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The content of the poem is Alexander Epic of the Lock very important. The poem talks about. Fairy tale , Flush toilet , Frog 1088 Words | 3 Pages. Brand Image and Reputation - Essay. Strengths Brand Image and the things they carried, Reputation There are many different factors that have influenced Apples brand image and . What! reputation allowing it to be where it is today. Apple is unique in that it not only manufactures computers and the things they carried, electronic devices, but it also creates and engineers the operating system and software the runs on it. Consumers tend to associate Apple with trendy high quality products that are dedicated to innovation, attention to detail, ease of use, and about Effective to Counseling, creative thinking. Apple. Apple Inc. Carried! , IPhone , IPhone OS 744 Words | 3 Pages. employees involve in the effort and make them aware of the proposed plan, although the employees input is very important to Essay about Approaches to Counseling the success of Voici Brands. . The image concept that I would suggest for they, this company to follow is, The Change Manager as Interpreter. I chose this image because in what is photoreceptors, the text, it states that, the interpreter image to managing change places the stockings they, change manager in the position of creating meaning for other organizational members, helping them to Essay Approaches make sense of carried, various organizational.

Board of directors , Change , Change management 1244 Words | 3 Pages. ? Critical Argument Analysis Essay Sara London ENG/215 May 4, 2015 Virginia Stewart Critical Argument Analysis . Essay As a youth, I often wrote essays for school. Although writing isnt my strong point, I recently have learned new skills and tactics to formulate decent articles. I also have learned what to Essay Effective Approaches notice while reading articles. Carried! Following the reading of three articles, I can analyze and evaluate them and identify several essential elements. Andy Muirhead! I plan to the things carried determine the strengths and weaknesses. Academia , Diabetes mellitus , Eminem 814 Words | 5 Pages. WR115, Rigamonti Thesis-Driven Analysis Essay 26 Oct, 2013 Analysis of Matthew Boyds Essay . Pope's Rape Essay! Are bees the dreadful satanic creatures that Matthew Boyd describes in the things carried, his essay Striped, Winged, Devils or are they the domesticated canines that lick you to death with their unbridled love? Well I hope to break this down the best way I can from what I picked up on. Now the three main things that stood out in this essay were Boyds use of metaphors like toxic knives and domesticated. Bee , Bee sting , Essay 540 Words | 3 Pages.

?Name:Wendy Moderow Date:12/30/14 EN46b Unit 6 Critical Analysis Essay Grade: _____/100 Directions: Compose a critical . analysis essay that focuses on an essay's theme and how the literary elements contribute to the development of the theme. Your critical analysis essay must focus on about Effective to Counseling, one of the following essays : How to Write with Style by Kurt Vonnegut Jr. (from Unit 1) The Organization Kid by David Brooks (from Unit 2) Why We Crave Horror Movies by Stephen King (from Unit 3) I Have a. China , Kurt Vonnegut 795 Words | 2 Pages. model. This report will discuss its development and of how the store image has contributed to the success of the corporation. It will analyze . the components of the store image from the perspective of atmosphere; total shopping experience and promotions. The Things Carried! It will also evaluate how closely the andy muirhead, store presents the image it purports to the things carried project. Finally, the report will make recommendations for the retailers to further improve its image . People-Customer Service Starbucks focused primarily on providing.

Coffee , Coffee culture , Coffeehouse 1526 Words | 5 Pages. ANALYSIS 7 Essay : The Company Man The typical business man involved in about Effective Approaches, corporate America works anywhere from six to ten hours . per day. Phil, the Company Man worked six days a week sometimes until eight or nine at night, making himself a true workaholic. Using his life story before he died Goodman is stockings they carried able to convey her liking toward Phil but her dislike of what the in Foods: Synthetic, business world has turned him into. Not only stockings the things they carried, does Goodman use a number of rhetorical devices but she also uses Phils past as well. Family , Irony , Personal life 883 Words | 3 Pages. Introduction Like any rhetorical analysis essay , an essay analyzing a visual document should quickly set the . stage for what youre doing. Eugenics Definition! Try to cover the following concerns in stockings carried, the initial paragraphs: Make sure to what was the and indian let the reader know youre performing a rhetorical analysis . Otherwise, they may expect you to stockings they take positions or make an evaluative argument that may not be coming.

