liver transplant?

case study :
HISTORY
Patient 6 years old, female. She came with her father. Her father want to sent her daughter into special school, because he found out that her daughter had difficulty in understanding expressive language. She seems confused, and father want to fill in OKU form for her daughter.This child had history of liver transplant since she is 4 years old. Currently on medication, to avoid negative rejection from her body.

Agak-agak... apa masalah yang kita boleh noted?
 (1) Learning problem
 (2) On medication

AUDIOLOGICAL FINDINGS


No abnormality found out through otoscopic examination and tympanometry.
Play Audiometry  : mild to severe sensorineural hearing loss at high frequencies ( 2K : 55dB, 4K : 60 dB, 6K : 90dB)

Discussions
Earlier on testing, patient had difficulty in understanding the task of testing She seems confused, and cannot respond well in conditioned state. Tester had increase the intensity of the conditioned level up to 80 dB, but then, patient seems to show false-positive respond, by responding with guess. Instead of changing the task, tester had try to modify the test, by using lower frequency to condition, and she able to respond accordingly.

This child had showed a hearing loss that may replicate the condition of ototoxicity. Her hearing is dropping slowly, and yes, it damaging the high frequency far more earlier than the lower frequency. This is due to anatomic locations of the cochlear, and frequency selectivity that God create. The lower frequency is place in apex of the spiral, and this protecting this region.

Management?
The confusion and symptoms that this patient may reflected due to hearing loss that she had. It's hearing is slowing diminishing, and yet the important phonemes in understanding speech lying on the high frequency region. Thus the impaired cochlear that due to toxicity, can cause problems in understanding speech, discriminating words that had similar sounds, inaudibility of speech, and many more. The right management of the patient, is to adopt a hearing aids, that can helps in assisting during conversation. But then, special specification needs to be consider. The child had a near normal low frequencies threshold. We dont want to fit hearing aids that can increase the threshold of the better frequencies.