USHER SYNDROME

This genetic condition causes hearing loss from birth and progressive loss of sight due to retinitis pigmentosa (RP), which causes degeneration of the retina. Often the first symptom of RP is night blindness, followed by narrowing side vision leading to what is called "tunnel vision".

THREE TYPES OF USHER SYNDROME

Usher Syndrome Type 1. There is severe damage to the cochlea from a very early age and therefore the child has severe deafness from birth. The child usually develops problems with night vision and tunnel vision due to RP in the first 10 years of life. People with this condition usually communicate by signing. This clearly can become more difficult as vision deteriorates.

Usher Syndrome Type 2. The hearing loss is more variable, ranging from mild to severe. Symptoms of RP usually develop from late adolescence to late twenties. Communication is enhanced in these people with hearing aids and lip reading.

Usher Syndrome Type 3. The person is born with normal hearing and close to normal balance. The loss of hearing becomes more pronounced as the person gets older. Measurable hearing loss occurs by puberty. Vision loss starts to develop during the teenage years and may progress during life. Balance deteriorates as the person gets older. The majority of people with US3 live in Finland.

DIAGNOSIS

It is important to consider Usher syndrome in any child who is having considerable hearing problems, since this may be evident before the symptoms of RP develop. A common early symptom may be the delayed development of speech. Early diagnosis in children is important so that a child's educational needs can be met, and career choices made.

Figures from the USA and Scandinavia suggest that 3 to 6% of all people born deaf have this condition. In Victoria, a recent survey of people with RP showed that 8% have Usher syndrome.

Diagnosis will normally include the following:

Assessment by an ear, nose and throat specialist to ensure correct diagnosis of the hearing loss.

Assessment by an ophthalmologist to assess the presence and severity of RP. Special hearing and vision tests (such as ERG) to confirm the diagnosis. (An Electro Retinogram (ERG) measures the electrical activity in the retina. A person with RP has a significantly abnormal ERG).

STRUCTURE AND FUNCTION OF THE EAR

auricle - the outer part of the ear, situated on either side of the head.
ear canal - lined with skin, it passes from the hole in the auricle through cartilage and bone to the tympanic membrane (ear drum).
tympanic membrane - the thin transparent piece of skin at the end of the ear canal.
outer ear - the auricle, ear canal and outer surface of tympanic membrane.
middle ear - a small air-filled bony chamber that contains three small bones connecting the tympanic membrane to the inner ear.
inner ear - This consists of two parts:
1. cochlea - a small shell-shaped, fluid-filled structure with many small hairs along its length
2. semi circular canals - structures filled with fluid.
vestibulo-cochlear nerve - connected to both the cochlea and semi circular canals, it connects the inner ear to the brain.

Diagram: Ear anatomy and physiology

FUNCTION OF THE EAR

When a trumpet produces a sound, it sets up vibrations (in the air) that are trapped by the auricle, and conducted to the tympanic membrane, that then vibrates. This causes movement of the three small bones in the middle ear that, in turn, transmit the vibrations to cause ripples in the cochlear fluid. These stimulate the hairs to move, thereby affecting the vestibulo-cochlear nerve that sends messages to the brain that recognises the sound as a trumpet blowing. Higher pitched sounds cause more hairs to vibrate than do the lower sounds.

The semi circular canals respond to changes in body position and send messages to the brain, thereby helping to control balance. For unknown reasons, people with Usher syndrome become deaf because damage occurs to the hair cells that vibrate in the cochlear fluid. This damage may increase with age. Thus, when a sound is made near the auricle, it will pass through the canal to

the middle ear. However, subsequent transmission of the sound to the cochlea will be faulty and hence the sound will be inadequately passed along the vestibulo-cochlear nerve or recognised
by the brain.

GENETIC FACTORS

This disease is a genetic autosomal recessive disorder.

LIVING WITH USHER SYNDROME

Loss of both sight and hearing affects communication, mobility and daily living. It can make independent living more difficult to achieve.

We depend on sight and sound to communicate. People with Usher syndrome depend more on their sight for communication, lip-reading and reading sign language. The effects of vision loss can cause serious problems in communication, particularly in poor light.

Members of both the vision impaired and hearing impaired communities need to be aware of this condition to provide support to those members of their communities who have this condition.

Special consideration and understanding is important because both senses of vision and hearing are affected to a greater or lesser degree. Advice about mobility and supporting aids may need to the modified to ensure maximum benefit.

These issues also need to be considered by medical and other people who provide advice and care for people with Usher syndrome.

SUPPORT SERVICES

With the appropriate support, training and aids, people with Usher syndrome can live independently. Services for a person with Usher Syndrome will depend on age and severity of the hearing and vision problems, but will normally include the following types:

• Genetic counselling

• Audio logical support, including fitting of hearing aids when necessary.

• Educational training that, at different ages, may include:

• Preschool and school assessment and placement, independent living training,

and/or career guidance.

Rehabilitation counselling that may include:

• Family support, orientation and mobility training, and/or communication aids.

• The state branches of the Deaf-Blind Society and Deaf and Blind Children's Institute

should also be contacted.

EVENTS