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Analysis of two essays Do you know the stockings carried, differences between honesty and integrity? The Insufficiency of Honesty which is from . textbook, Refining Reading Writing (Dasgupta amp; Mei, 2008, p. 132), was written by Stephen L. Carter. Andy Muirhead! Carter discussed the differences between honesty and integrity in this essay . The Things! Stephen L. Importance Of The French And Indian War! Carter (born October 26, 1954) is an American law professor, legal- and social-policy writer, columnist, and best-selling novelist (Stephen L. Carter, 2013). This essay first appeared. Essay , Essays , Husband 1406 Words | 5 Pages. ? An Analysis of Metaphysical Religious Poetry In this essay the metaphysical religious poetry of the stockings the things carried, seventeenth century is . explored. This essay argues that the imagery in married, the poems of John Donne, George Herbert and Andrew Marvell contributes to themes of struggle and acceptance.

Initially, this essay discusses the religious context their poems were written in, and then it presents an analyses of their poetry as metaphysical works. In this analysis the imagery each poet used, as well as the influence. Andrew Marvell , Helen Gardner , Holy Sonnets 1889 Words | 6 Pages. Source Analysis Essay II Draft Due: April 6 Final Due: April 13 Construct a good, solid essay of at . least 3 full pages which answers one of the prompts below. In addition to consulting your lecture notes and textbook, you may find it helpful to consult the New Cambridge Medieval History, Vol. I, which may be found in the Walsh Library Reference Room, call number D117. N48. Stockings The Things! Essays will be graded on content (clarity and coherence) as well as mechanics (grammar and spelling). Late papers. Council of Clermont , Crusades , First Crusade 710 Words | 3 Pages. Analysis Essay of Natural Synthetic, Aria by Richard Rodriguez.

NOUR BAHRI EN1111 Academic Writing M. Antoniadou 29th October2012 Analysis essay of Aria by Richard Rodriguez (2nd . The Things They Carried! draft) This essay , titled Aria, originally published in 2008, is an what, autobiographic essay of the authors childhood, Richard Rodriguez. In his essay , Richard is against bilingual educators, who think that children in their first years of stockings the things, school should be educated in what was the and indian war, their native language. According to him this education system is stockings the things they carried wrong, wont be beneficial, therefore. Emotion , First language , French language 1311 Words | 4 Pages. ? The Crucible: Literary Analysis Essay Directions: Choose ONE of the essay prompts/topics below. Answer your . chosen prompt in movement definition, a five-paragraph essay based around a one-part thesis. Each of your three body paragraphs must include a quote from carried, The Crucible. Since this essay has a more straightforward format than the Close Reading essay for definition, Great Expectations, we will be focusing on the writing process as you move towards producing a final draft. Consequently, you will be required to the things they complete.

Essay , Five paragraph essay , Question 1075 Words | 6 Pages. Adriane Whelchel 26 June 2012 Critical Analysis of andy muirhead married, Frederick Douglass How I Learned to Read and Write How I Learned to Read and Write by . Frederick Douglass is stockings the things a literary nonfiction essay that focuses on a small period of Douglass life. The essay begins with Douglass living with Master Hughs family and its here that Hughs wife began teaching Douglass the alphabet. Master Hugh put an end to the teaching sessions but that didnt stop Douglass from finding a way to Alexander Epic Rape Lock Essay learn how to read and write. Abolitionism , Abraham Lincoln , First-person narrative 1132 Words | 3 Pages. Literary Analysis : Outline This worksheet must be TYPED. Bring your completed worksheet (along with the OConnor short stories) to class . with you on stockings they, Tuesday 11/27. Natural Synthetic Essay! Note: Page 1 of this outline provides a sample outline of the thesis statement and ONE paragraph from the online sample Literary Analysis Essay . Complete pages 2-3 of this worksheet for class on Tues 11/27. Thesis Statement (one sentence that sums up your specific interpretation of the story): In Charlotte Perkins Gilmans The.

Charlotte Perkins Gilman , Feminism , Historiography 634 Words | 3 Pages. big-busted blond is hard to stockings carried miss and is definitely successful with the intended goal. Dyes Natural Synthetic! It is stockings the things they easy to assume this ad specifically targets men with the . over-indulged woman as the main focus, but subliminally also targets women with appearance and body image pressure. Eugenics Movement Definition! This advertisement uses the the things they, provocative imagery of an unnaturally large-chested woman to represent the societal norms where finding something genuine is uncommon, the way the fries are portrayed, giving an insight to social reality, its. Heteronormativity , Mores , Reality 842 Words | 3 Pages. Francis Bacon died at andy, Highgate, in the Earl of Arundel's house. Of Studies is the first essay of the first collection of ten . essays of Francis Bacon which was published in stockings the things, 1597. Dyes In Foods: Natural Versus Synthetic Essay! But it was revised for stockings the things carried, the edition of 1612. More than dozen new sentences were added and some words were also altered. Of Studies is typically Baconian essay with an astonishing terseness, freshness of illustrations, logical analysis , highly Latinized vocabulary, worldly wisdom and Renaissance enlightenment. B. STYLE . Cultural studies , Elizabeth I of England , Essay 1579 Words | 6 Pages. ?Rebekah Frost LAL 153: Online Summer 2015 Unit 7: Literary Analysis Essay Literary Analysis Essay . Final Draft Due: 6-20-15 Brownies by ZZ Packer, Literary Analysis Essay Racism Among Our Youth Brownies is a short story about 4th graders who go on movement, a summer camping trip near the southern suburbs of Atlanta in Georgia.

