[Nonorganic (functional) hearing loss in children]. / Nichtorganische (funktionelle) Hörstörungen bei Kindern.

Nonorganic (functional) hearing loss in children is characterized by hearing loss without a detectable corresponding pathology in the auditory system. It is not an uncommon disease in childhood. Typically, there is a discrepancy between elevated pure tone thresholds and normal speech discrimination in everyday life. We evaluated 85 original publications, 27 reviews and 4 textbook articles. Mean age at diagnosis was 11.3 years. Girls were affected twice as often as boys. Patient histories showed a high prevalence of emotional and school problems. Pre-existing organic hearing loss can be worsened by nonorganic causes. A brainstem audiometry should confirm the diagnosis. The differential diagnosis includes auditory processing disorder, elevated thresholds in mental retardation and auditory neuropathy. We recommend taking a personal history including biographical factors, a psychological assessment including intelligence testing and referral to a child psychiatrist. Prognosis seems to be dependent on the severity of the patient's school and/or personal problems. Categorization following the Austen-Lynch model can be a valuable prognostic factor.

Clinical features of functional hearing loss with inattention problem in Japanese children.

OBJECTIVE: Functional hearing loss is a condition in which hearing is lost without actual pathology. In children, inattention during pure tone audiometry may be due in part to functional hearing loss. This study examined the issue of inattention as a psychological trait by analyzing the clinical features of functional hearing loss children in Japan. METHODS: Using the ADHD-Rating Scale IV, 97 functional hearing loss children were screened for inattention (27 boys, 70 girls; mean age 9 years 5 months, range 5-17 years). Those with high levels of inattention (Inattention group) were compared with others (Attention group) for clinical features statistically. Furthermore observed psychological clinical features were described. RESULTS: 36.1% were categorized in the Inattention group, which had more boys, lower in age, and had more physical, developmental, and environmental problems than the Attention group. Two groups had very different psychological feature. CONCLUSIONS: In children's functional hearing loss, there exists a group with psychological trait of inattention. Three younger children 5-6 years old with attention problems showed no psychological problems, their FHL was considered to be caused by generalized maturation and development. Nearly all of the rest children showed psychological problems, supporting the notion that FHL in children is psychogenic in nature. Because clinical features in Inattention group children were different from the Attention group significantly, it was concluded that distinguishing the Inattention group as a subtype of functional hearing loss in children would be effective for both diagnosis and treatment. Larger scale studies with many angles needed for the inattention problem in FHL children.

Educational level and pseudohypacusis in medico-legal compensation claims: a retrospective study.

Pseudohypacusis or the intentional feigning of hearing loss is a challenging situation in the medicolegal evaluation of hearing levels. Few studies have been performed on predisposing factors that make compensation claims susceptible to malingering. The goal of this study was to investigate the relationship between educational level and frequency of pseudohypacusis in a group of medico-legal clients. Retrospectively, we studied the files of subjects (n=421) referred to the audiology clinic of a government hospital during a 12 month period. Educational levels of the individuals with and without pseudohypacusis were compared by the Chi-square test. The results show that individuals with pseudohypacusis have lower educational levels than cooperative clients. The relative frequency of individuals with pseudohypacusis among illiterates (43.5%) was clearly higher than individuals with higher educational levels (17.5%). The education level of a person filing a compensation claim may alert an examiner in detecting pseudohypacusis.

Auditory evoked magnetic fields in children with functional hearing loss.

OBJECTIVES: Abnormal cortical responses in patients with functional hearing loss were evaluated by magnetoencephalography, which can better separate bihemispherical activity than electroencephalography. METHODS: Auditory evoked fields in response to 1 kHz or 2 kHz tone bursts at 80 dB sound pressure level were measured by a helmet-shaped magnetoencephalography system in 22 patients with functional hearing loss (18 females, mean age 13.2 years) as well as 5 control subjects under 10 years old. Waveform, latency, and equivalent current dipole of N100m responses were used to evaluate activity in the bilateral auditory cortices. RESULTS: Abnormal N100m of the contralateral response to the stimulated ear, either absence or delayed latency in comparison to normal adult subjects, was found in 6 of the 7 patients with functional hearing loss aged 9 years or younger, but in only 3 of the 15 patients aged 10 years or older. However, such abnormalities were also observed in younger control subjects. CONCLUSION: Auditory evoked field may be applied to objectively evaluate cortical auditory function in patients with functional hearing loss, but the normal findings for young children have not yet been established.

