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Zhang VW, Hou S, Wong A, Flynn C, Oliver J, Weiss M, Milner S, Ching TYC. Audiological characteristics of children with congenital unilateral hearing loss: insights into Age of reliable behavioural audiogram acquisition and change of hearing loss. Front Pediatr 2023; 11:1279673. [PMID: 38027307 PMCID: PMC10663346 DOI: 10.3389/fped.2023.1279673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives The aims of this study were to report the audiological characteristics of children with congenital unilateral hearing loss (UHL), examine the age at which the first reliable behavioural audiograms can be obtained, and investigate hearing changes from diagnosis at birth to the first reliable behavioural audiogram. Method This study included a sample of 91 children who were diagnosed with UHL via newborn hearing screening and had reliable behavioural audiograms before 7 years of age. Information about diagnosis, audiological characteristics and etiology were extracted from clinical reports. Regression analysis was used to explore the potential reasons influencing the age at which first reliable behavioural audiograms were obtained. Correlation and ANOVA analyses were conducted to examine changes in hearing at octave frequencies between 0.5 and 4 kHz. The proportions of hearing loss change, as well as the clinical characteristics of children with and without progressive hearing loss, were described according to two adopted definitions: Definition 1: criterion (1): a decrease in 10 dB or greater at two or more adjacent frequencies between 0.5 and 4 kHz, or criterion (2): a decrease in 15 dB or greater at one octave frequency in the same frequency range. Definition 2: a change of ≥20 dB in the average of pure-tone thresholds at 0.5, 1, and 2 kHz. Results The study revealed that 48 children (52.7% of the sample of 91 children) had their first reliable behavioural audiogram by 3 years of age. The mean age at the first reliable behavioural audiogram was 3.0 years (SD 1.4; IQR: 1.8, 4.1). We found a significant association between children's behaviour and the presence or absence of ongoing middle ear issues in relation to the delay in obtaining a reliable behavioural audiogram. When comparing the hearing thresholds at diagnosis with the first reliable behavioural audiogram across different frequencies, it was observed that the majority of children experienced deterioration rather than improvement in the initial impaired ear at each frequency. Notably, there were more instances of hearing changes (either deterioration or improvement), in the 500 Hz and 1,000 Hz frequency ranges compared to the 2,000 Hz and 4,000 Hz ranges. Seventy-eight percent (n = 71) of children had hearing deterioration between the diagnosis and the first behavioural audiogram at one or more frequencies between 0.5 and 4 kHz, with a high proportion of them (52 out of the 71, 73.2%) developing severe to profound hearing loss. When using the averaged three frequency thresholds (i.e., definition 2), only 26.4% of children (n = 24) in the sample were identified as having hearing deterioration. Applying definition 2 therefore underestimates the proportion of children that experienced hearing changes. The study also reported diverse characteristics of children with or without hearing deterioration. Conclusion The finding that 78% of children diagnosed with UHL at birth had a decrease in hearing loss between the hearing levels at first diagnosis and their first behavioural audiogram highlights the importance of monitoring hearing threshold levels after diagnosis, so that appropriate intervention can be implemented in a timely manner. For clinical management, deterioration of 15 dB at one or more frequencies that does not recover warrants action.
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Affiliation(s)
- Vicky W. Zhang
- Audiological Science Department, National Acoustic Laboratories, Sydney, NSW, Australia
- Department of Linguistics, Macquarie University, Sydney, NSW, Australia
| | - Sanna Hou
- Audiological Science Department, National Acoustic Laboratories, Sydney, NSW, Australia
| | - Angela Wong
- Audiological Science Department, National Acoustic Laboratories, Sydney, NSW, Australia
| | - Christopher Flynn
- Audiological Science Department, National Acoustic Laboratories, Sydney, NSW, Australia
- Lutwyche centre, Hearing Australia, Brisbane, QLD, Australia
| | - Jane Oliver
- Audiological Science Department, National Acoustic Laboratories, Sydney, NSW, Australia
- Upper Mt Gravatt centre, Hearing Australia, Brisbane, QLD, Australia
| | - Michelle Weiss
- Audiological Science Department, National Acoustic Laboratories, Sydney, NSW, Australia
- Dandenong centre, Hearing Australia, Melbourne, VIC, Australia
| | - Stacey Milner
- Audiological Science Department, National Acoustic Laboratories, Sydney, NSW, Australia
- Cheltenham centre, Hearing Australia, Melbourne, VIC, Australia
| | - Teresa Y. C. Ching
- Audiological Science Department, National Acoustic Laboratories, Sydney, NSW, Australia
- NextSense Institute, Macquarie Park, Sydney, NSW, Australia
- Macquarie School of Education, Macquarie University, Sydney, NSW, Australia
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, QLD, Australia
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Ting FN, Kiing JSH, Li WW, Chan YH, Loo JHY, Kang YQ. Prevalence and Profiles of Late-Onset Hearing Loss in Preschool Children with Autism Spectrum Disorder Who Passed Newborn Hearing Screening in a South East Asian Population. J Autism Dev Disord 2023:10.1007/s10803-023-06060-0. [PMID: 37480440 DOI: 10.1007/s10803-023-06060-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 07/24/2023]
Abstract
Prevalence of hearing loss in children with autism spectrum disorder (ASD) is uncertain, as it is more challenging to assess hearing function in children with developmental difficulties (DD). We aimed to determine the prevalence and profiles of hearing loss in preschool children with ASD in a Southeast-Asian population who passed newborn hearing screening. A retrospective study of preschool children with DD (ASD, Global Developmental Delay (GDD), and Speech and Language Delay (SLD)) attending the Child Development Unit (CDU) at our hospital was performed. Three hundred and thirty-three children (ASD: n = 129; GDD: n = 110; and SLD: n = 94) underwent hearing assessments. Of these, 10.8% of children (n = 36, comprising 15 with ASD, 12 with GDD and 9 with SLD) had confirmed hearing loss. Hearing loss was predominantly bilateral in children with ASD and GDD; in those with SLD, unilateral and bilateral hearing loss were equally common. Conductive hearing loss occurred as frequently as sensorineural hearing loss in children with ASD and SLD, but was the dominant subtype in those with GDD. Moderate to severe hearing loss (n = 2) was noted only in children with ASD. Children with ASD and GDD required significantly more audiology visits and procedures to obtain conclusive hearing test results, compared to those with SLD. The need to identify hearing loss and monitor for resolution is particularly important in vulnerable populations with communication deficits, such as in those with ASD.