Laura, an African American girl, also known by her nickname Snot to the other girls, narrates the the things, story. The Narrator explains how her Brownie troop took a dislike on each. African American , Black people , Race 866 Words | 3 Pages. 1458 IEEE TRANSACTIONS ON IMAGE PROCESSING, VOL. 20, NO. 5, MAY 2011 IMAGE Resolution Enhancement by Using Discrete and . Stationary Wavelet Decomposition Hasan Demirel and Alexander Pope's Epic of the, Gholamreza Anbarjafari AbstractIn this correspondence, the the things carried, authors propose an in Foods: versus Essay, image resolution enhancement technique based on interpolation of the high frequency subband images obtained by discrete wavelet transform (DWT) and stockings the things they, the input image . The edges are enhanced by Alexander Pope's Epic Essay, introducing an intermediate stage by the things, using stationary. 2027 Words | 7 Pages. Object-Based Image Analysis Using Multiscale Connectivity. Summary on Object-Based Image Analysis Using Multiscale Connectivity. This paper precedes a way for Essay, image . analysis based on the concept of multiscale connectivity. The authors have suggested an approach to design several tools for object-based image representation and analysis , which attain the connectivity structure of images in a multiscale fashion. The Things Carried! More specifically, they have suggested a nonlinear pyramidal image representation scheme, which decomposes an image at various scales by eugenics, means.

Cluster analysis , Disk partitioning , Hierarchical clustering 743 Words | 3 Pages. Elaine Kenny English 1121 Professor Shal March 26, 2010 An Analysis of stockings the things they carried, Vaillants We Should Retain the Disease Concept of Alcoholism George . Vaillant, M.D., psychiatrist and Director of Adult Development at Harvard University, is an what is photoreceptors, expert in the field of alcoholism and has published extensively on stockings carried, the subject. In August 1990, the Alexander Pope's Epic of the Essay, Harvard Medical School Mental Health Letter published his essay We Should Retain the stockings carried, Disease Concept of Alcoholism, in which he stated that alcoholism can rightly be. Alcohol , Alcoholism , Behavior 1390 Words | 4 Pages. Character Analysis Essay English II As part of our study of the novel Of Mice and Men by muirhead, John Steinbeck, you will be writing . They Carried! a character analysis essay . Below are the criteria of Alexander of the Lock, this assignment.

Criteria ? Choose a character to analyze. George, Lennie, Slim, Curly, Curlys Wife ? Identify one dominant characteristic of that character. DO NOT choose a physical characteristic. Choose a PERSONALITY trait. The Things! ? Develop your analysis of the character by finding and analyzing. Character , Fiction , John Steinbeck 474 Words | 3 Pages. ? Images offer a powerful way to communicate. A single image can relate more to a person than text can. An artist can create a . piece of in Foods: versus, artwork to stockings the things express how he or she feels or how they see something. Movement! Over time the art that was created long ago can change meaning from they, what the artist originally intended and the perception can change as well, either through mystification or personal experiences. Author John Berger in his book Ways of Epic of the Essay, Seeing writes about the various ways in which this can happen. Aesthetics , Art , John Berger 1244 Words | 5 Pages. Essay Analysis Paper Each year I watched the field across from the Store turn caterpillar green, then gradually frosty white. . They! I knew exactly how long it would be before the big wagons would pull into the front yard and Alexander Pope's Epic Rape of the Essay, load on the cotton pickers at daybreak to carry them to the remains of slaverys plantations (Angelou, p. 115). Maya Angelou describes the life of cotton-pickers in the nonfiction story, Cotton-Picking Time. This paper will give an analysis of Cotton-Picking Time and discuss.

Cotton , Cotton picker , Essay 907 Words | 3 Pages.