Programa poblacional de cribado de sordera neonatal en Galicia: organización y resultados 2002-2007 / No disponible

Introducción. La detección precoz del déficit auditivo en el periodo neonatal permite instaurarun programa de rehabilitación temprana para mejorar la capacidad de comunicación de los niños afectadospor déficit de audición. Con este objetivo se han iniciado en los sistemas sanitarios de muchospaíses programas poblacionales de cribado de hipoacusia a los recién nacidos.Material y métodos. La población objetivo la constituyen todos los recién nacidos en Galicia. Elprograma fue implantado de forma progresiva desde mayo del 2002 hasta junio del 2008 en todoslos hospitales de la red pública gallega y en algunos hospitales privados. La prueba de cribado consisteen la realización de potenciales evocados auditivos automatizados. Se realiza preferentementeantes del alta hospitalaria. Las unidades de cribado están integradas por personal del propio centro.El personal de enfermería es el encargado de realizar la prueba de cribado de forma habitual en sujornada laboral. Si antes de que el niño abandone el centro se obtiene un resultado positivo de laprueba, tanto unilateral como bilateral, el niño es derivado para confirmación diagnóstica.Resultados. Tanto la cobertura como la participación aumentaron desde un 46 y un 69,11% en2002 a un 89 y un 99,78% respectivamente en 2007, con un total de 80.166 niños cribados en los 6años de funcionamiento. La tasa de derivación global fue de 0,84% y el número de casos diagnosticadosde hipoacusia fue de 64, lo que sitúa la tasa de detección global en 0,80 por mil niños cribados.Conclusiones. La aceptación de la prueba ha sido muy buena, hecho que se refleja en la altaparticipación que alcanzó, el 99% en 2003, manteniéndose en años sucesivos. La tasa de derivaciónobservada —0,84%— es relativamente baja, por lo que está siendo motivo de estudio. La tasa dedetección ha ido aumentando con la cobertura del programa, acercándose a la incidencia estimadade hipoacusia neonatal

Early detection of hearing deficit in the neonatal period makes it possible to establish a rehabilitationprogram to enhance the communication capacity of infants born with hearing loss.With this aim,the health care authorities of many countries have implemented population-screening programs aimingthe early detection of neonatal deafness.Material and methods. The target population is made up of all newborn infants in Galicia.Screening was gradually introduced in all the Galician public maternity hospitals and some privateones from May 2002 to June 2008. The screening test was made by performing the automatedauditory brain response, preferentially performed prior to discharge from hospital.The screening unitsare formed by center’s own staff.The test is performed by nurses, performing the screening during theusual daily work in the nursery. If a unilateral or bilateral positive result is obtained before dischargefrom the maternity ward, the baby is referred for diagnostic confirmation.Results. Both the coverage and the participation rate increased from 46% and 69.11% in 2002to 89% and 99.78% in 2007, respectively, with 80,166 children screened during 6 years of experience.The global referral rate was 0.84% and the number of cases of deafness diagnosed was 64.Detection rate was 0.80 per one thousand children tested.Conclusions. Acceptance of the test by the parents has been very good, this being reflected inhigh participation that reached 99% in 2003 and has been maintained over successive years.The observedreferral rate of 0.84 % is relatively low, which is the reason for this study. The detection rate hasbeen increasing as the coverage of the program has been growing, approaching the estimated incidenceof neonatal deafness

Non-organic hearing loss in Chinese teenagers.

