Paediatric Hearing Loss

1
Paediatric Hearing Loss
Dr Nirmal Patel MBBS (Hons)(Syd) FRACS (OHNS) MS
(UNSW) Associate Professor of Surgery (Macquarie
University) Director, Kolling Deafness Research
Centre (University of Sydney)
2
Summary

• Introduction
• Conductive Hearing Loss
• Sensorineural Hearing Loss
• Diagnosis
• Treatment

3
Introduction

• Hearing loss is common
• 1 in 1000 babies have significant hearing loss at
  birth
• 10 in 1000 children have significant hearing loss
  at school (inc. mild and moderate)
• 80 of all children will have at least one middle
  ear infection

4
And Mild Unilateral Hearing Loss has an Impact...

• Significant reduction in language acquisition and
  speech with prolonged mild unilateral hearing
  loss.

http//www.cdc.gov/ncbddd/ehdi/documents/unilatera
lhl/Mild_Uni_200520Workshop_Proceedings.pdf
5
Paediatric Conductive Loss

• Congenital
• Atresia of ear
• Congenital stapes fixation
• Cholesteatoma
• Acquired
• Acute and chronic otitis media

6
Microtia / Atresia
7
Congenital Cholesteatoma
8
Paediatric Sensorineural Loss

• Sensorineural Hearing Loss (Nerve deafness)
• Genetic and Idiopathic (70)
• Acquired (30)
• Low birth weight/ NICU residents
• Hyperbilirubinaemia
• Ear and Head trauma
• Anoxia and Hypoxia
• Ototoxic Drugs and Chemicals
• Infectious Diseases
• Recurrent otitis media

9
Diagnosis

• SWISH (Statewide Infant Hearing Screening
  Programme) aims to test every child born in NSW
  and identify significant hearing loss by the age
  of 3 months
• Parental (other carers) clues
• Family physician

10
Diagnosis

• History
• Risk factors for SNHL
• Auditory milestones
• 3 months Startled by loud sounds and calmed by
  familiar sounds
• 6 months ability to localise
• 9 months respond to name mimic environmental
  sounds
• 12 months First meaningful words
• 18 months Vocabulary of 20 words or more
• 24 months Small sentences

11
Diagnosis

• Examination
• Local
• Auricle
• Canal
• Tympanic membrane (pneumatic otoscopy)
• Regional
• Syndromic features
• Tuning Forks
• Difficult under 6 yrs

12
Diagnosis

• Investigations
• Hearing test - refer to audiologist with
  childrens experience

13
Diagnosis

• Refer to ENT if concerned
• Tests if suspecting SNHL
• Imaging - CT, MRI (dysplasias, large vestibular
  aqueduct)
• TFT (Pendreds syndrome)
• Urinalysis (Alports)
• Liase with opthalmologist (Ushers Syndrome),
  geneticist (Connexin 26)

Hart CK, Choo DI Laryngoscope April 2013
14
Treatment for Conductive Hearing Loss - Chronic
Otitis Media

• Observation - minimise day care exposure and
  passive smoking, reflux disease (prevalence 48)
• Autoinflation/ otovent - low cost no adverse
  effects, reasonable to consider cochrane review
  small studies no significant benefit.
• Nasal Steroids, antihistamines,antibiotics - no
  evidence to support use. Largest effect when
  used for 4 weeks to 3 months.

American Academy Otolaryngology, Pediatrics
Family Physicians Consensus 2005 Miura et al OHNS
March 2012 Cochrane Review Oct 2010, Sept 2011
and Sept 2012
15
Treatment for Conductive Hearing Loss - Chronic
Otitis Media

• Middle Ear Ventilation Tubes (Grommets) - effect
  is small is normal speech and development.
  Likely significant effect in either speech/
  hearing delayed child or developmental delayed
  child. Measures of disease specific quality of
  life improve in all studies.
• Children lt24 months untreated have a higher risk
  of speech and language delay.
• Hearing Aids - poor compliance, fluctuating
  pathology therefore difficult to fit, damage.

American Academy Otolaryngology, Pediatrics
Family Physicians Consensus 2005 Miura et al OHNS
March 2012 Cochrane Review Oct 2010, Sept 2011
and Sept 2012
16
Bone Anchoured Hearing Aids for Conductive
Hearing Loss
17
Treatment for Paediatric Sensorineural Hearing
Loss

• Hearing assistive techniques
• Preferential seating
• Techniques to use at home
• Rehabilitation
• Hearing Aids
• FM systems
• Cochlear Implantation

18
Cochlear Implantation Operation Video
19
Summary

• Hearing loss in children is common and
  significantly impacts speech and development even
  in mild unilateral loss.
• Early diagnosis is the key to treatment success.

20
www.HillsENT.com 9439 1199