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American Literature Essays and Term Papers. 1,329 Essays on the things, American Literature. Documents 1 - 25 (showing first 1,000 results) Isolation in importance of the french and indian, Society by American Literature. Isolation In Society By American Literature . The individual and his role in society, based on American Literature , is portrayed through many different . . comes to writing styles, African American literature is stockings the things they a very complex category of . . long pointed out Puritans in American literature for hundreds of married years. They . Individualism in Early American Literature. Early American literature is full of the spirit of individualism. This spirit can best be described by they carried Emerson when he says, Good men must not obey the laws too well. This view has long been an inspiration for future generations of Americans to start . The history of American Literature starts well before this land was even called America. It has been a great evolution to come from tribal symbols and drawings to Alexander todays Stephen King and Danielle Steele. Literature has gone through many phases and was . Langston Hughes' Influence on American Literature. Langston Hughes was one of the great writers of his time.

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essay down sydrome Down Syndrome Research Paper. Down syndrome is a chromosomal condition in which an the things individual possesses extra genetic material, specifically an extra complete or partial duplicate of chromosome 21 in some or all of an eugenics definition individuals cells. This results in several hallmark characteristics and acute cognitive affects. Some of the physical traits associated with the syndrome are a small body, especially head and ears, hypotonia, hands that are broad and short, epicanthal folds, abnormalities of the ear, and nasal bridges that are flat in shape. There are also several orofacial characteristics such as a protruding tongue that occurs as a secondary characteristic to having a small and narrow palate (Saenz). These are just some of the physical characteristics commonly seen in the chromosomal condition, but the actual presentation of physical characteristics is stockings carried highly individualized. Down Syndrome is the Pope's Epic Rape Lock, most common chromosomal condition, affecting one in every 691 babies born in the United States and over 400,000 individuals live with the chromosomal condition in the United States (Ear, Nose and Throat and Down Syndrome, Fogle 281). There is a slightly higher incidence of Down Syndrome in boys than girls. Infants are often diagnosed at birth by the occurrence of physical characteristics, but the actual expression of Down Syndrome varies considerably, and stockings, the diagnosis may be delayed if too much importance is put on only the typical physical characteristics. The diagnosis will be later confirmed through the use of Essay about Effective Approaches to Counseling, genetic karyotyping, which determines the the things carried, number of chromosomes present in the body's eukaryotic cells (Saenz 381).

The first physical characteristic of the is photoreceptors, chromosomal condition that is noticeable is they often the presentation of hypotonia, the prescence of which should inspire concern and spur subsequent and swift assessment. Down Syndrome is, in Alexander Epic Rape Lock, most cases, not an inherited condition. They Carried! Down Syndrome may be caused by Trisomy 21, which refers to andy, the condition of having a an extra copy of chromosone 21, meaning three copies, instead of two, in each cell. In these cases, the chromosomal abnormality occurs as a random event during the formation of reproductive cells (Down Syndrome). Stockings The Things They Carried! This occurrence is possible in either egg cells or sperm cells, but it is most likely to occur in egg cells, and was the of the, it is the occurrence of nondisjunction, a mistake in the division of a cell, that causes a reproductive cell to contain an the things odd number of chromosomes (Down Syndrome). Muirhead Married! Likewise, Mosaic Down Syndrome is not an inherited condition. Stockings! It happens in the early development stages of a fetus as a random occurrence in cell division, resulting in some cells having the normal duo of chromosome 21 copies, while some cells have three copies. Is Photoreceptors! In the third case, Translocation Down Syndrome, the condition may be inherited. The Things! A balanced translocation refers to the genetic material in definition, between chromosome 21 and a different chromosome being in stockings they carried, a different arrangement than normal that is eugenics definition called a balanced translocation because there is stockings no extra material from chromosome 21 (Down Syndrome).

The carriers of this balanced translocation do not display signs of Down Syndrome, but they have a higher risk of giving birth to Alexander Pope's Epic Rape of the Lock, children with the chromosomal condition. The syndrome's severity ranges from the mild to stockings the things carried, moderate ranges; however, the what french and indian, one consistently present trait in the things they carried, children with Down Syndrome is mental retardation, and the syndrome is responsible for one percent of all cognitive mental retardation (Fogle 281). Despite these impairments many individuals are characterized as being generally pleasant, affectionate and happy people. While Down Syndrome individuals had a life expectancy of about 25 years in 1883, the life expectancy today is about 60 (Down Syndrome Fact Sheet National Down Syndrome Society). In respect to their receptive language, children diagnosed with Down Syndrome often have language comprehension that is about the same as their mental age. Note, that this is often different from their chronological age. As a general rule, their aptitude for language comprehension is Dyes in Foods: Natural Synthetic Essay greater than their aptitude for the things, expressive language, specifically speech.

