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Determining the etiology of childhood hearing loss
Otolaryngology Head and Neck Surgery Volume 115 Number 2
10:20 AM to 12:00 NOON Room 38 e
Pediatric Otolaryngology Session MICHAEL POOLE, MD, AND BECKY McGRAW-WALL, MD (moderators), Houston, Tex,
10:20 AM
Middle Ear Effusion Effects on Vestibular System in Children AVISHAY GOLZ, MD (presenter), AVIRAM NETZER, MD, S. THOMAS WESTERMAN, MD, and LIANEM. GILBERT,MA, Haifa, Israel, and Shrewsbury, N.J.
Although middle ear effusion (MEE) is one of the most frequent diagnoses recorded in children, only in the past two decades have authors considered it to be an etiologic factor in balance disorders in childhood. Nevertheless, the association between MEE and vestibular dysfunction remains controversial. Electronystagmographic tests were performed on 136 children, ages 4 to 9 years, with MEE but without clinical evidence of middle ear infections, before and after ventilation tube insertions; they were also compared with 74 healthy children with no history of middle ear diseases (controls). A spontaneous, jerk-type horizontal nystagmus or positional nystagmus or both was found in 58% (79) of the children with MEE compared with 4% (3) of the controis. Clinical signs and symptoms of balance disorders were found in 50% of the children with MEE and none of the controls. Abnormal electronystagmographic findings resolved in 96% of the children after ventilation tube insertion. Follow-up of over 12 months revealed that clinical signs and symptoms of balance disorders had resolved in all of the surgically treated children. The results of this study imply that the clumsiness, stumbling, and tendency to fall often encountered in young children may result from chronic MEE, and that these symptoms will resolve following the insertion of ventilation tubes. 10:28 AM
Determining the Etiology of Childhood Hearing Loss AMY Y. CHEN, MD (presenter), LAURIE A. OHLMS, MD, MICHAEL G. STEWART, MD, and DANIEL J. FRANKLIN, MD, Houston, Tex,
The cause of heating loss (HL) in a child is often difficult to identify. We evaluated a cohort of children referred with newly diagnosed HL (non--otitis media) to identify factors predictive of etiology and type of HL. Clinical (history and physical examination), laboratory, and radiographic data were collected. One hundred fourteen children (47 boys and 67 girls) ranging in age at the time of diagnosis from birth to 10 years were evaluated for a new diagnosis of HL. One hundred children (87.7%) had sensorineural hearing loss (SNHL) and 14
Scientific Sessions- - Monday
P 61
(12.3%) had conductive or mixed HL. The cause was identified in 54 children (48%). Patients with isolated aural atresia (7) and with a known diagnosis of congenital cytomegalovirus infection (21) were excluded from further data analysis. Identified etiologies included meningitis (5), nonsyndromic hereditary loss (3), and syndromic hearing loss ( 3 - Waardenburg's, KID, and Cornelia de Lange's syndromes). We performed univariate and multivariate analyses, using logistic regression with forward entry of variables to identify factors predictive of the etiology and type of HL. Clinical factors that aided in identifying a cause included abnormal physical examination (p = 0.001) and craniofacial anomalies (p = 0.006). Of the 47 temporal bone computerized tomography (CT) scans performed, eight were abnormal and predicted etiology (p < 0.001). Findings included bilateral cochlear agenesis, Mondini's malformation, and enlarged vestibular aqueduct. In contrast, no serum laboratory abnormalities led to detection of an etiology in this series. Factors predictive of the type of HL detected (SNHL vs. conductive or mixed HL) were abnormal physical examination (p = 0.01) and craniofacial anomalies (p = 0.004). In this age of cost containment and managed health care, performing a thorough yet cost-effective evaluation for childhood hearing loss is of utmost importance. In our series, a complete history and physical examination, with careful attention to craniofacial anomalies, were the most effective methods of determining an etiology. A temporal bone CT scan was the only ancillary study that had predictive value. An exhaustive laboratory or radiographic workup did not prove beneficial in our series. 10:36 AM
Documentation of Pediatric Reflux: Standardization of a New Technique and Review of 300 Children JOHN LITTLE,MD (presenter), BRIAN MATTHEWS, MD, WILLIAM F. McGUIRT, JR., MD, and JAMES A. KOUFMAN, MD, WinstonSalem, N.C.
Objective: Extraesophageal reflux has been implicated in the etiology of many pediatric airway and respiratory diseases. In the past, reflux testing has included barium esophagography, endoscopy _+biopsy, radionuclide scanning, the Bernstein acid perfusion test, and intraesophageal pH monitoring. Each of these tests has been found to lack sensitivity and/or specificity. We propose a new technique of monitoring pediatric reflux using 24-hour simultaneous esophageal and pharyngeal pH monitoring. Methods: Prospective evaluation of 300 children with various manifestations of pediatric reflux using 24-hour dual electrode pH monitoring was performed to evaluate both distal and proximal gastric acid reflux. Results: The technique and verification of probe placement and the results for 300 children are presented. Approximately half of the children with normal distal esophageal acid exposure times still had significant pharyngeal acid exposure. In addition, children with laryngeal and pulmonary disorders had a significantly higher amount of pharyn-
10:20 AM to 12:00 NOON Room 38 e
Pediatric Otolaryngology Session MICHAEL POOLE, MD, AND BECKY McGRAW-WALL, MD (moderators), Houston, Tex,
10:20 AM
Middle Ear Effusion Effects on Vestibular System in Children AVISHAY GOLZ, MD (presenter), AVIRAM NETZER, MD, S. THOMAS WESTERMAN, MD, and LIANEM. GILBERT,MA, Haifa, Israel, and Shrewsbury, N.J.
