Hearing Loss AAP

Question 1

The goal of the universal newborn hearing screening (UNHS) program is which of the
following:

A. Identify all children with moderate hearing loss by age 2 months and initiate
intervention by age 4 months.

B. Identify all children with permanent hearing loss by age 3 months and initiate
intervention by age 4 months.

C. Identify all children with moderate hearing loss by age 1 month and initiate
intervention by age 4 months.

D. Identify all children with permanent hearing loss by age 3 months and initiate
intervention by age 6 months.

E. Identify all children by age 1 month and initiate intervention by age 3 months.

Answer 1

D. Identify all children with permanent hearing loss by age 3 months and initiate
intervention by age 6 months.

Question 2

2. A 3-year-old girl presents to your clinic with a 2-month history of otitis media, resistant to
   amoxicillin and amoxicillin clavulanate. On otoscopic examination, she has
   nonerythematous tympanic membranes, which are dull and do not move on insufflation.
   You perform a tympanogram in your office. Which of the following tympanograms would
   be most consistent with an ear effusion?

A. Type A.
B. Type B.
C. Type C.
D. Type D.
E. Type E.

Answer 2

B. Type B.

Type B or flat
tympanograms are present if there is no mobility of the
tympanic membrane (eg, otitis media with effusion) or if
there is complete fixation of the ossicles. This will also be
present if there is a tympanic membrane perforation.

Type A- Normal middle
ear pressures indicate normal tympanic membrane
and ossicular mobility and compliance.

Type C tympanograms are typically caused by retraction of the
tympanic membrane secondary to eustachian tube dysfunction.
Results of the tympanograms can be a useful adjunct
when interpreting all other audiometric testing

Question 3

3. An infant with auditory neuropathy spectrum disorder presents to your clinic. You know
   this disorder involves a defect in the signal transmission of sound from the inner ear to the
   brain. Which of the following hearing screen results would you expect in this patient?

A. Present otoacoustic emissions and absent auditory brainstem response.
B. Present otoacoustic emissions and present auditory brainstem response.
C. Absent otoacoustic emissions and absent auditory brainstem response.
D. Absent otoacoustic emissions and present auditory brainstem response.
E. Otoacoustic emissions and auditory brainstem response are not reliable in this
disorder.

Answer 3

A. Present otoacoustic emissions and absent auditory brainstem response.

These children typically have present OAEs but absent or abnormal ABRs. Thus, they may pass screening paradigms that use
only OAEs. These children can have variable audiologic
presentations with hearing loss or hearing ability that do
not match what would be expected from their audiometric
data. These patients should be closely monitored for speech
and language development and may benefit from traditional
hearing aids or cochlear implantation

Question 4

A 38-week-old female infant weighs 2100 g. On physical examination, she has
microcephaly and a palpable liver and spleen. She exhibits petechiae on her face and
trunk. You strongly suspect congenital cytomegalovirus (CMV). In counseling the parents,
you inform them of the progressive sensorineural hearing loss associated with congenital
CMV. Furthermore, you inform them the likelihood of sensorineural hearing loss in their
infant is:

A. 10%.
B. 25%.
C. 50%.
D. 75%.
E. 100%.

Answer 4

C. 50%.

If symptomatic from the CMV infection, there is 50% likelihood
that the child will have SNHL to a variable degree

even if the infant is asymptomatic from the CMV
infection, there is a 10% to 15% chance of developing SNHL

Question 5

A 7-year-old boy is admitted to the hospital with fever and rash and is treated for bacterial
meningitis. He passes a hearing screen in the hospital before discharge. As you prepare his
discharge consultations, you schedule him for follow-up audiology testing. Which of the
following schedule is most appropriate?

A. Follow-up hearing tested at 3 months, 6 months, and 9 months after discharge.
B. Follow-up hearing tested at 6 months and 1 year after discharge.
C. Follow-up hearing tested at 1 month, 6 months, and 12 months after discharge.
D. Follow-up hearing tested at 1 month and 12 months after discharge.
E. No follow-up hearing tests indicated unless clinical symptoms of hearing loss.

Answer 5

B. Follow-up hearing tested at 6 months and 1 year after discharge.

Therefore, audiologic follow-up
is recommended. Patients should have follow-up hearing
testing 4 to 8 weeks after discharge and then at 6 and 12
months after infection