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Affiliation(s)
- Fang Ni Ting
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jennifer S H Kiing
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Child Development Unit, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Wei Wen Li
- Child Development Unit, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jenny H Y Loo
- Department of Otolaryngology, Head & Neck Surgery (Audiology), National University Hospital, Singapore, Singapore
- Department of Otolaryngology, Head & Neck Surgery (Audiology), National University of Singapore, Singapore, Singapore
| | - Ying Qi Kang
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Child Development Unit, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore.
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Cholesteatoma Is Associated With Pediatric Progressive Sensorineural Hearing Loss. Ear Hear 2022; 43:1282-1290. [PMID: 34860720 PMCID: PMC9149138 DOI: 10.1097/aud.0000000000001176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This study identified an association between cholesteatoma and progressive sensorineural hearing loss using a large pediatric longitudinal audiologic dataset. Cholesteatoma is a potential sequela of chronic otitis media with effusion, a commonly observed auditory pathology that can contribute to hearing loss in children. The purpose of this report is to (i) describe the process of identifying the association between cholesteatoma and progressive sensorineural hearing loss in a large pediatric dataset and (ii) describe the audiologic data acquired over time in patients identified with cholesteatoma-associated progressive sensorineural hearing loss. DESIGN Records of patients included in the Audiologic and Genetics Database (n = 175,215 patients) were examined using specified criteria defining progressive hearing loss. A linear regression model examined the log frequency of all diagnostic codes in the electronic health record assigned to patients for a progressive hearing loss cohort compared with a stable hearing loss group. Based on findings from the linear regression analysis, longitudinal audiometric air (AC) and bone conduction (BC) thresholds were extracted for groups of subjects with cholesteatoma-associated progressive (n = 58 subjects) and stable (n = 55 subjects) hearing loss to further analyze changes in hearing over time. RESULTS The linear regression analyses identified that diagnostic codes for cholesteatoma were associated with progressive sensorineural hearing loss in children. The longitudinal audiometric data demonstrated within-subject changes in masked BC sensitivity consistent with progressive sensorineural hearing loss in children diagnosed with cholesteatoma. Additional analyses showed that mastoidectomy surgeries did not appear to contribute to the observed progressive hearing loss and that a high number of cholesteatoma patients with progressive hearing loss had normal-hearing thresholds at their first test. CONCLUSIONS The statistical analyses demonstrated an association between cholesteatoma and pediatric progressive sensorineural hearing loss. These findings inform clinical management by suggesting that children with cholesteatoma diagnoses may be at increased risk for progressive sensorineural hearing loss and should receive continued monitoring even after a normal masked BC baseline has been established.
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Carol Liu YC, Ibekwe T, Kelso JM, Klein NP, Shehu N, Steuerwald W, Aneja S, Dudley MZ, Garry R, Munoz FM. Sensorineural hearing loss (SNHL) as an adverse event following immunization (AEFI): Case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2020; 38:4717-4731. [PMID: 32418788 DOI: 10.1016/j.vaccine.2020.05.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/06/2020] [Indexed: 01/22/2023]
Abstract
This is a Brighton Collaboration case definition of the term "Sensorineural Hearing Loss" to be utilized in the evaluation of adverse events following immunization. The case definition was developed by a group of experts convened by the Coalition for Epidemic Preparedness Innovations (CEPI) in the context of active development of vaccines for Lassa Fever and other emerging pathogens. The case definition format of the Brighton Collaboration was followed to develop a consensus definition and define levels of diagnostic certainty, after an exhaustive review of the literature and expert consultation. The document underwent peer review by the Brighton Collaboration Network.
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Affiliation(s)
- Yi-Chun Carol Liu
- Department of Otorhinolaryngology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Titus Ibekwe
- Department of Otorhinolaryngology, University of Abuja, Nigeria
| | - John M Kelso
- Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, CA, USA
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Oakland, CA, USA
| | - Nathan Shehu
- Department of Pediatric Infectious Diseases, Jos University, Nigeria
| | - Wendy Steuerwald
- Department of Audiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Satinder Aneja
- Department of Pediatrics, School of Medical Sciences and Research, Sharda University, Gr Noida, India
| | - Matthew Z Dudley
- Department of International Health, and Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Flor M Munoz
- Department of Pediatrics, Section of Infectious Diseases, and Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA.
