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Cephalometric analysis in speech and hearing impaired children.

BACKGROUND

Deafness means impairment of Hearing. It may be congenital or acquired. Hearing is a vital part of a newborn's contact with his environment. It is also vital for the development of speech and language in infants. So to limit the handicap and for the overall wellbeing of the child, an early diagnosis of hearing loss in infants is important.

A landmark study of cephalometric indices in speech and hearing impaired children of 7-16 years was conducted by Arole et al. [1] Nasal breadth, nasal height and facial length were found to be of better value in identifying children with speech and hearing impairment. Similar studies by Karve [2] reveal that the above measurements are significant and sufficient to draw the conclusions. Literature search did not reveal much of studies pertaining to speech and hearing impairment in children of Kerala. A preliminary workup showed that there is a high prevalence of speech and hearing impairment. This study was undertaken with the aim of identifying whether observation of cephalometric indices would help identify speech and hearing impairment at an earlier stage and thus help in taking measure which will help early rehabilitation.

MATERIALS AND METHODS

After clearance from the Institutional Ethics Committee, the study was conducted on 112 speech and hearing impaired children selected from the 'Institute for speech and hearing impaired', Jagathy, Trivandrum and 119 Normal school children from Government Model High School for Girls, Pattom and Medical College High School, Kumarapuram. The students were in the age group of 5-15 years. The children of each category were divided into two groups on the basis of age i.e. Group I - 5 to 10 years and Group II - 11 to 15 years.

The Following Measurements were taken

1. Head circumference (Occipitofrontal circumference, OF): Using a flexible centimetre tape the circumference was noted at the level of external occipital protuberance and glabella. Glabella is the midpoint of the portion of the frontal bone above the nasal root between the supraorbital ridges.

2. Anteroposterior Dimension (APD): The maximum length of the cranial diameter from the glabella to the external occipital protuberance is measured using a spreading calliper.

3. Biparietal Dimension (BPD): The greatest horizontal and transverse diameter measured on the head by the spreading calliper above the supramastoid region.

4. Cranial Height: The distance between the vertex superiorly and the superior border of the auditory opening inferiorly measured by the spreading calliper.

5. Facial Height: The distance between glabella and the symphysis menti was measured using the sliding calliper.

6. Bizygomatic Breadth: The distance between the midpoints of two zygomatic arches was measured using the spreading calliper.

7. Nasal length: The distance from nasion to tip of nose was measured the using the sliding calliper.

8. Nasal Breadth: Distance between alae of nose was measured using the sliding calliper. Using the above measurements various indices [3,4] were calculated.

Cranial Capacity

It constitutes one of the most important characters for determining the racial differences. It is also an indirect approach to evaluate the size of the brain.

Cranial capacity can be calculated as per the formula given below.

For Males, Cranial capacity = 0.000337 (L-11) (B-11) (H-11)+ 406.01 cc.

For Female, Cranial capacity = 0.000400 (L-11) (B-11) (H-11) + 206.60 cc.

L, B, H - Length, Breadth and Height of cranium.

1. Cranial index = Cranial breadth/Cranial length x 100.

2. Cranial length height index = Cranial height/cranial length x 100.

3. Transverse craniofacial index=Bizygomatic distance/ biparietal distance x 100.

4. Facial index= Bizygomatic distance/Facial length x 100.

5. Nasal index= Nasal breadth/Nasal length x 10.

Means and standard deviation of the control and the speech and hearing impaired children were calculated. For all measurements and indices, mean and standard deviation were computed and mean was used for making comparison between the groups. The 't' test for independent samples was used for finding the statistical significance and corresponding non-parametric test, Mann-Whitney U was applied wherever 't test cannot be applied.

OBSERVATION

All cranial dimensions except anteroposterior dimension, cranial height and bizygomatic breadth showed significant decrease in speech and hearing impaired children in the age group of 5-10 years. As age progressed, it was only the biparietal dimension, cranial height which showed a statistically significant decrease.

In the age Group I (5-10 Years)

Cranial index and facial index was found to be significantly lower in speech and hearing impaired children in both male and female children than the control group.

Transverse craniofacial index and facial index was found to be higher in speech and hearing impaired male and female children.

In the age group (11-15 Years)

Cranial index and facial index was found to be significantly lower in speech and hearing impaired children than the control group.

Length height index, nasal index and facial index showed a significant increase in value among the speech and hearing impaired children than in control group.

DISCUSSION

The development of normal speech is largely dependent on the ability to hear. Deafness either congenital or acquired early in life will delay or prevent normal speech development. In any speech disorder of childhood, it is essential to ascertain whether there is any hearing defect. [5] The cochlear system is fully developed by 12 weeks of intrauterine life, although much of the auditory system develops after birth. In the newborn, hearing produces reflex activity, but it does not become discriminatory until about 9 months of age. [6] The present study aims to assess variations in the anthropometric measurements and indices in speech and hearing impaired children of the age group (5-15 yrs.).