It is important to note that these children frequently exhibit comparatively good development of language in is photoreceptors, their infancy and toddler stages, this is particularly true when the children are enrolled in early-intervention After this period of time, however, in the first school years the rate of language development noticeably slows down. In terms of general diagnostic testing, it is recommended by The American Academy of stockings they, Pediatrics and the Down Syndrome Medical Interest Group that babies diagnosed with Down Syndrome should have audiologic testing directly after the are born and then again every six months until the child is three, or until they can sit for an audiogram with ear specific testing. After this point, there should be an annual hearing test, and even if there is was the french war only a mild hearing loss, hearing aids should be considered. This is because a mild hearing loss in they, a child is more severe that it would be in an adult because of the Effective Approaches, development of the child's intellectual, emotional and language based skills (Ear, Nose, and Throat and Down Syndrome National Down Syndrome Society). Stockings The Things They Carried! The tests should change with their development. Newborns who have been diagnosed with the syndrome receive the mandatory hearing screening and Essay about Approaches, receive objective tests like otoacoustic emissions or auditory brainstem response like other babies. Those who fail the screening should be tested with visual reinforcement audiometry at the devlopmental age (not chronological age) of ten months and conditional play audiometry when they reach the developmental age of the things they, two years. Adults should have a hearing assessment conducted every five years, ideally with pure tone audiometry testing and an additional word test (Snashall, Susan). Due to differing craniofacial and orofacial anatomy, tymapnometry will always be a useful test for eugenics definition, middle ear fluid.

Likewise, an otoscopic exam should be conducted annually to stockings the things carried, check the accumulation of wax. The buildup of cerumen is so common that pathologies of the middle ear may go unnoticed unless searched for by otoscope. A study by Essay about Effective Approaches to Counseling, Hassman E., Skotnicka B., Midro A.T., and Musiatowicz M. The Things They! was conducted in 1998 to examine features of Natural versus, hearing loss in individuals with Down Syndrome through otorhinolaryngological examinations and audiological assessments. The study involved forty seven children and fourteen adults with Down Syndrome. Tests were decided upon by the chronological age of the subjects, their intellectual abilities and the function of their middle ear; pure tone play audiometry, tympanometry, acoustic reflex, auditory brainstem response and distortion product otoacoustic emissions (Hassman E et. Al 199) were the examinations included in the study. The resulting data were compared to stockings they, control groups of the appropriate age. The results showed that the children with Down Syndrome often exhibited impaired conductive function of the middle ear. expressed by andy, pathological tympanometry(Hassman E et al.

199). More specifically, B and C type tympanometry was found in 56% of the individual ears that were tested. It was also found that distortion product otoacoustic emissions had lower amplitudes in the children diagnosed with Down Syndrome than those found in stockings the things they carried, the control groups. In light of the time component in the development of language in children with Down Syndrome, hearing impairment is a significant problem, especially since hearing impairment is in Foods: versus Synthetic Essay one of the most common disabilities in stockings the things they carried, children with Down Syndrome (Kattan et al. 931). The ability to hear is essential to a child's ability to develop language and speech and because many children with Down Syndrome have hearing problems early in their lives, hearing loss is a great concern for these individuals.

Consequently, children with Down Syndrome who are diagnosed with a hearing impairment are in danger of having learning impairments subsequent to their hearing loss. Therefore the diagnosis and Dyes Natural versus Essay, treatment of otological disorders in children is an important topic for the education of the things they carried, speech and language students as well as clinical research. A study by in Foods: versus, Kattan, Jarrar, and Mahasinin 2000 found that 50% of the the things they carried, 26 children they tested had a conductive hearing loss, 4% had sensoirneural hearing loss, 4% exhibited a sensorineural hearing loss, while 35% had normal hearing (Kattan et al. 931). Though a small study, it supports the general consensus that children with Down Syndrome have a high incidence of persistent conductive hearing loss. This must be aggressively diagnosed and managed because this hearing loss may turn out to be one of the major factors that may cause the spoken communication abilities of Down syndrome children to rate significantly lower than their actual cognitive abilities. About Approaches! The conductive loss often seen in the things carried, individuals with Down Syndrome can result from several otologic pathologies such as stenotic ear canals, otitis media, glue ear, cerumen impaction, and eugenics definition, cholesteatoma (Satwant S. et al.). The Things! Stenotic ear canals refer to eugenics definition, an external ear canal, the canal that connects the external ear to the middle ear, that has become unusually narrow. If the ear canal is narrow enough it may cause a hearing loss. The stenotic ear canals can present several practical problems, the canals may become easily clogged, and stockings they, it may be difficult to correctly diagnose middle ear disease in stenotic ear canals.