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From Bimodal Hearing to Sequential Bilateral Cochlear Implantation in Children—A Within-Subject Comparison. Otol Neurotol 2020; 41:767-774. [DOI: 10.1097/mao.0000000000002644] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fitzpatrick EM, Nassrallah F, Vos B, Whittingham J, Fitzpatrick J. Progressive Hearing Loss in Children With Mild Bilateral Hearing Loss. Lang Speech Hear Serv Sch 2020; 51:5-16. [PMID: 31913798 DOI: 10.1044/2019_lshss-ochl-19-0013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose This study investigated progressive hearing loss in a cohort of children who were identified with permanent mild bilateral hearing loss. Method This population-based study included 207 children with permanent mild bilateral hearing loss, diagnosed and followed from 2003 to 2016 in 1 region of Canada. Clinical characteristics and initial audiologic results were collected prospectively at diagnosis, and audiologic information was updated. Changes in hearing levels between the 1st and most recent assessment were analyzed to determine progressive hearing loss. Clinical characteristics were compared between children with progressive and stable hearing loss. The association between risk indicators and progressive hearing loss was explored through logistic regression. Results A total of 47.4% (94 of 207) had progressive hearing loss in at least 1 ear, and 50% (47 of 94) of those experienced more than 20-dB average drop in thresholds. For these 94 children, a total of 147 ears were affected, and 116 (78.9%) ears experienced sufficient change in thresholds to be coded as a worse category of hearing loss. In the subset of 85 children with more than 5 years of audiologic follow-up, 56.4% (53/85) showed a decrease in hearing. Of the total sample of 207 children, 137 (66.2%) continued to have mild hearing loss in the better ear. There was no association between the risk factors examined (family history of hearing loss, admission to the neonatal intensive care unit, or presence of a syndrome) and progressive hearing loss. Conclusion This study found that almost half of children with mild bilateral hearing loss showed a decrease in hearing in at least 1 ear. One third of the children first diagnosed with mild hearing loss in the better ear now have moderate or worse hearing loss in both ears. These findings point to the importance of careful long-term monitoring of children who present with mild hearing loss.
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Affiliation(s)
- Elizabeth M Fitzpatrick
- Faculty of Health Sciences, University of Ottawa, Ontario, Canada.,Child Hearing Laboratory, CHEO Research Institute, Ottawa, Ontario, Canada
| | - Flora Nassrallah
- Faculty of Health Sciences, University of Ottawa, Ontario, Canada.,Child Hearing Laboratory, CHEO Research Institute, Ottawa, Ontario, Canada
| | - Bénédicte Vos
- Child Hearing Laboratory, CHEO Research Institute, Ottawa, Ontario, Canada.,School of Public Health, Université Libre de Bruxelles, Brussels Belgium
| | - JoAnne Whittingham
- Child Hearing Laboratory, CHEO Research Institute, Ottawa, Ontario, Canada
| | - Jessica Fitzpatrick
- Child Health Evaluative Sciences Program, SickKids Research Institute,The Hospital for Sick Children, Toronto, Ontario, Canada
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Molini E, Calzolaro L, Lapenna R, Ricci G. Universal newborn hearing screening in Umbria region, Italy. Int J Pediatr Otorhinolaryngol 2016; 82:92-7. [PMID: 26857323 DOI: 10.1016/j.ijporl.2016.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 01/04/2016] [Accepted: 01/06/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In Italy, universal newborn hearing screening (UNHS) was first introduced in some regions from 1997. Umbria Region has launched a UNHS program in all hospitals, which has been implemented throughout the region since July 2010. Before UNHS implementation in Umbria region, the average age of identification of congenital hearing loss was around 32 months of age with an average age of initial amplification treatment at least 2 months later. The coverage rate of newborn screening was only 34.4% in 2006. The aim of this study was to examine the results of this program and its evolution in the first 2.5 years since implementation in our region. METHODS Since July 2010, all 11 birth centers and hospitals in Umbria region have been involved in a UNHS program. The screening involves the automated otoacoustic emissions (AOAE) test and automatic auditory brain stem response (AABR) audiometry. The number of screening stages and tests used were different depending on whether the infants had audiological risk factors or not. RESULTS A total of 20,841 babies were born in the hospitals involved of whom 20,051 were well born babies (WB), while 790 babies (3.8%) presented identified audiological risk factors (BRF). The overall coverage rate in the study period was 93.8%. The prevalence of hearing loss was 2‰ for WB infants and 4.3% for BRF. Mean age at diagnosis was 5.31±3.95 and 11.28±7.73 months in the WB and BRF groups, respectively. CONCLUSIONS UNHS has allowed us to substantially increase the coverage rates and decrease the mean age at diagnosis and subsequent treatment. The identification of audiological risk factors is very important for adequate screening and follow-up. However the Joint Committee on Infant Hearing 2007 quality indicators and benchmarks for screening have not yet been fully achieved and there is still scope for some improvement. This could be achieved with a closer cooperation among institutions, parents, pediatricians, and ENT doctors.