In this study, head measurements such as biparietal dimension, occipitofrontal circumference, bizygomatic breadth were significantly lower in speech and hearing impaired children irrespective of age and sex. This is in accordance with the marked retardation in growth rates in the speech and hearing impaired children. [1] The following head measurements such as cranial height, nasal breadth, nasal length are greater in speech and hearing impaired children. It shows that there is arrested general growth but increased breadth in the subfrontal region of the face.

Certain findings in the defective children of group I and II are similar to that in the normal children of same age group like height, weight, anteroposterior dimension, chest circumference, cranial capacity. The circumference of head is significantly smaller in speech and hearing impaired children which is similar to the findings suggested by Karve. [2] There is significant decrease is cranial index in speech and hearing impaired children of both the age groups. All speech and hearing impaired children studied are dolichocephalic. This is in contrast to the finding that normal children of 5-10 years of age are mesocephalic while those between 11-15 years of age are brachycephalic.

There is a significant increase in the facial and nasal indices in speech and hearing impaired children of both the age groups. The increased value of nasal index show that the nasal breadth is increased in speech and hearing.

Inference

In speech and hearing impaired children, the head remains smaller, but the facial breadth below frontal region increases. The decreased circumference of head may be as a result of poor sensory stimuli which fails to stimulate normal growth of the brain in addition to some intrinsic metabolic defect affecting skull development. This failure of development of skull can result in a defective temporal bone. [1] The increased cranial height in speech and hearing impaired children in contrast to lesser circumference of head may be partly to compensate for the shortage of available space or capacity.

The increase in all breadth measurements may be the result of comparative rapid and compensatory overgrowth of the air sinuses in these defective children there by increasing the breadth of the face when compared to normal children. It may be nature's attempt to compensate for defective hearing apparatus by increasing the resonance. Thus, congenitally speech and hearing impaired children have a small but high head with a broad face below frontal region as compared with the normal child.

There is no definite methodology for prenatal diagnosis of deafness using techniques like amniocentesis and so the defect cannot be eliminated by terminating an affected pregnancy. The X linked deafness syndromes are amenable to control by foetal sex determination and selective termination. Finally, it is possible that prenatal diagnosis will be revolutionised by recent advances concerning the determination of actual gene structure in foetal cells by means of recombinant DNA technique. The role of this new scientific discipline of molecular genetics in the area of inherited deafness is not yet fully apparent, but there is little doubt that it will have important applications in the foreseeable future. [7]

Kenna (2003) performed neonatal hearing screening using reliable and reproducible methods. [8] Intervention before the age of 6 months with hearing aids and appropriate educational support services will give the infant the best possible opportunity to develop language.

SUMMARY AND CONCLUSION

This study was undertaken with the objective of identifying parameters in cephalometric indices which can help diagnose speech and hearing impairment at an early stage. It was observed that in speech and hearing impaired children, the head remains smaller, but the facial breadth below frontal region increases. Similar studies conducted at different centre could help us standardise cephalometric parameters. Once done, this could be extended to intrauterine studies and help in prenatal diagnosis and prediction of speech and hearing impairment.

REFERENCES

[1.] Vasanthi A, Kate BR, Athanikar KA. Cephalometry in congenitally speech and hearing impaired children. J Anat Soc India 1981; 30(3):90-94.

[2.] Karve I, Dandekar VM. Anthropometric measurements of Maharashtra. Deccan College Monograph Series 1951; 8: 1-55.

[3.] Hrdlicka A. Anthropometry B.-introduction to anthropometry. Am J Phys Anthrop 1919; 2(2):175-194.

[4.] Montagu MFA. An introduction to physical anthropology. 3rd edn. Springfield, Illinois: Charles C Thomas 1960.

[5.] Michael E, Deafness LE. Cited by the basic neurology of speech and language. 3rd edn. Black Well Scientific publications 1983:99-104.

[6.] Gupta KR, Kakar PK, Misra UC. Early detection of streptomycin ototoxicity. J Indian Med Assoc 1970; 54(5): 184-6.

[7.] Beighton P. Hereditary deafness. In: Emery AEH, Rimon DL, eds. Principles and practice of medical genetics. Vol. 1. New York: Churchill Livingstone 1983:562-575.

[8.] Kenna MA. Neonatal hearing screening. Pediatr Clin North Am 2003; 50(2):301-313.

Manju S (1), Mini A (2)

(1) Assistant Professor, Department of Anatomy, Government Medical College, Thiruvananthapuram.