Although middle ear effusion (MEE) is one of the most frequent diagnoses recorded in children, only in the past two decades have authors considered it to be an etiologic factor in balance disorders in childhood. Nevertheless, the association between MEE and vestibular dysfunction remains controversial. Electronystagmographic tests were performed on 136 children, ages 4 to 9 years, with MEE but without clinical evidence of middle ear infections, before and after ventilation tube insertions; they were also compared with 74 healthy children with no history of middle ear diseases (controls). A spontaneous, jerk-type horizontal nystagmus or positional nystagmus or both was found in 58% (79) of the children with MEE compared with 4% (3) of the controis. Clinical signs and symptoms of balance disorders were found in 50% of the children with MEE and none of the controls. Abnormal electronystagmographic findings resolved in 96% of the children after ventilation tube insertion. Follow-up of over 12 months revealed that clinical signs and symptoms of balance disorders had resolved in all of the surgically treated children. The results of this study imply that the clumsiness, stumbling, and tendency to fall often encountered in young children may result from chronic MEE, and that these symptoms will resolve following the insertion of ventilation tubes. 10:28 AM
Determining the Etiology of Childhood Hearing Loss AMY Y. CHEN, MD (presenter), LAURIE A. OHLMS, MD, MICHAEL G. STEWART, MD, and DANIEL J. FRANKLIN, MD, Houston, Tex,
The cause of heating loss (HL) in a child is often difficult to identify. We evaluated a cohort of children referred with newly diagnosed HL (non--otitis media) to identify factors predictive of etiology and type of HL. Clinical (history and physical examination), laboratory, and radiographic data were collected. One hundred fourteen children (47 boys and 67 girls) ranging in age at the time of diagnosis from birth to 10 years were evaluated for a new diagnosis of HL. One hundred children (87.7%) had sensorineural hearing loss (SNHL) and 14
Scientific Sessions- - Monday
P 61
(12.3%) had conductive or mixed HL. The cause was identified in 54 children (48%). Patients with isolated aural atresia (7) and with a known diagnosis of congenital cytomegalovirus infection (21) were excluded from further data analysis. Identified etiologies included meningitis (5), nonsyndromic hereditary loss (3), and syndromic hearing loss ( 3 - Waardenburg's, KID, and Cornelia de Lange's syndromes). We performed univariate and multivariate analyses, using logistic regression with forward entry of variables to identify factors predictive of the etiology and type of HL. Clinical factors that aided in identifying a cause included abnormal physical examination (p = 0.001) and craniofacial anomalies (p = 0.006). Of the 47 temporal bone computerized tomography (CT) scans performed, eight were abnormal and predicted etiology (p < 0.001). Findings included bilateral cochlear agenesis, Mondini's malformation, and enlarged vestibular aqueduct. In contrast, no serum laboratory abnormalities led to detection of an etiology in this series. Factors predictive of the type of HL detected (SNHL vs. conductive or mixed HL) were abnormal physical examination (p = 0.01) and craniofacial anomalies (p = 0.004). In this age of cost containment and managed health care, performing a thorough yet cost-effective evaluation for childhood hearing loss is of utmost importance. In our series, a complete history and physical examination, with careful attention to craniofacial anomalies, were the most effective methods of determining an etiology. A temporal bone CT scan was the only ancillary study that had predictive value. An exhaustive laboratory or radiographic workup did not prove beneficial in our series. 10:36 AM
Documentation of Pediatric Reflux: Standardization of a New Technique and Review of 300 Children JOHN LITTLE,MD (presenter), BRIAN MATTHEWS, MD, WILLIAM F. McGUIRT, JR., MD, and JAMES A. KOUFMAN, MD, WinstonSalem, N.C.
Objective: Extraesophageal reflux has been implicated in the etiology of many pediatric airway and respiratory diseases. In the past, reflux testing has included barium esophagography, endoscopy _+biopsy, radionuclide scanning, the Bernstein acid perfusion test, and intraesophageal pH monitoring. Each of these tests has been found to lack sensitivity and/or specificity. We propose a new technique of monitoring pediatric reflux using 24-hour simultaneous esophageal and pharyngeal pH monitoring. Methods: Prospective evaluation of 300 children with various manifestations of pediatric reflux using 24-hour dual electrode pH monitoring was performed to evaluate both distal and proximal gastric acid reflux. Results: The technique and verification of probe placement and the results for 300 children are presented. Approximately half of the children with normal distal esophageal acid exposure times still had significant pharyngeal acid exposure. In addition, children with laryngeal and pulmonary disorders had a significantly higher amount of pharyn-