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Affiliation(s)
- Egisto Molini
- Department of Surgical and Biomedical Sciences, Section of Otolaryngology-Head and Neck Surgery, University of Perugia, S.M. della Misericordia Hospital, Via G. Dottori 1, Perugia 06156, Italy
| | - Lucia Calzolaro
- Department of Surgical and Biomedical Sciences, Section of Otolaryngology-Head and Neck Surgery, University of Perugia, S.M. della Misericordia Hospital, Via G. Dottori 1, Perugia 06156, Italy
| | - Ruggero Lapenna
- Department of Surgical and Biomedical Sciences, Section of Otolaryngology-Head and Neck Surgery, University of Perugia, S.M. della Misericordia Hospital, Via G. Dottori 1, Perugia 06156, Italy.
| | - Giampietro Ricci
- Department of Surgical and Biomedical Sciences, Section of Otolaryngology-Head and Neck Surgery, University of Perugia, S.M. della Misericordia Hospital, Via G. Dottori 1, Perugia 06156, Italy
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Mirvakili A, Dadgarnia MH, Baradaranfar MH, Atighechi S, Zand V, Ansari A. Role of Platelet Parameters on Sudden Sensorineural Hearing Loss: A Case-Control Study in Iran. PLoS One 2016; 11:e0148149. [PMID: 26829393 PMCID: PMC4734775 DOI: 10.1371/journal.pone.0148149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 01/13/2016] [Indexed: 01/05/2023] Open
Abstract
Sudden sensorineural hearing loss (SSNHL) is a common otological disorder characterized by a hearing loss greater than 30 dB over three consecutive frequencies, in less than 72 hours. It has been established that platelet parameters, such as mean platelet volume, are associated with ischemic heart events, whose clinical manifestations are similar to those of SSNHL. Hence, we aimed to determine if the platelet count, mean platelet volume and platelet distribution width are related to the occurrence and severity of sudden sensorineural hearing loss. A case-control prospective study was conducted in a teaching hospital in Iran. One hundred-eight patients with SSNHL and an equal number of healthy, age- and sex-matched controls were enrolled in the study. Peripheral venous blood samples were collected from the subjects, and the platelet count, mean platelet volume and platelet distribution width were measured with an automated blood cell counter. Analysis of the audiometry and hematological test results using SPSS22 software showed no statistical correlation between the platelet parameters and the occurrence of SSNHL, but correlation coefficients showed a significant correlation between PDW and hearing loss severity in patients group. However, further investigation is required to unequivocally establish the absence of correlation between the platelet parameters and occurrence of SSNHL.
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Affiliation(s)
- Abbas Mirvakili
- Otorhinolaryngology Research Center, Department of Otolaryngology, Head & Neck Surgery, Shahid Sadoughi University Of Medical Sciences, Yazd, Iran
| | - Mohammad Hossein Dadgarnia
- Otorhinolaryngology Research Center, Department of Otolaryngology, Head & Neck Surgery, Shahid Sadoughi University Of Medical Sciences, Yazd, Iran
| | - Mohammad Hossein Baradaranfar
- Otorhinolaryngology Research Center, Department of Otolaryngology, Head & Neck Surgery, Shahid Sadoughi University Of Medical Sciences, Yazd, Iran
| | - Saeid Atighechi
- Otorhinolaryngology Research Center, Department of Otolaryngology, Head & Neck Surgery, Shahid Sadoughi University Of Medical Sciences, Yazd, Iran
| | - Vahid Zand
- Otorhinolaryngology Research Center, Department of Otolaryngology, Head & Neck Surgery, Shahid Sadoughi University Of Medical Sciences, Yazd, Iran
| | - Abdollah Ansari
- Otorhinolaryngology Research Center, Department of Otolaryngology, Head & Neck Surgery, Shahid Sadoughi University Of Medical Sciences, Yazd, Iran
- * E-mail:
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Tharpe AM, Gustafson S. Management of Children with Mild, Moderate, and Moderately Severe Sensorineural Hearing Loss. Otolaryngol Clin North Am 2015; 48:983-94. [DOI: 10.1016/j.otc.2015.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Aarhus L, Tambs K, Nafstad P, Bjørgan E, Engdahl B. Childhood sensorineural hearing loss: effects of combined exposure with aging or noise exposure later in life. Eur Arch Otorhinolaryngol 2015; 273:1099-105. [PMID: 25975623 DOI: 10.1007/s00405-015-3649-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 05/04/2015] [Indexed: 10/23/2022]
Abstract
The aim of the study was to examine childhood high-frequency sensorineural hearing loss (HF-SNHL) and the effects of combined exposure with aging or noise exposure on HF hearing thresholds in adulthood. Population-based cohort study of 30,003 adults (mean age 40 years) underwent an audiometry and completed a hearing questionnaire. At age 7-13 years, the same people had participated in a longitudinal school hearing investigation, in which 283 participants were diagnosed with HF-SNHL [PTA 3-8 kHz ≥ 25 dB HL (mean 45 dB HL), worse hearing ear], and 29,720 participants had normal hearing thresholds. The effect of childhood HF-SNHL on adult hearing threshold was significantly moderated by age. Age stratified analyses showed that the difference in HF hearing thresholds between adults with and without childhood HF-SNHL was 33 dB (95 % CI 31-34) in young adults (n = 173, aged 20-39 years) and 37 dB (95 % CI 34-39) in middle-aged adults (n = 110, aged 40-56 years). The combined exposure of childhood HF-SNHL and noise exposure showed a simple additive effect. It appears to be a super-additive effect of childhood-onset HF-SNHL and aging on adult hearing thresholds. An explanation might be that already damaged hair cells are more susceptible to age-related degeneration. To exclude possible birth cohort effects, the finding should be confirmed by a study with several audiometries in adulthood.