(2) Associate Professor, Department of Anatomy, Government Medical College, Parippally, Kollam.

Financial or Other, Competing Interest: None.

Submission 08-09-2016, Peer Review 01-10-2016, Acceptance 07-10-2016, Published 11-10-2016.

Corresponding Author: Dr. Manju S, Assistant Professor in Anatomy, Governmen t Medical College, Thiruvanan thapuram.

E-mail: poojagopan6@gmail.com

DOI: 10.14260/jemds/2016/1377
Table 1: Distribution of Control, Speech and Hearing
Impaired Children into groups based on Age and Sex.
C--Control children, Test--Speech and Hearing
Impaired children

Group      Age                Number of Children

                       Male        Female      Total

                     C    Test   C    Test   C    Test

I       5-10 yrs.    30    32    34    30    64    62
II      11-15 yrs.   25    25    30    25    55    50

Table 2: Cranial Dimensions of Control and Speech and Hearing
Impaired Children. (Male and female): Mean and SD in brackets of
Group I (5-10 years) and II (11-15 years)

                                      Group I

Parameter          Sex     Study   Control     t     Significance

                   Male     17      17.0     0.287      p>0.05
Anteroposterior            (0.7)    (1.0)
Dimension APD     Female   16.7     16.8     0.353      p>0.05
                           (0.6)    (0.8)
                  Total     6.9     16.8     0.278      p>0.05
                           (0.9)    (0.8)
Biparietal         Male    12.8     13.4     3.18       p<0.05
dimension (BPD)            (0.8)    (0.6)
                  Female   12.4     13.1     4.15       p<0.05
                           (0.6)    (0.7)
                  Total    12.6     13.2     4.70       p<0.05
                           (0.7)    (0.6)
Cranial            Male    11.3     11.31    0.323      p>0.05
Height                     (0.8)    (0.9)
                  Female   11.2     11.2     0.212      p>0.05
                           (0.6)    (0.7)
                  Total    11.2     11.2     0.025      p>0.05
                           (0.9)    (0.9)
Occipitofrontal    Male    50.8     51.7      1.1       p>0.05
Circumference              (1.3)    (1.7)
(OF)              Female   49.5     50.9      3.4       p<0.05
                           (1.7)    (1.6)
                  Total    50.2     51.1      2.9       p<0.05
                           (1.7)    (1.6)
Bizygomatic        Male    11.3     11.1     0.734      p>0.05
breadth                    (1.1)    (0.7)
                  Female   10.7     11.1     2.14       p<0.05
                           (0.9)    (0.5)
                  Total    11.0     11.1     0.643      p>0.05
                           (0.6)     (1)
Nasal breadth      Male     3.5      3.0     5.63       p<0.05
                           (0.4)    (0.2)
                  Female    3.2      2.9      4.1       p<0.05
                           (0.5)    (0.2)
                  Total     3.4      2.9      6.7       p<0.05
                           (0.5)    (0.2)
Nasal length       Male     4.8      4.1     5.16       p<0.05
                           (0.7)    (0.4)
                  Female    4.5      4.0     2.97       p<0.05
                           (0.8)    (0.4)
                  Total     4.7      4.0     5.66       p<0.05
                           (0.7)    (0.4)

                                    Group II

Parameter          Sex     Study   Control     t     Significance

                   Male    17.3     17.6     1.37       p>0.05
Anteroposterior            (0.7)    (0.9)
Dimension APD     Female   17.4     17.2      1.1       p>0.05
                           (0.6)    (0.8)
                  Total    17.3     17.4     0.218      p>0.05
                           (0.6)    (0.8)
Biparietal         Male    12.8     14.5      6.3       p<0.05
dimension (BPD)            (0.7)    (1.1)
                  Female   17.4     17.2      1.1       p>0.05
                           (0.6)    (0.8)
                  Total    15.1     14.4      5.9       p<0.05
                           (1.5)    (1.1)
Cranial            Male    11.4     10.8      2.5       p<0.05
Height                     (1.0)    (0.6)
                  Female   11.2     11.0     0.81       p<0.05
                           (0.9)    (0.7)
                  Total    11.3     10.9      2.3       p<0.05
                           (0.9)    (0.6)
Occipitofrontal    Male    51.9     52.5     1.29       p>0.05
Circumference              (1.7)    (1.6)
(OF)              Female   52.9     52.8     0.231      p>0.05
                           (1.8)    (1.8)
                  Total    52.4     52.7     0.746      p>0.05
                           (1.8)    (1.7)
Bizygomatic        Male    12.1     12.2      1.1       p>0.05
breadth                    (0.5)    (0.4)
                  Female   12.4     12.1     0.78       p>0.05
                           (0.6)    (0.5)
                  Total    12.0     12.2      1.3       p>0.05
                           (0.5)    (0.5)
Nasal breadth      Male     3.4      3.3     1.04       p>0.05
                           (0.4)    (0.3)
                  Female    3.4      3.2      1.9       p>0.05
                           (0.4)    (0.3)
                  Total     3.4      3.2      1.9       p>0.05
                           (0.4)    (0.3)
Nasal length       Male     4.7      4.7      0.0       p>0.05
                           (0.4)    (0.4)
                  Female    4.4      4.7      2.2       p<0.05
                           (0.4)    (0.4)
                  Total     4.6      4.7      1.6       p>0.05
                           (0.4)    (0.4)

