Paeds / Hearing Loss Flashcards
Who is at risk of sensorineural hearing loss
SCBU FH Premature Hypoxia during birth Meningitis Jaundice TORCH - toxoplasmosis / Rubella / CMV / herpes
What is important in Hx of pregnancy
Any infections - TORCH
Ototoxic medication inc alcohol
Placental insufficeincy
IUGR
What is important in Hx of birth / post natal period
Pre-term Signfiicant hypoxia Prolonged ventilation Hyperbilirubin Ototoxic medication Post natal infections Bacterial menignitis Breast or bottle Passive smoking Immunisation
What else in the history
Maternal health
FH hearing loss
What do you examine
Full physical Eyes, ears and palate important Otoscopy Look for dysmorphic features Development - speech / school / growth / behaviour
How do you assess hearing at birth
Universal neonatal screening for SNHL
Automatic otoacoustic emission
Automated auditory brainstem response if abnormal
How do you assess hearing in childhood
Distraction test - 6-18 months
Visualy reinforced audiometry - up to 3
Play audiometry - 3-5
Pure tone audiometry - 5+
What investigations once hearing loss established
MRI of inner ears and IAM = 1st line
What does MRI show
Most structural abnormalities + soft tissue e.g. brain / CN / membranous labyrinth
When would you do an urgent MRI
If meningitis is the cause
If progressive or fluctuating
What are other investigations
CT - petrous temporal bone ECG Genetics Congenital infection Opthalmology Bloods - not that useful Urine
When would you do CT
If need info of bony structures
Do not show soft tissue
High level of radiation
What is ECG useful for
JLNS = very rare syndrome with sensorineural loss + long QT
What congenital infection can cause
CMV = most common cause
Rubella
Toxoplasma
Syphilis
What bloods
FBC U+E Thyroid Haemoglobinopathy ESR