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Affiliation(s)
- Lisa Aarhus
- Department of Psychosomatic and Health Behavior, Division of Mental Health, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403, Oslo, Norway.
| | - Kristian Tambs
- Department of Psychosomatic and Health Behavior, Division of Mental Health, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403, Oslo, Norway
| | - Per Nafstad
- Department of Chronic diseases, Division of Epidemiology, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403, Oslo, Norway
| | - Eskil Bjørgan
- Namsos Hospital, Helse Nord-Trøndelag HF, Postboks 333, 7601, Levanger, Norway
| | - Bo Engdahl
- Department of Psychosomatic and Health Behavior, Division of Mental Health, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403, Oslo, Norway
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Hatton JL, Janssen RM, Stapells DR. Auditory brainstem responses to bone-conducted brief tones in young children with conductive or sensorineural hearing loss. Int J Otolaryngol 2012; 2012:284864. [PMID: 22988461 PMCID: PMC3440927 DOI: 10.1155/2012/284864] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 06/29/2012] [Indexed: 11/18/2022] Open
Abstract
The bone-conduction (BC) tone ABR has been used clinically for over 20 years. The current study formally evaluated the test performance of the BC tone-evoked ABR in infants with hearing loss. Method. By comparing BC-ABR results to follow-up behavioural results, this study addressed two questions: (i) whether the BC tone ABR was successful in differentiating children with conductive versus sensorineural hearing loss (Study A; conductive: 68 ears; SNHL: 129 ears) and (ii) the relationship between BC ABR and behavioural hearing loss severity (Study B: 2000 Hz: 104 ears; 500 Hz: 47 ears). Results. Results demonstrate that the "normal" BC-ABR levels accurately differentiated normal versus elevated cochlear sensitivity (accuracy: 98% for 2000 Hz; 98% for 500 Hz). A subset of infants in Study A with elevated BC-ABR (i.e., no response at normal level) had additional testing at higher intensities, which allowed for categorization of the degree of cochlear impairment. Study B results indicate that the BC ABR accurately categorizes the degree of cochlear hearing loss for 2000 Hz (accuracy = 95.2%). A preliminary dBnHL-to-dBHL correction factor of "0 dB" was determined for 2000 Hz BC ABR. Conclusions. These findings further support the use of BC tone ABR for diagnostic ABR testing.
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Affiliation(s)
- Jennifer L. Hatton
- School of Audiology and Speech Sciences, The University of British Columbia, Vancouver, BC, Canada V6T 1Z3
- Audiology Department, Britsh Columbia's Children' Hospital, Vancouver, BC, Canada V6H 3V4
- British Columbia Early Hearing Program, Provicial Health Services Authority Victoria, BC, Canada V8V 3K3
| | - Renée M. Janssen
- School of Audiology and Speech Sciences, The University of British Columbia, Vancouver, BC, Canada V6T 1Z3
- British Columbia Early Hearing Program, Provicial Health Services Authority Victoria, BC, Canada V8V 3K3
| | - David R. Stapells
- School of Audiology and Speech Sciences, The University of British Columbia, Vancouver, BC, Canada V6T 1Z3
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Kataoka Y, Fukushima K, Maeda Y, Sugaya A, Nagayasu R, Masuda Y, Nishizaki K. [Progressive or delayed early-onset pediatric sensorineural hearing loss]. NIHON JIBIINKOKA GAKKAI KAIHO 2011; 114:557-561. [PMID: 21770305 DOI: 10.3950/jibiinkoka.114.557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The introduction of newborn-hearing screening has enabled early childhood hearing loss to be diagnosed and increased the number of children undergoing early care. Bilateral hearing loss is found in 0.08% of newborns and children whose hearing loss progresses or onset is delayed account for 4 to 30% of all pediatric hearing impairment. Children with perinatal risk factors tend to have deteriorated hearing or delayed-onset hearing loss in early childhood, necessitating audiometric follow-up. We also are aware of some children without risk factors who develop hearing impairment during infancy or early childhood. Hearing deterioration may be difficult to diagnose objectively, especially in young children, the presence of risk factors must be determines as soon as possible, especially given the lack of hearing management and close examination of children without apparent risk factors. We retrospectively studied children born from April 1998 to March 2007 and undergoing cochlear implantation as of April 2008. Among cases, we focused on 10 whose hearing impairment advanced during infancy -4 with risk factors known before hearing deterioration progressed, and 6 cases thought not to have any risk factors. We detected enlarged vestibular acquaduct in 3 of these 6 cases, and 3 more of whom had no risk factors -2 passing newborn-hearing screening and 1 in whom such screening detected hemilateral hearing loss. Our results underscore the need for early temporal computed tomography for detecting enlarged vestibular aquaduct. Even children with mild or hemilateral hearing loss should undergo audiometric and developmental testing at least every 6 months up to going to elementary school. Children suspected of impaired hearing should undergo thorough hearing tests regardless of newborn hearing-screening results to catch any problems early. Appropriate regular hearing and language development check-up tests must also be developed.
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Affiliation(s)
- Yuko Kataoka
- Department of Otolaryngology, Head and Neck Surgery, Okayama University Postgraduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama
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Abstract
OBJECTIVE To determine the response to treatment of pediatric patients diagnosed with autoimmune inner ear disease. PATIENTS Seven children who presented with sensorineural hearing loss and were diagnosed with autoimmune inner ear disease. INTERVENTION Diagnosis through blood testing. Treatment with steroids and/or cytotoxic medication. MAIN OUTCOME MEASURES Improvement in pure-tone average and speech discrimination scores on audiometric testing. RESULTS Six of the 7 children (85.7%) improved with treatment, and the remaining patient had no measurable progression of disease. CONCLUSION Children with autoimmune inner ear disease seem to benefit from treatment with steroids and/or cytotoxic medication. Although such medications must be used with caution in the pediatric population, they should not be withheld simply because of young age.
