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Edith Smith of New York was concerned about her 18-month-old daughter, Amanda The daughter did not respond when her parents spoke to her, and never react to noises. "She doesn't seem to know what is happening around her," she told the doctor. Without examining Amanda, the doctor assured Edith that her little girl was fine.

But when Amanda was not talking by the time she was two, Edith and her husband became more and more anxious.【1】Finally, Edith took Amanda to an ear, nose and throat specialist, who did an auditory brain-stem response test in which clicking sounds sent through earphones are measured in the brain. This examination showed that Amanda was severely hearing-impaired in both ears. The tragedy was that late detection had delayed her language development and threatened, long-term, to hinder her growth socially.

Hearing impairment is one of the most common birth defects in Asia today.【2】Dr. Andrew Smith, medical officer with the World Health organization's Activities for Prevention of Deafness and Heating Impairment Team in Geneva, Switzerland, estimates that 5.5 million children in Asian-Pacific region are deaf or hearing-impaired. He says that the lack of awareness among parents and some physicians about hearing impairment is a major reason for late detection in children.

Choy Kwee Yuen of Singapore initially did not suspect there was anything wrong with his child. At six month, Choy Jing Xian cooed and gurgled like any other baby. But when Jing Xian was eight months old, Choy became concerned. The infant would sleep through loud noises, including slaps of thunder. His doctor referred the boy to a specialist, who found that Jing Xian had a severe hearing impairment.【3】"All babies up to six months old make vocal noises--it's a natural reflex," says the specialist, "It's hard to distinguish between a three-month-old hearing baby and a three-month-old deaf baby."

He also stresses that even children with moderately severe hearing loss may hear loud sounds or react to hand movements.【4】If a doctor tests a young deaf child's hearing by ringing a bell next to his ear, he may react to the movement of hand rather than the sound. Because hearing problems are often not detected, many children muddle along until hearing screenings are given at school. They don't know they have a problem, and their symptoms may be misinterpreted.

【5】Mounting evidence shows that the longer the delay in diagnosing the problem, the more trouble the child has in developing language and social skills.

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