Noncongenital hereditary hearing loss in children. Prospective documentation.

Younger siblings of children with sensorineural hearing loss of possible hereditary cause underwent interval audiologic examination. Seven siblings (in unrelated families) were found to have progressive sensorineural hearing loss despite early audiograms documenting normal hearing levels for age. Continued testing of these children allowed for early identification and intervention. We advocate regular otolaryngologic and audiologic follow-up even after normal audiologic assessments are made for younger siblings of children with documented sensorineural hearing loss, unless a definite nongenetic origin of the hearing loss in the older child is known. Recessive sensorineural hearing loss with onset in infancy or childhood may present with no antecedent family history and with normal behavioral audiograms early in life.

How accurate is parent rating of hearing for children with otitis media?

OBJECTIVE: To determine the accuracy of parent assessment of child hearing. DESIGN: Prospective study. SETTING: Hospital-based pediatric otolaryngology practice in a metropolitan area. PATIENTS: One hundred eighty-six children aged 6 months to 12 years (median age, 3.4 years) with chronic otitis media with effusion or recurrent acute otitis media enrolled in a quality-of-life study. INTERVENTION: Parents rated their child's hearing over the prior 4 weeks using a 7-point response scale. Otoscopic findings, static admittance, tympanometric width, and audiometric thresholds were recorded concurrently. Fifty children were reassessed to monitor changes in hearing. MAIN OUTCOME MEASURE: Correlation of parent hearing assessments with baseline hearing status (pure tone average for the better hearing ear) and with changes in hearing status. RESULTS: The hearing loss questions had good test-retest reliability (R=0.79) but did not correlate with audiometric results (R=-0.13; P=.09). Only when caregivers reported hearing to be an "extreme problem" were median hearing levels (31 dB) significantly greater than the median response (20 dB). Conversely, static admittance and tympanometric gradient were significant predictors of hearing levels (2-way analysis of variance, P<.01) and explained 44% of the ear-specific variations. Abnormal immittance measures in both ears had an 84% predictive value for hearing loss (20-dB hearing level or poorer), and normal immittance measures in both ears had a 76% predictive value for normal hearing. Caregiver assessments of change in hearing status did not correlate with changes in audiometric results (R=0.07; P=.65). CONCLUSIONS: Caregiver assessments of child hearing do not accurately predict hearing levels or changes in hearing status. Immittance measures can help identify children at low or high risk for hearing loss, but cannot substitute for audiometry.

Parents cannot detect mild hearing loss in children. First place--Resident Clinical Science Award 1998.

Otitis media with effusion is among the most common illnesses of childhood and is often associated with chronic or persistent middle ear effusion (MEE). Our goal was to develop and validate a self-administered parent survey that would identify children at high risk for mild hearing loss caused by MEE. We evaluated 115 children. Parents rated their child's hearing using the HL-7, a 7-item self-administered survey, and a global visual-analog scale. Static admittance and gradient were recorded. Test-retest reliability, internal consistency, and validity of the HL-7 were compared with the 4-frequency pure-tone average (PTA) hearing level (HL) for the better hearing ear. The HL-7 had good test-retest reliability and internal consistency. Survey scores correlated well with the global hearing rating (R = 0.67, P < 0.001) but did not correlate with PTA (R = 0.10, P = 0.29). Tympanometric gradient was unrelated to ear-specific PTA, but not abnormal static admittance (<0.2 cc), which produced a mean 7-dB HL decrease in hearing (ANOVA, P = 0.02). The HL-7 is a reliable and internally consistent measure of parent perception of child hearing, but unfortunately these perceptions are inaccurate for mild hearing loss. Abnormal static admittance is a risk factor for hearing loss.

Amplification for hearing-impaired children: basic considerations.

The importance of the selection of proper amplification for the hearing impaired child is discussed including goals of amplification, specific methods of choosing amplification, and test procedures including speech audiometry. Evaluation controversies discussed include: monaural versus binaural amplification; body worn versus post auricular hearing aids; maximum output; and special hearing aid modifications.

Acupuncture for sensorineural hearing loss.

Forty children, aged 9 to 16 years, with severe and profound sensorineural hearing loss received acupuncture five times weekly for three out of four weeks for a period of six months. The children had weekly audiometric evaluations. There were no clinically important differences during and post acupuncture.

FM systems as primary amplification for children with profound hearing loss.

The use of FM systems as primary amplification for children with severe and profound hearing loss is discussed. The FM advantage for improving speech perception and for reducing the detrimental effects of distance, noise, and reverberation is described. Both hypothetical and actual cases are used to demonstrate the FM advantage. An evaluation method for selecting an appropriate FM system is described.

Earmolds for patients with severe and profound hearing loss.

Fabricating feedback-free earmolds has become an increasingly critical problem as more powerful hearing aids become commonplace. Current earmold impression materials and techniques may be contributing to the problem. This paper evaluates current earmold materials and techniques and makes suggestions for modifications in current procedures to reduce or eliminate feedback.