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Ghirri P, Liumbruno A, Lunardi S, Forli F, Boldrini A, Baggiani A, Berrettini S. Universal neonatal audiological screening: experience of the University Hospital of Pisa. Ital J Pediatr 2011; 37:16. [PMID: 21481246 PMCID: PMC3082242 DOI: 10.1186/1824-7288-37-16] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 04/11/2011] [Indexed: 11/25/2022] Open
Abstract
The early identification of pre-lingual deafness is necessary to minimize the consequences of hearing impairment on the future communication skills of a baby. According to the most recent international guidelines the deafness diagnosis must occur before the age of three months and the prosthetic-rehabilitative treatment with a traditional hearing aid should start within the first six months. When a Cochlear implant becomes necessary, the treatment should start between the age of 12 months and 18 months. The only way to diagnose the problem early is the implementation of universal neonatal audiological screening programs. Transient evoked otoacoustic emissions (TEOAE) is the most adequate test because it's accurate, economic and of simple execution. Automatic auditory brainstem response (AABR) is necessary to identify patients with auditory neuropathy but it is also important to reduce the number of false-positives.The 20-30% of infant hearing impairment is represented by progressive or late-onset hearing loss (HL) so it's also necessary to establish an audiological follow up program, especially in infants at risk.From November 2005 all neonates born in the University hospital of Pisa undergo newborn hearing screening. From 2008 the screening program follows the guidelines for the execution of the audiological screening in Tuscany which have been formulated by our group according to the 2007 JCIH Position Statement and adaptated to our regional reality by a multidisciplinary effort. From November 2005 to April 2009 8113 neonates born in the Neonatal Unit of Santa Chiara Hospital (Pisa) have undergone newborn hearing screening. 7621 neonates (93.9%) without risk factors executed only the TEOAE test. 492 (6.1%) neonates had audiological risk factors and thus underwent TEOAE and AABR. 84 patients (1,04%) failed both TEOAE and AABR tests. 78 of them underwent further investigations. 44 patients resulted false positives (the 0,54% of the screened newborns). 34 neonates (4,2 ‰) had a final diagnosis of hearing impairment. 8 patients (0.99 ‰) had unilateral hearing loss (HL). 26 patients (3,2 ‰) had bilateral hearing impairment.In our screening program the percentage of false-positives was quite low (0.54%) while the incidence of bilateral HL (3.2 ‰) is a little higher than that found in literature reports. In most of our patients premature birth or neonatal suffering represent the main cause of HL.
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Affiliation(s)
- Paolo Ghirri
- Mother and Child Department, Neonatology Unit and Section of Neonatal Endocrinology and Dysmorphology, University Hospital of Pisa, Pisa, Italy
| | - Annalisa Liumbruno
- Division of ENT, Department of Neuroscience, University of Pisa, Pisa, Italy
| | - Sara Lunardi
- Mother and Child Department, Neonatology Unit and Section of Neonatal Endocrinology and Dysmorphology, University Hospital of Pisa, Pisa, Italy
| | - Francesca Forli
- Division of ENT, Department of Neuroscience, University of Pisa, Pisa, Italy
| | - Antonio Boldrini
- Mother and Child Department, Neonatology Unit and Section of Neonatal Endocrinology and Dysmorphology, University Hospital of Pisa, Pisa, Italy
| | - Angelo Baggiani
- Department of Experimental Pathology, Medical Biotechnologies, Infectious Diseases and Epidemiology, University of Pisa, Pisa, Italy
| | - Stefano Berrettini
- Division of ENT, Department of Neuroscience, University of Pisa, Pisa, Italy
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Fortnum H. Epidemiology of permanent childhood hearing impairment: Implications for neonatal hearing screening. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/16513860310001997] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Come hear, baby! Identifying and managing congenital hearing loss. JAAPA 2008; 21:22-6. [DOI: 10.1097/01720610-200806000-00084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Coticchia JM, Gokhale A, Waltonen J, Sumer B. Characteristics of sensorineural hearing loss in children with inner ear anomalies. Am J Otolaryngol 2006; 27:33-8. [PMID: 16360821 DOI: 10.1016/j.amjoto.2005.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2005] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine whether hearing loss in children with inner ear anomalies has some distinctive characteristics when compared to children with hearing loss but without inner ear anomalies. METHODS Temporal bone computed tomography scans of 69 patients with sensorineural hearing loss were examined for inner ear abnormalities of which 17 were identified. The medical histories of these patients were reviewed for the characteristics of their hearing loss, including initial presentation, natural history, and nature of loss, as well as the family history of hearing loss and risk factors for hearing loss. These were compared to age-matched controls with hearing loss but without inner ear anomalies. RESULTS Seventeen patients had inner ear anomalies. Records of 14 of these patients were compared to patients without inner ear anomalies. Regarding age of onset, 71.4% of patients with anomalies had onset of their hearing loss at less than 2 years old vs 78.6% without anomalies. Regarding unilateral vs bilateral, 42.9% of patients with anomalies were unilateral vs 28.6% of patients without anomalies. For patients with anomalies, 85.7% were stable and 14.3% were progressive; without anomalies, 71.4% were stable, 21.4% were progressive, and 7.1% were fluctuating. Regarding family history, only 14.3% of patients without anomalies had a positive family history vs 56% of patients with anomalies. CONCLUSIONS Children with inner ear anomalies and sensorineural hearing loss have an increased incidence of unilateral hearing loss and stable hearing loss as compared to controls with sensorineural hearing loss without inner ear anomalies. In addition, children with inner ear anomalies and sensorineural hearing loss are less likely to have a family history of hearing loss.
