Audit of local performance compared with standards recommended by the national guidelines for aetiologic investigation of permanent childhood hearing impairment

Value of systematic aetiological investigation in children with sensorineural hearing loss

Sensorineural hearing loss is the most common form of sensory impairment in children. As a precise aetiological diagnosis has major prognostic and management implications, it is useful to evaluate the contents of the aetiological investigation of sensorineural hearing loss in France. This article presents a retrospective review of professional practices by comparing the aetiological investigation of hearing loss in children with a cochlear implant and children without a cochlear implant.

PATIENTS AND METHODS

One hundred and seven children under the age of 18 years with unilateral or bilateral sensorineural hearing loss attending the paediatric ENT department for the first time between January 2007 and January 2009 were included in the study. Data from the clinical interview and all complementary investigations were analysed.

RESULTS

The various aetiologies of hearing loss were classified as genetic, acquired, or unknown in each of the two populations. Hearing loss was of unknown origin in 52% of the 87 non-implanted children and 15% of the 20 children with a cochlear implant.

CONCLUSION

This study demonstrates the heterogeneous practices in terms of aetiological investigation of sensorineural hearing loss as a function of the target population. A more systematic aetiological investigation was performed in children fitted with a cochlear implant, requiring multidisciplinary management. This study indicates the need to define a standard aetiological investigation for all children with sensorineural hearing loss.

Electrocardiogram screening of deaf children for long QT syndrome: are we following UK national guidelines?

INTRODUCTION

Jervell-Lange-Nielsen syndrome is characterised by congenital deafness and a long QT interval on electrocardiography.

AIM

(1) To survey UK national practice regarding electrocardiography screening of deaf children referred to cochlear implant centres, performed to evaluate for prolonged QT interval as recommended by national guidelines, and (2) to review local practice.

METHODS

Data were collected via a questionnaire sent to all UK cochlear implant centres, and via review of the medical records of a local cochlear implant centre database.

RESULTS

Eight (42 per cent) of the 19 cochlear implant centres surveyed performed electrocardiographic screening. Thirteen cases of long QT syndrome were reported in seven centres, with two related deaths. In our local cochlear implant centre, 14 (7.1 per cent) of 193 children had abnormal electrocardiograms; one definite long QT syndrome case and 13 borderline cases were identified.

CONCLUSION

Despite clear national guidelines for electrocardiographic screening of deaf children, there is wide variation in practice. Our local practice of performing investigations, including electrocardiography, during magnetic resonance imaging sedation has been very successful. Electrocardiograms should be reviewed by trained clinicians, and corrected QT intervals should be calculated manually.