Table 3: Mean and Standard Deviation (in brackets) of Indices of
Control and Speech and Hearing Impaired Children of Group I (5-10
years) and II (11-15 years)

                                           Group I

Parameter        Sex      Study     Control      t      Significance

Cranial index    Male     73.67      77.67     2.847       p<0.05
                          (6.7)      (4.0)
                Female     72.4      77.78      4.4        p<0.05
                          (5.1)      (4.6)
                Total     73.06      77.77      5.07       p<0.05
                          (5.9)      (4.3)
Cranial          Male     406.01     406.01    0.0001      p<0.05
Capacity                 (0.0001)   (0.0001)
                Female    213.25     206.6      1.05       p>0.05
                          (36.4)     (5.2)
                Total     312.74     301.56    0.535       p<0.05
                         (100.4)    (100.4)
Length Height    Male     66.39      66.32     0.043       p<0.05
Index                     (7.1)      (5.09)
                Female     67.0       66.5     0.486       p>0.05
                          (4.2)      (4.6)
                Total     66.39      66.48      1.01       p<0.05
                          (4.8)      (5.7)
Transverse       Male     88.49      83.51      2.5        p<0.05
craniofacial              (9.5)      (5.9)
Index           Female    87.41      85.64      0.83       p>0.05
                          (10.3)     (6.1)
                Total     87.96      84.62      2.3        p<0.05
                          (9.9)      (6.3)
Nasal index      Male     73.11      74.44      0.66       p<0.05
                          (8.3)      (7.4)
                Female    73.96      72.06      0.74       p>0.05
                          (11.3)     (8.8)
                Total     73.52      73.19      1.86       p>0.05
                          (9.9)      (8.2)
Facial Index     Male     104.36     109.85     2.4        p>0.05
                          (15.4)     (9.6)
                Female    104.09     113.18     3.2        p>0.05
                          (13.0)     (9.7)
                Total     104.24     111.59     4.1        p>0.05
                          (13.9)     (9.7)

                                            Group II

Parameter        Sex      Study     Control      t     Significance

Cranial index    Male     74.51      82.18      4.5       p<0.05
                          (5.8)      (6.1)
                Female    75.15      83.63      5.2       p<0.05
                          (3.4)      (7.4)
                Total     74.82      82.97     7.01       p<0.05
                          (4.7)      (6.8)
Cranial          Male     406.02     406.01    1.53       p<0.05
Capacity                 (0.0002)   (0.0004)
                Female    206.59     206.57     1.2       p>0.05
                         (0.0012)   (0.001)
                Total     292.71     297.22    0.22       p<0.05
                          (99.9)    (100.2)
Length Height    Male     65.88      61.35      2.8       p<0.05
Index                     (6.4)      (4.8)
                Female    64.17      64.30     0.284      p>0.05
                          (5.6)      (4.9)
                Total     64.07      62.96     2.15       p<0.05
                          (6.1)      (5.1)
Transverse       Male     95.11      109.5      6.9       p<0.05
craniofacial              (6.4)      (8.2)
Index           Female    93.03      88.09      2.5       p>0.05
                          (6.4)      (6.5)
                Total     94.07      85.02      6.9       p<0.05
                          (6.5)      (6.7)
Nasal index      Male     73.22      71.73     0.56       p<0.05
                          (9.3)      (10.7)
                Female    77.11      68.78      3.5       p>0.05
                          (9.6)      (7.9)
                Total     75.12      70.12      2.8       p>0.05
                          (9.3)      (9.3)
Facial Index     Male     115.47     109.56    2.35       p>0.05
                          (9.5)      (8.2)
                Female    114.86     111.15    1.71       p>0.05
                          (8.1)      (7.8)
                Total     115.17     110.42     2.9       p>0.05
                          (8.8)      (8.0)
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Title Annotation:Original Research Article
Author:Manju, S.; Mini, A.
Publication:Journal of Evolution of Medical and Dental Sciences
Article Type:Report
Date:Oct 13, 2016
Words:3075
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