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Affiliation(s)
- James M Coticchia
- Department of Otolaryngology Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI 48202, USA.
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Costa KS, Garcia RID, Cecatto SB, Rapoport PB, Mendonça R. Disacusia sensorioneural autoimune em criança: relato de caso. ACTA ACUST UNITED AC 2004. [DOI: 10.1590/s0034-72992004000300016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A disacusia sensorioneural autoimune é reconhecida como uma das poucas causas reversíveis de perda auditiva sensorioneural. Acomete na grande maioria das vezes mulheres entre 30 e 40 anos, sendo extremamente raro em crianças. O diagnóstico baseia-se no quadro clínico, testes laboratoriais, bem como resposta satisfatória a corticoterapia. O exame audiológico não apresenta características típicas. Neste trabalho os autores descrevem o caso de um menino de sete anos com diagnóstico de disacusia sensorioneural autoimune.
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Pittman AL, Stelmachowicz PG. Hearing loss in children and adults: audiometric configuration, asymmetry, and progression. Ear Hear 2003; 24:198-205. [PMID: 12799541 PMCID: PMC2556459 DOI: 10.1097/01.aud.0000069226.22983.80] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to characterize the sensorineural hearing losses of a group of children and adults along three parameters important to the hearing instrument fitting process: 1) audiometric configuration, 2) asymmetry of loss between ears, and 3) progression of loss over several years. DESIGN Audiograms for 248 60- and 61-yr-old adults and 227 6-yr-old children were obtained from the audiological database at Boys Town National Research Hospital. Based on right-ear air-conduction thresholds, the configurations were assigned to one of six categories: sloping, rising, flat, u-shaped, tent-shaped, and other. Left- and right-ear thresholds were compared to determine asymmetry of loss. Progression of loss was evaluated for 132 children for whom additional audiograms over an 8-yr period were available. RESULTS In general, the children's hearing losses were more evenly distributed across configuration categories while most of the adult's audiograms were sloping or u-shaped in configuration. The variability of loss at each frequency was greater for the children than the adults for all configuration categories. Asymmetrical losses were more common and the degree of asymmetry at each frequency was more extensive among the children than the adults. A small number of children showed either improved or deteriorated hearing levels over time. In those children for whom progressive hearing loss occurred, no frequency was more vulnerable than another. CONCLUSIONS The results of the present study suggest that substantial differences in audiological characteristics exist between children and adults. Implications for amplification include the development of appropriate fitting protocols for unusual audiometric configurations as well as protocols for binaural amplification in cases of asymmetric hearing losses.
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Affiliation(s)
- A L Pittman
- Boys Town National Research Hospital, 555 N. 30th Street, Omaha, NE 68131, USA.
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Berrettini S, Forli F, Franceschini SS, Ravecca F, Massimetti M, Neri E. Distal renal tubular acidosis associated with isolated large vestibular aqueduct and sensorineural hearing loss. Ann Otol Rhinol Laryngol 2002; 111:385-91. [PMID: 12018321 DOI: 10.1177/000348940211100501] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Distal renal tubular acidosis (dRTA) is characterized by a defect in urinary acidification with various degrees of metabolic acidosis; it can be inherited either as an autosomal dominant trait or as a recessive trait. The recessive form is associated in about one third of cases with progressive sensorineural hearing loss (SNHL). We performed a neuroradiological study in 3 consecutive unrelated pediatric patients affected with sporadic dRTA and progressive SNHL that disclosed an enlarged vestibular aqueduct (VA) and endolymphatic sac (ES) in each. The presence of an enlarged VA in our patients with dRTA and SNHL could contribute to the development, or at least the progression, of the hearing impairment. We suppose that the same molecular defect present in both the kidney and the inner ear could be the cause of dRTA and of the development of the enlarged VA and ES.
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Tomasi JP, Lona A, Deggouj N, Gersdorff M. Autoimmune sensorineural hearing loss in young patients: an exploratory study. Laryngoscope 2001; 111:2050-3. [PMID: 11801995 DOI: 10.1097/00005537-200111000-00034] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES P0 protein is expressed exclusively in myelinating Schwann cells of the peripheral nervous system. In a previous study from our laboratory, 27% of patients with sensorineural hearing loss (SNHL) had antibodies to P0 protein in their serum. The purpose of the present exploratory study was to examine the relationship between the clinical presentation of SNHL among children and young adults (age range, 5-30 y) and the presence of serum anti-P0 antibodies. STUDY DESIGN The data were collected by retrospective questionnaires from Belgian otolaryngologists. METHODS Patients were divided for comparison into two groups according to the presence or absence of anti-P0 antibodies. RESULTS Analyses of clinical data and audiometric results indicated that a progressive hearing loss was more frequently recorded in the patients in the anti-P0 antibody-positive group (82% [14 of 17]) than in those in the anti-P0 antibody-negative group (35% [6 of 17]) (P <.005). CONCLUSIONS Thus, in the age group in the present study, autoimmune SNHL (as measured in the present study by the presence of anti-P0 antibodies) is more frequently associated with progressive than with sudden hearing loss. The implications of this finding for preventive screening of hearing loss in children and young adults are discussed.
