cause: No
Perinatal Cause: No
Side of Hearing Aid/Cochlear Implant insertion: In The Ear
Type Of Hearing Aid/Cochlear Implant: 90 dB
Problems Faced: Nil

Case 18

Patient Sex: Male
Consanguineous Marriage: Third Degree
Maternal Cause: No
Perinatal Cause: No
Problems Faced: Nil

Case 19

Patient Sex: Male
Maternal Cause: No
Perinatal Cause: Asphyxia, Low Birth Weight, Prematurity
Problems Faced: Nil
Medel Cochlear Implant

Case 20

Patient Sex: Male
Maternal Cause: No
Perinatal Cause: No
Type of Hearing Loss: Moderate
Degree of Hearing Loss: 70-75dB
Problems Faced: Nil

Observation Table
Sl Ag Sex Consan Matern Perinata Type of Degre Side and Problem
No e guineou al l Cause Hearing e of type of s Faced
s Cause Loss Hearin Hearing
Marriag g Loss Aid/
e Cochlear
Implant
insertion
1 6 Male Cousin No No Severe 85 Behind The Speech
Ear, Widex delay
2 6 Male No No No Severe 85 Behind The Nil
Ear, Widex
3 4 Female No No No Severe 80 Behind The Not Much
Ear, Widex Improveme
nt
4 5 Female Maternal No No Sensorineura 90-95 Behind The Nil
Uncle l HLprofound Ear, Widex
5 10 Male Second No No Severe 80-85 Behind The Nil
Degree Ear, Widex
6 6 Female No Hypertensi Low Birth Profound 100 CP 802 Nil
on Weight,
Prematurity
7 7 Male No No Low Birth Severe 73 N/A N/A
Weight,
Prematurity
8 3.5 Female Third No No Profound R-70,L-60 Widex Nil
Degree
9 7 Male Maternal Fever, No Profound 90 R-Implant, L- Nil
Uncle Thyroid Hearing Aid
Disease,
Anaemia
10 7 Male Maternal No Jaundice Severe R-75,L-80 Resound Nil
Uncle Company
11 8 Male No No Prematurity Profound 90 CP 802 Nil
12 3 Female No No No Profound R-90,L-70 R- Implant, Nil
L- CP 802
13 7 Female No Thyroid NICU Profound 90 CP 802 Nil
Disease, Admission
Fever
14 8 Female No Thyroid Jaundice Moderately R-90,L-85 N/A N/A
Disease Severe
15 3 Male Third Thyroid Jaundice Profound 90 Medel Nil
Degree Disease
16 6 Male No No No Severe 90 CP 802 Speech
delay
17 2 Female Second No No Profound R-65, L-70 Behind The Nil
Degree Ear, Widex
18 9 Male Third No No Profound 93 Medel Nil
Degree
19 8 Male No No Low Birth Severe 80 Medel Nil
Weight,
Prematurity,
Asphixia
20 6 Male No No No Moderate 70-75 Widex Nil

Graphical representation of various
causes of Hearing Loss
Third degree
15% Second Degree
30%
Normal
55%
Consanguineous Marriage
• 45% of the patients were children of consanguineous marriages.
Moderate
10%
Severe
40%
Profound
50%
Type of hearing loss
• 50% of cases su ered profound HL, 40% su ered severe HL and 10%
su ered moderate HL

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16
12
0
Thyroid BP Fever Anemia Una ected
Maternal Causes
• 25% of the cases were children born to mothers su ering from

diseases during child birth
Juandice
Low Birth Weight
Prematuriy
Asphixia
NICU admission
Una ected
0 3 6 9 12
Perinatal Causes
• 40% of cases had perinatal cause

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Result
• Detection of majority of the cases occurred at the age of 6-8 years
either by screening or detection by parents (cases
1,2,6,7,9,10,11,13,14,16,19,20)
• From the above data we can establish a clear relation between

consanguineous marriage of parents and deafness in their children (cases
1,4,5,8,9, 10,15,17,18)
• It is also noted that children su ering from perinatal diseases such as

jaundice, low birth weight are at higher risk of hearing loss (cases
6,7,10,11,13,14,15,19)
• Children whose mothers were su ering from diseases such as

