Download Early Detection and Diagnosis of Infant Hearing Impairment

General
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 Hearing loss may lead to delayed language development
and poor school performance.
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 Universal newborn hearing screening allows for earlier
detection and intervention in infants with hearing loss,
which may result in improved language development in
affected children.

 Estimated rates of congenital sensorineural hearing loss
(SNHL) range from 1 per 1000 to 3 per 1000 live births,
depending on the degree of hearing loss.
1969 H.R.R. ;High Risk Regisery 
1994 HRR ;risk factors 
U.N.H.S. Universal neonatal hearing screen 
Delay in Identification
 A significant delay exists in the identification and intervention of
hearing impairment for infants without risk factors. For infants with
parents of high-risk infants first suspected the loss when their infants
were at a median age of 8 months. By contrast, the parents of infants
without risk factors first suspected their infant had a hearing loss when
the child was 15 months old.[10,11] Hearing loss was confirmed in infants
without risk factors at 22 months of age, compared with 12 months of
age for infants with risk factors, and infants were enrolled in
intervention at 28 and 18 months, respectively. Ages of suspicion (7 to 8
months), diagnosis (12 to 13 months), and intervention (18 to 19
months) were essentially the same for infants with severe to profound
hearing loss, regardless of whether risk factors were present. Recent
retrospective studies indicate that infants with hearing loss enrolled in
appropriate early intervention by 6 months of age incur significantly
fewer delays than those who enroll after 6 months of age.[10,12] These
findings are for children with all degrees of hearing loss, as well as for
children with other handicapping conditions.
RF positive 
Susp 8mt/diag 12 mt/treat 18 mt 
RF negative 
Susp 15 mt/diag 22 mt/treat 28 mt 
Without concentration on risk factor 
Susp 7-8 mt/diag 12-13 mt/treat 18-19 mt
UNHS
3mt (before discharge) 
The best method 
Susp 1mt/diag 3mt/treat 6mt 
Principles and Techniques of Newborn Hearing Assessment

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Screening outcomes are either “pass” (no further testing indicated) or “refer” (infant is at risk for
hearing loss and requires diagnostic hearing evaluation).
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The auditory brainstem response (ABR) measures action potential responses of the eighth cranial
nerve to an auditory stimulus.
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Evoked otoacoustic emissions (EOAEs) measure sound waves generated by the outer hair cells of the
cochlea after an auditory stimulus.

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Most newborns with hearing loss do not have obvious abnormalities on physical examination, but
ophthalmologic examination is warranted in these patients because of the high incidence of ocular
defects in patients with severe to profound hearing loss.
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A strong association between hearing loss and impaired vestibular function in infants and children
has been documented.
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Newborns who fail initial hearing screening tests should undergo careful otomicroscopic
examination, because middle and external auditory canal problems are a frequent cause of such
results.
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Diagnostic audiology (or visual reinforcement audiometry for infants unable to understand verbal
instruction) is indicated by the age of 3 months for all infants not passing a newborn hearing
screening test.
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Standardized laboratory tests in infants failing initial screening are not necessary or cost effective.
1)Testing protocols ; 
powerful/objective/rapid/noninvasive/easy/bilateral
Behavioral methods 
2)ABR ; 
Air conduction/10-20 ms delay-30-35 db-25 weak
gestational-/sleep/attention/sedation/morphology
External ear/middle ear/cochlea/auditory nerve/brain stem 
3)Evoked OAE ; 
Transient E-OAE/DP E-OAE 
Cochlea evaluation is the most useful clinical application 
Less time/ nurologic pathology 
Peripheral noise/vernix/EE collapse during first day 
HOSPITAL BASED UNHS
OAE before discharge-OAE outpatient
OAE and ABR before discharge
ABR before disharge-ABR outpatient
2 fail screening test is indication for referring to
diagnostic fallow-up
DIAGNOSIS
1)Hx; maternal diabetus/maternal hypothyroid/alcohol 
2)Physical examination; 
Iris RP/vardenburg 
Anterior neck pitt Turner 
Goiter pendred 
Cleft palate stickler/down/ 
Skull shape craniosynostosis 
Fingers count BOR 
Hypopigmented areas neurofibromatosis 
3)Vestibular function 
4)Otomicroscopy the most common cause ME/EE 
5)MEE fallow up/ABR/2-3 mt/systemic steroids/AOM/VT/after 1 year 
6)Audiology up to 3 mt/AC and BC/ABR/E-OAE/less than 4 mt 226 
7)VRA VRBAL/gift/turning of head/reliable/prematures 6-8 mt/ 
8) Lab. 
CBC/ routin biochemistry/ 
Platelet Fechtner/EBV 
Renal Alport 
MPS

SYNCOPE Jervel-Lange-Wielsen 
9) Genetic AR/AD/X linked /cariotype/connexin 26-/pendred/ 
10)Temporal bone imaging choice;NCECT/craniofacial anomally-progressive 
SNHL/PENDRED/MONDINI/SCC/MRI/
11)Maternal transmitted infections CMV/ SYPHILIS/RUBELLA/TOXO/HSV2/ 
INTERVENTION STRATEGIES
CHL surgery TT/ 
Bone Conuction Amplification BAHA 
Amplification hearing aids/BTE less than 7 Y/O 
Fallow up 3 mt/ 
Choclear implants profound 12 mt/severe 18 mt/contra. 
Cochlear ossification and vestibular nerve
aplasia//////enlarged vestibular aquiduct//post meningitis
deafness/
Early intervention ;primary goal is communication 
IDEA individuals with disabilities education act 
0-3 Y/O/home based/ 
Pediatric Chronic
Sinusitis
General
 Pediatric sinusitis is of primarily infectious origin secondary to immaturity of
the immune system and small developing sinuses.
 Allergy, immunodeficiency, and GERD may be important associated diseases.
 Imaging is not required for medical management in children. Plain films are
not useful in children. CT scans should be obtained only if ethmoidectomy is
being contemplated.
 Medical management consists primarily of parental education regarding the
frequency of upper respiratory tract infections and medical management but
also may include broad-spectrum oral antibiotics as indicated, topical nasal
steroid sprays if the patient is allergic, and appropriate management of GERD.
 Surgical management is considered in patients in whom medical management
has failed and who have infections outside the norm. Options include
endoscopic anterior ethmoidectomy and conservative maxillary antrostomy,
adenoidectomy (to rid the nasopharynx of possible contamination secondary
to biofilms), and rarely, sphenoidotomy.
 Surgical intervention has not been shown to interrupt facial growth in children
and, in appropriately selected patients, is very successful.
Etiology
1)Age
2)URI viral infection
3)Allergy mold PAR SAR
4)Fungal infection
5)Asthma
6)GERD PPI surgery
7)Bacteria Pneumococcus
Imaging
1)Plain film 
2)Coronal CT scan 3-4 weak 
Treatment
Irrigation 
Culture 
Medical primary modality 
Antibiotics ;Coamoxi cipro erythro intravenus 
topical
Decongestant 
Topical steroids 
IVIG 
Surgery 
Adenidectomy 
FESS indications absolute partial 
Enlarged Adenoid Pad
Polyps Secondary to Fungal Sinusitis
Fungal Sinusitis