نام بهخدا

 Early Detection and Diagnosis of Infant 

Hearing Impairment

General

      Hearing loss may lead to delayed language

development and poor school performance.      

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 Regisery1994 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 positiveSusp 8mt/diag 12 mt/treat 18 mt

RF negativeSusp 15 mt/diag 22 mt/treat 28 mtWithout concentration on risk factor

Susp 7-8 mt/diag 12-13 mt/treat 18-19 mt

UNHS3mt (before discharge)

The best methodSusp 1mt/diag 3mt/treat 6mt

Principles and Techniques of Newborn Hearing Assessment      

Screening outcomes are either “pass” (no further testing indicated) or “refer” (infant is at risk for hearing loss and requires diagnostic hearing evaluation).

     The auditory brainstem response (ABR) measures action potential responses of the

eighth cranial nerve to an auditory stimulus.      

Evoked otoacoustic emissions (EOAEs) measure sound waves generated by the outer hair cells of the cochlea after an auditory stimulus.

     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.

     A strong association between hearing loss and impaired vestibular function in infants

and children has been documented.     

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.

     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.

      Standardized laboratory tests in infants failing initial screening are not necessary or cost

effective.

1)Testing protocols ; powerful/objective/rapid/noninvasive/easy/bilateral

Behavioral methods2)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 stem3)Evoked OAE;

Transient E-OAE/DP E-OAECochlea evaluation is the most useful clinical application

Less time/ nurologic pathologyPeripheral noise/vernix/EE collapse during first day

HOSPITAL BASED UNHSOAE before discharge-OAE outpatientOAE and ABR before dischargeABR before disharge-ABR outpatient

2 fail screening test is indication for referring to diagnostic fallow-up

DIAGNOSIS1)Hx; maternal diabetus/maternal hypothyroid/alcohol

2)Physical examination;Iris RP/vardenburg

Anterior neck pitt TurnerGoiter pendred

Cleft palate stickler/down/Skull shape craniosynostosis

Fingers count BORHypopigmented areas neurofibromatosis

3)Vestibular function4)Otomicroscopy the most common cause ME/EE

5)MEE fallow up/ABR/2-3 mt/systemic steroids/AOM/VT/after 1 year6)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 AlportMPS

SYNCOPE Jervel-Lange-Wielsen9 )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 STRATEGIESCHL surgery TT/

Bone Conuction Amplification BAHAAmplification 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 act0-3 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 infection3)Allergy mold PAR SAR

4)Fungal infection5)Asthma

6)GERD PPI surgery7)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