Jaundice, Thyroid disease or Anaemia were also at risk of hearing loss
(cases 6,9,13,14,15)
• It is also noted that the risk factor due to maternal causes is much
lower than risk factors due to either congenital or perinatal causes.
• Children admitted to NICU for various complications/diseases

occurring at neonatal period were also at risk of heating loss (cases
6,7,10,13,14,19)
• It is also noted that CP-802 and cochlear implants were used in cases
of profound hearing loss compared to normal hearing aids. (cases
6,9,11,12)

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Inference
• Hearing loss in children is more likely to be detected middle

childhood age group i.e 6 years old to 8 years old
• We can infer that consanguineous marriage (second and third degree)

and inbreeding was a severe risk factor for hearing loss in children.
• Perinatal causes such as low birth weight, jaundice, prematurity were

also major risk factors
• NICU admission was a strong indicator of hearing loss later in the

patients.
• Maternal causes such as thyroid fever and anaemia were also risk
factors but the incidence of these cases were less than either perinatal or
consanguineous causes.
• Problems in treatment were not common but hearing aids and

implants did cause speech delay in some patients
• Implants and CP-802 were preferred in cases with profound hearing

loss .

Bibliography
1. Report published by Dr. Ravishankar C., Professor & Head,

Department of ENT, Bowring and Lady Curzon Hospital, Shri Atal Bihari
Vajpayee Medical College & Research Institute and team.
2. https://en.wikipedia.org/wiki/Aminoglycoside
3. https://en.wikipedia.org/wiki/Aminoglycoside
4. https://www.who.int/news-room/fact-sheets/detail/deafness-and-
hearing-loss
5. https://www.gov.uk/government/publications/newborn-hearing-
screening-making-sounds-checklist/newborn-hearing-screening-
making-sounds-checklist

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Biology Investigatory Project

Study Of Causes Of Hearing Loss In Children

Biology Investigatory Project 1

Signature of internal examiner

Signature of external examiner

Biology Investigatory Project 2

I am deeply grateful to my school Sindhi High School Hebbal, Bangalore,

I take this opportunity to gratefully acknowledge my Biology teacher Mrs

Biology Investigatory Project 3

Introduction: Page 5-12

Biology Investigatory Project 4

The normal hearing thresholds of both ears is around 25 dB. A person

Structure of ear with hearing loss Structure of normal ear

Biology Investigatory Project 5

Hearing loss in Children

Sensorineural Hearing Loss

Biology Investigatory Project 6

Degree of hearing loss refers to the minimum loudness of sound

Biology Investigatory Project 7

conductive hearing loss

Biology Investigatory Project 8

• Prenatal factors: Genetic factors, Intrauterine infections etc

• Chronic ear infections

Amino-glycosides: An Ototoxic Chemical

Biology Investigatory Project 9

Hearing loss can be treated by the following methods

• Medical treatment: This includes treatment by surgery or medications

• Hearing aids: It is a small electronic device which ampli ies sounds. It

• Cochlear implant: It is a small electronic device mainly used by those

Biology Investigatory Project 10

• Aural rehabilitation and listening and auditory rehabilitation

Biology Investigatory Project 11

It is estimated that 60% of hearing loss occurring in children under the

• Immunisation against Rubella, H. In luenza and S. pneumoniae which

• Immunisation against measles, mumps and meningitis and prevention

• Avoidance of certain types of medication as well as exposure to

• Avoiding exposure to loud noises in school, workplace etc

Infant undergoing neonatal hearing screening

Biology Investigatory Project 12

Biology Investigatory Project 13

Biology Investigatory Project 14

Biology Investigatory Project 15

• Number of male and female cases were roughly equal.

• Most cases have undergone radiological MRI as investigation

• Distraction Techniques were used in almost all the cases for

• All patients showed good compliance during tests and procedures

Meeting Dr Ravishankar C at home clinic Shri Atal Bihari Vajpayee

The following case studies reveal speci ic characters

Biology Investigatory Project 16

Patient Age: 6 Years

Biology Investigatory Project 17

Patient Age: 6 Years

Biology Investigatory Project 18

Patient Age: 4 Years

Biology Investigatory Project 19

Patient Age: 5 years

Biology Investigatory Project 20

Patient Age: 10 Years

Biology Investigatory Project 21

Patient Age: 6 Years

Biology Investigatory Project 22

Patient Age: 7 Years

Biology Investigatory Project 23