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HESP645 Exam 1 > Hearing Loss in Children > Flashcards

Hearing Loss in Children Flashcards

1
Q

What are the most common/treatable reasons for CHL?

A
  • Impacted cerumen

- Otitis media with effusion

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2
Q

What are the Joint Committee on Infant Hearing’s recommendations for middle ear conditions?

A
  • Complete head/neck exam for craniofacial anomalies
  • Pneumatic otoscopy
  • Tympanometry
  • Referral of children with persistent OME lasting >3 months for otologic evaluation
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3
Q

Describe craniofacial anomalies that could be indicative of pediatric HL.

A

-Need to inspect pinna for size, shape, landmarks, and position on the head

  • Ear tags/pits
  • Low set ears
  • Classification of microtia severity
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4
Q

Describe Grade 1 of microtia severity?

A

-Pinna is smaller than normal but EAC is patent, all normal ear structures are present

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5
Q

Which is more common: atresia/EAC stenosis or microtia?

A

-Atresia/EAC stenosis

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6
Q

What other abnormalities of the ME structures also frequently occur with microtia?

A
  • Stapes deformity
  • Absence of oval and round windows
  • Facial nerve absence
  • Anomalous development
  • Poor pneumatization of the middle ear cells & space
  • Fusion of the malleus and incus
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7
Q

Describe treatment options for congenital aural atresia.

A
  • Bone conduction HAs
  • CROS
  • Osseointegrated devices
  • Atresiaplasty to create an ear canal/middle ear
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8
Q

What populations are high risk for OM/OME?

A
  • Down syndrome
  • Cleft lip and palate
  • Indigenous populations (i.e. Alaskan inuit, Australian aboriginals)
  • Countries with high poverty rates
  • Bottle feeding
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9
Q

What ENT problems are often associated with Down syndrome?

A
  • Stenotic ear canal

- Eustachian tube dysfunction

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10
Q

What Eustachian tube dysfunctions are associated with cleft lip/palate?

A
  • ET obstruction
  • Narrow opening
  • Abnormal control
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11
Q

What should families be encouraged to do to reduce risk of chronic OM?

A
  • Breastfeed as long as possible
  • Place baby supine to sleep
  • Advise parents not to smoke
  • Avoid large group child care
  • Wash their hands and children’s hands before eating
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12
Q

What are the Agency for Healthcare Research and Quality (AHRQ) recommendations for the treatment of OME & AOM?

A
  • Watchful waiting for 3 months is recommended for low-risk child with OME because of likelihood of resolution in most children
  • Reduce risk factor
  • Medication if still not resolved
  • Surgically-placed tympanostomy (PE) tubes if medication is unsuccessful
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13
Q

What would make a child at-risk for OME & AOM?

A
  • ASD
  • Cleft palate
  • Craniofacial anomalies
  • Developmental disorder/delay
  • Down syndrome
  • Persistent HL
  • Speech-language delay
  • Visual impairment
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14
Q

Describe the medical aspects of ANSD.

A
  • Hyperbillirubinemia
  • Hypoxia and accompanying metabolic acidosis
  • Genetic mutations of Connexin 26 and otoferlin
  • Congenital disorders, i.e. atresia of the auditory nerve
  • Immune disorders (i.e. Guillain-Barre syndrome)
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15
Q

Describe the screening process for ANSD.

A
  • JCIH recommends using ABR, at least for babies in the NICU
    • Programs using only OAEs will miss a high proportion of ANSD
  • Suggested that ARTs could be used to ID children in need of ABR assessment for screening programs using OAEs
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16
Q

Describe ANSD management at diagnosis.

A

MEDICAL/DEVELOPMENTAL WORK-UP

  - Otologic eval with imaging (CT/MRI) of cochlea and auditory nerves and vestibular assessment
  - Medical Genetic eval
  - Ophthamlogic assessment
  - Communication development assessment and ongoing monitoring 
  - Referral for neurological evaluation to assess peripheral and cranial nerve function
17
Q

Describe ANSD audiologic follow-up.

A
  • Required when ABR and ASSR are unable to predict behavioral thresholds (can vary from normal to profound levels)
  • VRA (6 months+)
  • Behavioral audiometry (up to 6 months)
  • Parent observation including formal assessment (questionnaires)
18
Q

Describe the ANSD audiological clinical profile: sound detection thresholds.

A
  • Some show audios within normal range
  • Most (>90%) show impaired sound detection (typically symmetrical)
  • Unilateral ANSD most commonly associated with auditory nerve hypoplasia (cochlear nerve deficiency)
  • Reverse slope configuration is common
  • Fluctuations are common
19
Q

Describe the ANSD audiological clinical profile: middle ear muscle reflex.

A
  • Modulated by the IHCs, CN VIII, and auditory brainstem pathways
  • Consistently abnormal in cases of ANSD regardless of behavioral hearing levels
20
Q

Describe the ANSD audiological clinical profile: CAEPs.

A
  • Despite absence or abnormality of ABR,

- May reflect the fact that they are less dependent on synchronous neural firing than ABR

21
Q

Describe the ANSD audiological clinical profile: basic auditory processing.

A
  • Distortion of neural firing patterns results in impaired temporal resolution
  • Frequency resolution and intensity discrimination are usually unaffected because they depend on cochlear processing
22
Q

Describe the ANSD audiological clinical profile: functional hearing.

A
  • Speech perception difficulty

- Higher degrees of everyday listening and communication difficulty than matched controls

23
Q

Describe Grade 2 of microtia severity?

A

-External ear is malformed, EAC is present but stenotic, ME space is small, ossicles are malformed/fused

24
Q

Describe Grade 3 of microtia severity?

A

-Severe malformation of the pinna, absence/complete stenosis of EAC, absence/near absence of ME space and ossicles

25
Q

Describe Grade 4 of microtia severity?

A

-Anotia (total absence of ear canal)

26
Q

What are some factors of at-risk populations for OM/OME?

A
  • Overcrowding in the home
  • Increased smoking rates, cooking smoke in the home
  • Pacifier use
  • Large daycare settings
  • Infants sleeping face-down
  • Lack of protective factors: breastfeeding, vaccines, access to preventative care, high-quality daycare, clean water, hygiene practices

HESP645 Exam 1 (10 decks)

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