EAR ROUNDS
description
Transcript of EAR ROUNDS
EAR ROUNDSClinical Clerks of Block 5A UP Medicine 2011Department of Otorhinolaryngology, UP-PGHJanuary 21, 2010
COMMON CAUSES OF HEARING LOSS
AMONG NEONATES
INTRODUCTION
NEONATAL HEARING LOSS• A significant disability which any delay in early
recognition, diagnosis and intervention will cause a significant detrimental impact on speech, language and cognitive abilities (Fakhim
2007).• Important to determine its prevalence,
frequency, usual causes and significant risk factors
Types of Hearing
Loss
Types of hearing loss
CONDUCTIVE HEARING LOSS• ANYTHING PREVENTS THE
TRANSMISSION OF SOUND FROM THE EXTERNAL ENVIRONMENT TO THE COCHLEA
cerumen cholesteatomaneoplasm
Types of hearing loss
SENSORINEURAL HEARING LOSS• DISRUPTIONS IN
TRANSMISSION AFTER THE COCHLEA
• MAY BE RESULTS OF HAIR CELL DESTRUCTION OR COCHLEAR NERVE DAMAGE
Types of hearing loss
MIXED HEARING LOSS
Categories of Hearing
Loss
Categories of hearing loss
American National Standards Institute defines hearing loss:
Slight hearing loss: 16-25 dB lost
Mild hearing loss: 26-40 dB lost
Moderate hearing loss: 41-55 dB lost
Severe hearing loss: 71-90 dB lost
Profound: > 90 dB lost
Epidemiology of Hearing
Loss
EPIDEMIOLOGY
• In the US, hearing loss occurs in about 10/1000 children1 / 1000 profound3-5 / 1000 mild-moderate10-20% acquired
EPIDEMIOLOGY• Hearing loss requiring intervention among NICU admitted patients ranges from 1 to 4%
• SNHL occurs in 9-27 per 1000 children worldwide
• Though no sex predilection is noted, hereditary causes may occur more frequently in one sex than the other
EPIDEMIOLOGY• Most hearing loss in children is congenital or acquired perinatally but may occur at any age
• Approximately 10-20% of all cases are acquired postnatally
EPIDEMIOLOGY
• Prior to routine neonatal hearing screening, hearing loss was usually diagnosed at 2.5 years, now it improved to 14 months
EPIDEMIOLOGY
•Suspicion & Detection– Parents: 2/3 of the
cases– Pediatricians: 10%– Other Healthcare providers: 15%
•The mean time from suspicion to diagnosis is about 9 months
High-Risk Criteria for HL in
Neonates & Infants
High risk criteria
• The dissemination of high-risk criteria for neonates and infants in 1990 did not notably alter the mean age at diagnosis.
• About 50% of children with SNHL do not meet any of the criteria listed, and only 10% of neonates have 1 or more of the high-risk criteria that prompt an evaluation.
High risk criteria
•These rates are among the reasons cited for the need for universal neonatal hearing screening.
•The goals of such screening are to identify children who are deaf or hard of hearing and to start intervention by age 6 months.
Neonates (birth to 28 d)• Family history of congenital or early SNHL• Congenital infection known to be associated
with SNHL• Craniofacial anomalies• Birth weight of more than 1500 g (<3.3 lb)• Hyperbilirubinemia over the exchange level• Exposure to ototoxic medications• Bacterial meningitis• Low APGAR scores at birth• Prolonged mechanical ventilation• Findings of a syndrome associated with SNHL
Infants (29 d to 2y)
• Concern about hearing, speech, language, and/or developmental delay
• Bacterial meningitis• Neonatal risk factors associated with SNHL
• Head trauma, especially with fracture of the temporal bone
• Findings of a syndrome associated with SNHL
• Exposure to ototoxic medications• Neurodegenerative disorders• Infectious diseases associated with SNHL