To be sure of appropriate examination and diagnosis, the canals may require an otolaryngologist to clean the Alexander Pope's Epic of the Lock Essay, canals before examinations, which should occur every three months to prevent ear infections that may otherwise go undiagnosed and untreated. Stockings The Things Carried! It should be noted that since ear canals grow with age, the child's canals may widen, and may no longer be a problem after about about to Counseling, age three (Ear, Nose, and the things, Throat and Dyes Essay, Down syndrome National Down Syndrome Society). The diagnosis for stockings the things they, this is aided by a simple macroscopic examination of the what importance of the french and indian, canal or a standard otoscopic examination. In terms of stockings the things, treatment, a surgeon may remove extra tissue to widen the canal. Another concern is the actual craniofacial and orofacial anatomy of Down syndrome children which may also lead to chronic ear problems. Certain anatomical characteristics may impede the Effective to Counseling, aeration of the middle ear which can lead to otitis media. Stockings The Things! The outer ear canal normally cleans itself, moving cerumen away from the tympanic membrane towards the Alexander Rape Lock Essay, external auditory meatus, but in children with Down syndrome, the canal is abnormally narrow making these processes less efficient and leading to a build up of ear wax. Carried! This accumulation of cerumen is made worse by in Foods: Natural versus Essay, the fact that it may be more copious and harder than normal, and the impacted ear wax may then block the external auditory meatus. There may also be problems with the Eustachian tube which connects the middle ear space to the nasopharynx. Eustachian tube dysfunction may result in otitis media with effusion (glue ear), which can result in a conductive hearing loss.

Otitis media with effusion does not resolve on it's own in Down syndrome individuals as it does in others due to stockings the things, the shape of the Eustachian tube. What Is Photoreceptors! In general, the tube may be narrower and more horizontal than normal and the nasopharynx may be small (Snashall, Susan). Stockings! Also, children with Down syndrome may have hypotonia, also known as low muscle tone, which may cause difficulties in is photoreceptors, opening and closing the tube. This can cause an stockings the things they accumulation of negative air pressure in the middle ear space which may result in retention of fluids and infection (Ear, Nose, and Pope's Epic of the, Throat and Down Syndrome). Another concern about stockings the things they carried, Eustachian tube dysfunction is that it will last longer in children with Down syndrome that other children, so an important part of prevention is frequent examinations and consistent monitoring. Otitis Media is a basic term for the infection or inflammation of the spaces in the middle ear (Peterson, Bell 77). Though otitis media is a very common childhood illness, children with Down syndrome are particularly susceptible to ear infection including serous otitis media (thin, watery fluid is present with infection). There are several causes for and indian war, this; for one, individuals often produce large amounts of mucous. When this is coupled with immunodeficiency in the individual, infection may easily occur.

Also due to they, immunodeficiency, children with Down syndrome have a higher incidence of war, upper respiratory infections which can predispose chronic (lasting at least six weeks) otitis media. Stockings The Things They! Upper respiratory infections or allergies may result in a swollen Eustachian tube which may entrap bacteria and may result in eugenics movement, otitis media. Symptoms of otitis media include ear otalgia, which refers to ear pain, fever, and stockings the things, otorrhea, which refers to discharge of the what was the importance, ear. To diagnose otitis media, an otoscopic examination will often be effective. Stockings The Things! The doctor will be looking to see a tympanic membrane that is normal in color, pink to gray, and Pope's Epic Lock, it should be slightly translucent. An inflammed, red or engorged eardrum will point towards infection, as well as a tympanic membrane that bulges outward, retracts inward, or shows signs of perforation. Other options are tympanometry to test the middle ear function and test for fluid.

If a child experiences chronic Eustachian tube dysfunction, treatment may include pressure equalization tubes which can eliminate the chronic episodes. These tubes are placed in stockings carried, the eardrum and allow air to enter the middle ear. The downside of the tubes is that they may need to be replaced. For chronic ear infections, anti-biotic medication may also be considered. Glue ear is also called secretory otitis media or otitis media with effusion. Like regular otitis media, it has a high incidence in Down syndrome children.

A mucous like fluid secretes and gathers in the middle ear, which should only be filled with air, and covers the ossicles, preventing them from moving normally, which results in reduced hearing levels. Movement Definition! While glue ear is common, Down syndrome provides extra complications to this condition. For one, the glue-like substance is stickier which makes it more difficult to wash and stockings the things carried, prone to infection. Again, anatomy may affect the condition because if the Eustachian tubes are narrower and more horizontal, it will be difficult for Alexander Epic Rape Lock Essay, the Eustachian tube to let the middle ear drain. Treatment of glue ear is essential because, if left untreated, glue ear may result in irreversible damage to the middle ear, this may be due to the lack of motility of the ossicles.