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Affiliation(s)
- J P Tomasi
- Laboratory of Autoimmunity and the Department of Otorhinolaryngology, University of Louvain Medical School, Brussels, Belgium.
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Dinces EA, Yang S, Balogun AO. Pediatric fluctuating sensorineural hearing loss: problems in medical management. Laryngoscope 2001; 111:21-5. [PMID: 11192894 DOI: 10.1097/00005537-200101000-00004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To discuss the diagnosis and management of children with fluctuating sensorineural hearing loss, especially focusing on those problems dealing with autoimmune inner ear disease. STUDY DESIGN A retrospective chart review of a large pediatric otolaryngology practice. A series of 40 children with progressive hearing losses was identified. Of that group, 22 children, aged 1.5 to 12.2 years at first audiogram, were considered to have fluctuating sensorineural hearing loss (FSNHL). Criteria for inclusion in the FSNHL group were threshold variations of 15 dB or more in at least one ear at two or more of the standard audiometric frequencies on at least 2 testing days. METHODS Charts were reviewed for age, sex, otologic history, laboratory evaluations, medical or surgical treatments, significant medical history, and family medical history. RESULTS Twenty-two children met the criteria for fluctuating sensorineural hearing loss. Of those with fluctuating hearing loss, 15 were idiopathic, 3 had positive lymphocyte transformation tests (LTT) suggestive of autoimmune inner ear disease (AIED), and 4 had fistula on middle ear exploration. Average fluctuation for all groups was 29.1 dB. Average duration of fluctuations was 4.95 years. CONCLUSIONS The majority of pediatric FSNHL cases (15 of 22) were idiopathic in nature. Of those FSNHL children with positive LTTs, only one was treated with steroid therapy. In the other patients with positive LTTs, parents or other physicians were often reluctant to treat, or the patient was lost to follow-up. Mean fluctuations varied substantially across all standard audiometric frequencies for all groups.
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Affiliation(s)
- E A Dinces
- Department of Otolaryngology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10467, USA
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Sculerati N. Analysis of a cohort of children with sensory hearing loss using the SCALE systematic nomenclature. Laryngoscope 2000; 110:787-98. [PMID: 10807358 DOI: 10.1097/00005537-200005000-00009] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES What characteristics identify clinical types of childhood deafness? Which aspects of the otological evaluation best delineate them? To approach these related questions, a classification for deafness consistent with current medical concepts was constructed using a systematic nomenclature and then applied to a pediatric cohort of 168 children with sensorineural hearing loss (SNHL) who were referred for private consultation. A major aim of the analysis was to test the utility of SCALE, the new systematic nomenclature. METHODS Patients with SNHL were identified through the office records of a single faculty member of the Department of Otolaryngology in a medical school situated in a major US city. Inclusion criteria required bone conduction thresholds above 30 dB or equivalent in at least one of the frequencies from 250 Hz to 4 kHz on either behavioral audiogram or on electrophysiological testing. All identified patients had initial visits during an 8-year period from late 1990 to early 1999. Patients were excluded if age at first consultation was 19 years or more, if records were insufficient to confirm SNHL, or if further evaluation revealed that SNHL had been misdiagnosed. A formal nomenclature was designed to systematically encode clinical features with simple descriptive terms according to an acronym (SCALE [sidedness, component function, age of onset, lesion, and etiology]) for all included patients. RESULTS One hundred sixty-eight study patients were analyzed; sensory hearing loss was bilateral in 82% (137/168) and unilateral in 18% (31/168). The etiology of this impairment was determined to be intrinsic in 40% of children (67/168), either secondary to genotype (57/ 67), or to named congenital syndromes without known extrinsic cause (10/67). Recessive single gene mutations diagnosed by family history, recognition of syndrome, or determination of homozygous 35delG mutations in the gap junction protein gene, Connexin 26, accounted for bilateral sensory hearing loss in 33 children (24% of all bilateral cases). One girl had an X-linked dominant syndrome (Coffin-Lowry syndrome) with auditory brainstem response-documented childhood onset of SNHL. Nine patients (5%) had chromosomal aneuploidy, and 12 patients (7%) had either a family history of dominant deafness (7/ 12) or a recognizable autosomal dominant syndrome (5/12), most commonly, Waardenburg syndrome type 1 (4/5). Extrinsic causes of deafness were identified in only 13% of children (21/168) and included a relatively large number of referrals from neurosurgery (9/21). Three of these children had chronic middle ear disease and sensory hearing loss associated with inflammatory and bony changes on temporal bone imaging suggestive of chronic osteitis; all had a history of active otitis media during cranial irradiation. Congenital cytomegalovirus infections were documented in only 4 cases, but 41 patients could have had this as a cause or did not have this cause ruled out. An idiopathic cause or origin was assigned to 36% of patients (61/168) including patients with unnamed syndromic patterns of multiple anomalies. CONCLUSIONS The SCALE nomenclature facilitated complete descriptions of hearing-impaired children and provided a classification scheme applicable to broad categories of human disease. The single most useful diagnostic test was screening for Cx26 mutations. Computed tomography scan of the temporal bones was helpful in establishing etiology for selected patients and invaluable in patients with chronic ear disease. Magnetic resonance imaging scan was a superior diagnostic modality in one child with a posterior fossa arachnoid cyst.
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Affiliation(s)
- N Sculerati
- New York University School of Medicine, Department of Otolaryngology, New York, USA
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