Q: My nine months old son is a premature baby, and had severe jaundice. He still cannot sit without support. He is unable to respond to sounds. Is this due to jaundice?

A:Jaundice is one of the known risk factors for hearing impairment. However, you / your doctor have thoughtfully done a hearing assessment. Most probably, your child would have had a screening test like BERA. By doing it, you have already done taken the first step. Kindly follow this up with the same zeal. By age nine months, play audiometry / behavioural audiometry can be done (by an experienced audiologist) to ascertain the hearing thresholds. Depending on the threshold level, further assistance to the child can be planned. If the hearing impairment is significant, hearing aids will have to be fitted. Yes, even at nine months hearing aids can be fitted. Good hearing is absolutely essential for the over all development of the child. Hence, do not hesitate. After fitting the aid, start conversing with the child. Stimulate him to speak. Always remember to avoid gestures. In the last one-decade, two new devices have been added to the armamentarium of the ENT surgeon. They are bone anchored hearing aid (BAHA) and cochlear implant. The mechanisms of delivery of sound information by these two devices are a little different. These two new devices are expensive and also carry some operative and post operative risks. But, you have to realise that all the devices including the hearing aid can deliver only sounds. Understanding the sounds, interpreting the meanings of the sounds, formulation of speech and actual delivery of speech by the child depends on your efforts at teaching the child. These teaching efforts have to be prolonged over years. Hence, 'latest' does not mean the best. Provided a hearing aid does succeed in reaching the sounds into an impaired ear, the benefits will be equal or better than a cochlear implant. This is why it is mandated that a hearing aid will have to be tried in every hearing impaired child, for a few months. Only if this strategy fails, the option of cochlear implant will have to be entertained. In any child, some islands of hearing might be present. This strategy of 'hearing aid first' tries to maximises the benefits of these islands of hearing. In bringing back the child from the world of silence, the role of the parents, grand parents, siblings, teachers and neighbours is great. Special teachers are available to guide you in this issue. In some regions in our country, special schools are also available. Some such schools admit the children at a very tender age. Recently, one special school in Chennai admitted a child aged nine months. This school mandates that the mother also should accompany the baby to the school every day. The principle is that the parents also need to be trained in rearing such children. If we start early, hearing impaired children can quickly be transferred to the regular schools in two years, three years or even earlier. Unfortunately, such services are very few. Ask a second time; ask a second person. Please ask your paediatrician / ENT surgeon / audiologist to guide you.