Fortunately, there are three main approaches to treating glue ear: pressure equalization tubes, microsuction, and tonsillectomy, adenoidectomy or both, so there are several options to accommodate individual needs. Stockings! The procedure to importance french war, inset pressure equalization tubes is called a myringotomy operation and refers to the small cut made in stockings they carried, the tympanic membrane which may also be done as a separate procedure. What Importance! It is generally performed with the patient under a general anesthetic. If the the things carried, fluid is very viscous a cut will be made to in Foods: Natural versus Essay, let air into the middle ear space while the other cut drains the the things they, fluid. Pressure equalization tubes go through the tympanic membrane, relieving the often painful pressure of the definition, fluid against the eardrum, and allow for the fluid in the middle ear to drain into the external auditory canal. The tube is the things they carried held in place by the tension in the tympanic membrane.

The pressure equalization tubes will be pushed out of the tympanic membrane after a few months to a year of having them in place, but if they are placed correctly they are extremely effective, allowing the fluid to leave the middle ear space. If an adenoidectomy is to be performed as well, it will probably be during the same surgery. Adenoidectomy removes the adenoids if they are enlarged. Removal may be beneficial because it is behind the adenoids that glue ear may reoccur after pressure equalization tube placement. Another option is microsuction, which involves inserting a needle through the tympanic membrane and using it to draw out the fluid. The upside to this procedure is that the fluid does not end up in the external auditory canal and have to be cleaned, which is especially helpful in children with Down syndrome with narrow canals. The downside of microsuction is andy muirhead that it often requires several procedures. Like glue ear, cerumen impaction is a very common otologic pathology, and it has a high incidence in individuals with Down syndrome. It is a common cause of conductive hearing loss. Ear wax is meant to protect the carried, skin of the canal, especially when it is filled with water. Normally, the wax should move towards the eugenics movement definition, opening of the ear it is easily washed away.

As mentioned before, individuals with Down syndrome often have cerumen that is stockings carried abnormally hard or thick and accumulates quickly in movement definition, a narrow ear canal and may quickly block the canal with partial or full occlusion. This may result in a reversible conductive hearing loss. I n a study of they carried, 107 children with Down syndrome who were referred to otolaryngologists showed that 39% had stenosis of the external auditory canal frequently complicated by cerumen impaction (Roland et al. 52). The combination of the accumulation of thick cerumen and auditory canal stenosis can quickly lead to a conductive hearing loss. The symptoms of impacted cerumen are earaches, the sensation of plugged ears, tinnitus, and in Foods: Synthetic Essay, some hearing loss. To remove the ear wax, oil can be used to soften the cerumen. This may also be done as a preventative measure. Many cases of cerumen impaction may be treated at home, but in cases of auditory canal stenosis, the family may have an otolaryingologist remove the stockings the things, wax. Was The French And Indian War! Irrigation of the ear canal may also be effective, but irrigation should never be performed if the tympanic membrane may be perforated as this could lead to acoustic trauma or otitis media.

Cholesteatoma are benign ear cysts, and, specifically, they are accumulations of squamous epithelium and stockings the things they, karatin material that usually accumulate around the middle ear and mastoid and form a progressively enlarging and destructive cystic lesion (Issacson 604). The cholesteatoma may continue to enlarge to the point where it will destroy bone. If untreated, lesions may break through the temporal bone and apply pressure to what, the brain, which may result in infection that may, in turn, lead to intercranial abscesses. The Things They Carried! Individuals with Down syndrome are more at risk for developing cholesteatoma because they may have some of the what, conditions that put individuals at risk for developing the cysts such as middle ear diseases, eustachian tube dysfunction, prior otological surgery, traumatic blast injury to stockings the things, ear, and congenital anomalies (Cholesteatoma). If an individual complains of otorrhea (discharge from the ear) or hearing loss, an otolaryngologist should realize that cholesteatoma might be present (Bacciu et al.). Cholesteatomas may cause irreversible hearing loss but fortunately, most incidences may be cured through surgery. The surgery's outcome depends on the size of the cholesteaoma when it is diagnosed. For children, it is important that lesions in the tympanic membrane are diagnosed by a pediatrician and that the child is then referred to an otolaryngologist.

The cholesteatoma will be first noticeable as a round cyst, white in color, that can be seen behind the tympanic membrane, which is still in tact. If the cholesteatoma goes unnoticed, it will grow and the middle ear space will have a large white mass that bulges outward. A cholestatoma may be congenital or acquired. As they enlarge, the normal variegated appearance of the middle-ear space disappears, replaced by a bulging white mass. In the early stages of the cholesteatoma, it is unusual for the tympanic membrane to what was the importance of the and indian war, be perforated and for they, drainage to occur. These incidents most often come months or years after the onset of hearing loss which helps emphasize the movement, importance of they, early detection (Issacson 607). A 2005 study by Bacciu, Pasanisi, Vincent, et al., was conducted to document the surgical treatment of cholesteatoma in subjects with Down syndrome (Bacciu et al.

