Download Pediatric Hearing Loss

NUR 584 HEALTH PROMOTION AND CLINICAL
PREVENTION
UNIVERSITY OF MARY
Overview

Introduction

Primary Prevention

Secondary Prevention

Tertiary Prevention

Advice to Providers

Common Errors

Emerging Trends in Screening and Treatments
INTRODUCTION
What is considered hearing loss?
Hearing loss is the impairment
of auditory functions and
can range from mild to
severe.
Hearing loss/impairment
Understanding
Conductive hearing
loss: affects volumes of word
tones. Can be caused by fluid
accumulation.
Sensorineural hearing
loss: affects the structures of
the inner ear or auditory nerve.
Children are often coined as
having learning disabilities.
Mixed hearing loss:
combination of conductive and
sensorineural hearing loss.
Structural damage could be a
cause of this type of hearing
loss.
Speech production
Communication
Hearing loss can affect many areas of a
child’s social language learning. This
type of loss can effect a child’s
understanding of oral language around
them, their production of speech and
their communication with others.
Possible Causes
Hearing loss among children really has a
realm of different causes. The child can
be born with the disorder or it can be
acquired over time.

If the child is born with disorder:
Genetics
Prenatal infections
Neurological disorder
Certain types of medications/drugs used
during pregnancy
(Fetal Alcohol Syndrome)
(Down Syndrome)
(Clef lip/palate)
 If the child acquires the disorder:
Excessive loud noises
Fever driven diseases
Serious head injuries
Perforation to the eardrum
These causes of hearing loss are
easily preventable.
Signs and Symptoms

Speaking differently than other
children of the same age

Imitating others at play

Mumbling, shouting or talking
loudly

Rubbing or pulling at ears

Using gestures rather than words

Speech problems or delays

Difficulties in school

Odd question response

Failing to respond when called

Using high volumes on the TV and
radio
2 in every one hundred children are affected
by hearing loss. The earlier that the disorder
is detected, the better off the child will be in
the future on the terms of communication
and oral speech.
Signs and Symptoms for infants
and toddlers:

Absence of startle response to a
loud noise

Failure to stop crying briefly when
adult speaks to baby (3 months)

Failure to turn head in the direction
of sound (4 months)

Absence of babbling or interest in
imitating simple speech sounds (68 months)

No response to adult commands,
such as “no”
Condition Management
Regular screening should be done with
children and often times can be offered
free of charge at public schools.
Pediatric Hearing Screening should be:
Age appropriate
Requiring of behavioral response
(infants)
Safe and painless
Less than 30 minutes for children and
infants
Management Through Medical Technology:
Hearing aid or other amplification device
Cochlear Implant (surgery)
Therapy Treatment:
Speech therapy
Hearing Loss Prevention
Primary Prevention

Screening Pregnant Women

Infectious teratogens associated with congenital
hearing loss
 Rubella,
cytomegalovirus, syphilis, toxoplasmosis,
herpes simplex, varicella
 Immunize
in pre-pregnancy state or immediate
post-partum to prevent concerns with future
pregnancies.

Counseling during pregnancy

Avoidance of intrauterine medications associated
with hearing loss
 Streptomycin,
gentamycin, chloroquine (antimalarial), ethyl alcohol, diuretics
Primary Prevention


Avoidance of loud noise exposure
Breast feeding and avoidance of
tobacco
 There is no definitive evidence to
support breast feeding and tobacco
avoidance as a means of preventing
otitis media with effusion.
 Despite the lack of evidence, it is
reasonable to encourage mothers to
breast feed and avoid exposing
children to cigarette smoke for other
health related benefits.
Secondary Prevention

Newborn Screening

Screening High Risk Older Children

Evaluation and Treatment of Middle Ear Disease


Hearing evaluation for a child with a history of
middle ear effusion for 3 or more months.
School Based Screening Programs
Review CDC Just in Time Powerpoint Presentation
Tertiary Prevention

School seating

Sign language – Special Education Modifications

Hearing Aids

Cochlear Implants

Further avoidance of loud noises
Advice to Providers

Take parental concerns seriously

Follow screening guidelines

Arrange for proper evaluation

Refer to Multidisciplinary Team

Speech therapy

ENT specialist

Audiologist
Common Errors


Not screening high-risk neonates

Not all states follow a universal screening program for
neonates.

Any child with the following risk factors noted in the
following slides should be screened.
Inaccurate audiograms


Audiogram accuracy is affected by improper
techniques and background noise. Can result in falsepositive results.
Using Tympanometry as a screening tool

Tympanometry is a useful diagnostic tool, but not
recommended for universal screening.

Can result in false positive results and inappropriate
referrals.
High Risk History

Parental concern

Bacterial meningitis

Head trauma with LOC or skull fracture

Signs or other findings associated with a syndrome

Ototoxic medications

Chemotherapeutic agents, aminoglycosides used with loop
diuretics

Recurrent or persistent otitis media with effusion for 3 months

Family history of hereditary childhood hearing loss

In utero infection (rubella, CMV, syphilis)

Neurofibromatosis Type 2 and neurodegenerative DO

Anatomic deformities and other disorders that affect
Eustachian tube function
Emerging Concepts in
Screening and Treatment

Screening Technology


Rapidly advancing with handheld devices that are more accurate
and user friendly
Hearing Aid Technology

Smaller and better able to filter background noise

Closed-caption TV; Computer games for deaf

Special telephone systems, texting

Cochlear Implants

Research on Efficacy of Screening and Treatment


As discussed in the introduction, many recommendations are not
based on solid evidence; but continued research into the validity
of existing and new screening tools and on the efficacy of early
diagnosis and treatment is ongoing.
Genetic screening/identification

Genetic mutation screening and possible genetic manipulation
may be in the future.