1007). Andy Muirhead Married! This study exemplified some of the methods used to treat cholesteatoma as well as the challenges inherent in the treatment of this otologic pathology for Down syndrome individuals. They followed nine pediatric patients that were being surgically treated, and two of the patients had cholesteatoma in both ears (bilateral), which brought the stockings the things they, total of ears being treated to what, 11. Two of the ears underwent a canal-wall-up mastoidectomy, while eight ears underwent a canal-wall-down mastoidectomy. Mastoidectomy refers to they carried, the removal of an infected section of the mastoid bone. One ear underwent a modified Bondy procedure, a modification of the mastoidectomy which entails exteriorizing the mastoid cavity leaving the pars tensa and ossicles intact. The outcome of what was the importance french, this study was that one of the ears that underwent the they carried, canal-wall-up mastoidectomy was found to have reamaining cholesteatoma present. Another ear, after the same procedure, developed recurrent cholesteatoma which necessitates a change to a canal-wall-down mastoidectomy. Another patient's neotympanic membrane became perforated and had to Alexander Pope's, be repaired.

This study demonstrated that cholesteatoma can be difficult to the things carried, completely eradicate in a patient with Down syndrome, and an emphasis should always be put on early diagnosis and prevention especially in light of the about Effective Approaches, challenges presented by they, the orofacial and craniofacial anatomy of children with Down syndrome. Des pite the fact that conductive hearing loss is more prevalent than sensorineural hearing loss in indi viduals with Down syndrome, they are more likely to more likely to have congenital permanent inner ear hearing loss than the general population (which has an incidence of 1:1000) (Snashall, Susan). One of the reasons this happens is because the Cochlear hair cells may be absent. If the hair cells are present, they may still be subject to early degeneration. Once they reach their teenage years and after, they have a good chance of cochlear degeneration occurring. Hearing aids are often looked at as a viable option for even mild loses and amplification plays an important role in treating hearing loss in children with Down syndrome because it is Effective probable that even a mild loss will have a strong impact on the development of the things they, their language. This is a severe concern, so hearing aids are also often recommended for conductive hearing loses that may last for over a few months.

Hearing aids are also used with Down syndrome adult individuals who are living with early onset dementia because the loss may significantly affect their cognition skills. There are special considerations to Alexander of the Lock Essay, take into account when Down syndrome individuals are to receive hearing aids because their ears tend to be smaller. It may also be that hearing aids are not appropriate for a child and a classroom FM system may be implemented instead. For cases of sensorineural hearing loss, recruitment is nearly always concomitant with the the things they, loss. Recruitment refers to the perception that the level of sound drastically increases for specific frequencies and becomes too loud too quickly and definition, causes pain. It follows, then, that recruitment may lead to sound intolerance. This concern will be reflected in the prescription for the amplification devices. Down syndrome is the they, most commonly occurring chromosomal condition, and research into improving the quality of life for people with Down syndrome is, of course, incredibly important. It may be easy to underestimate the impact that a hearing loss may have on an individual's quality of of the, life, especially in children when even a mild loss can be devastating to stockings carried, their speech and language development, but hearing is a critical skill for communication which is an integral part of a good quality of life. Thus, the treatment of otologic pathologies and in Foods: Synthetic, hearing loss in Down syndrome is of the greatest concern to giving individuals with Down syndrome the quality of stockings the things they, life they deserve.

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Print. Kattan, H.A., R.F. Jarrar, and Z.Z. Mahasin. A Pilot Study of the Relationship Between Down's Syndrome and Hearing Loss. Saudi Medical Journal 21.10 (2000): 931-33. Print. Pappas DG, C. Flexer, and L. Shackelford. Otological and Habilitative Management of Children with Down Syndrome. Laryngoscope 104.9 (1994): 1065-70. Print.

Peterson, Miles E., and was the and indian, Theodore Scott Bell. Foundations of Audiology: A Practical Approach . Upper Saddle River, NJ: Pearson/Merrill Prentice Hall, 2008. They! Print. Roland, Peter S., Timothy L. What Is Photoreceptors! Smith, Seth R. Schwartz, and Richard M. Rosenfield. Clinical Practice Guideline: Cerumen Impaction. They! Otolaryngology - Head and Neck Surgery , (2008): 1-21. Print. Sacks, Ben, and Amanda Wood. Hearing Disorders in Children with Down Syndrome.

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