OBJECTIVE: To heighten the physician's awareness of non-organic hearing loss in teenagers in China. METHODS: Retrospective cases review of seven patients (six girls and one boy) with sudden hearing loss was conducted. RESULTS: Five patients presented with hearing loss bilaterally and two patients unilaterally. All patients suffered from severe to profound hearing loss. However, the acoustic reflex test indicated direct and indirect responses were present bilaterally at 1000 Hz 100 dB SPL. The results of ABR test revealed hearing threshold within 20-30 dB nHL. Further investigations indicated non-organic hearing loss was associated with school stress or environment conflict. Satisfactory outcomes were achieved in all patients. CONCLUSION: Non-organic hearing loss should be considered when teenagers present with severe to profound sudden hearing loss if the acoustic reflex is present. School and home stresses are associated with the occurrence of non-organic hearing loss in the present study.

The prevalence of hearing loss in children and adolescents with cancer.

UNLABELLED: The treatment of cancer in children has several side effects, including ototoxicity. Inner ear structures may be affected and hearing loss may ensue. AIM: To estimate the prevalence of hearing loss in patients with cancer using the American Speech-Language-Hearing Association (ASHA), the Pediatric Oncology Group Toxicity (POGT), and the Bilateral Hearing Loss (PAB) criteria. STUDY DESIGN: a prospective study. MATERIAL AND METHODS: 94 patients admitted between 2003 and 2004 were analyzed. Visual inspection of the external auditory meatus and an audiologic evaluation were done. Descriptive statistics was used to characterize the sample, and Kappa statistics was used to investigate concordance of hearing loss in the three types of classification. RESULTS: The prevalence of hearing loss was 42.5% using ASHA, 40.4% using POGT, and 12.8% using PAB. The concordance of hearing loss was weak for POGT and PAB (k=0.36) and for PAB and ASHA (k=0.33). The concordance between ASHA and POGT was almost perfect (k=0.96). CONCLUSIONS: Hearing loss is an important side effect of the treatment of cancer in children. Periodic audiology monitoring is recommended to detect early hearing loss and to revise the treatment if necessary. Adoption of a classification system that detects mild hearing loss (ASHA) is recommended.

A prevalência de perdas auditivas em crianças e adolescentes com câncer / The prevalence of hearing loss in children and adolescents with cancer

O tratamento do câncer infantil provoca diversos efeitos colaterais, como a ototoxicidade, que é capaz de lesar estruturas da orelha interna e pode levar à perda auditiva. OBJETIVO: Estimar a prevalência de perda auditiva em crianças e adolescentes com câncer, utilizando três classificações: American Speech-Language-Hearing Association (ASHA), Pediatric Oncology Group Toxicity (POGT) e Perda Auditiva Bilateral (PAB). Forma de Estudo: Transversal. MATERIAL E MÉTODO: Analisou-se 94 pacientes atendidos entre 2003 e 2004. Os indivíduos foram submetidos à inspeção visual do meato acústico externo e avaliação audiológica. Para caracterização da amostra utilizou-se a estatística descritiva e para a análise da concordância da perda auditiva nas três classificações foi utilizada a estatística Kappa. RESULTADOS: Houve prevalência de perda auditiva de 42,5 por cento pela ASHA, 40,4 por cento pela POGT e 12,8 por cento pela PAB. A concordância para POGT e PAB, e para PAB e ASHA foi fraca (respectivamente, k=0,36 e k=0,33). A concordância entre ASHA e POGT foi quase perfeita (k=0,96). CONCLUSÕES: A perda de audição é um efeito colateral importante nos pacientes com câncer. A monitorização auditiva é fundamental, pois possibilita detecção precoce e revisão do tratamento. Recomenda-se adotar uma classificação que contemple perdas auditivas leves, como proposta pela ASHA.

The treatment of cancer in children has several side effects, including ototoxicity. Inner ear structures may be affected and hearing loss may ensue. AIM: To estimate the prevalence of hearing loss in patients with cancer using the American Speech-Language-Hearing Association (ASHA), the Pediatric Oncology Group Toxicity (POGT), and the Bilateral Hearing Loss (PAB) criteria. Study design: a prospective study. MATERIAL AND METHODS: 94 patients admitted between 2003 and 2004 were analyzed. Visual inspection of the external auditory meatus and an audiologic evaluation were done. Descriptive statistics was used to characterize the sample, and Kappa statistics was used to investigate concordance of hearing loss in the three types of classification. RESULTS: The prevalence of hearing loss was 42.5 percent using ASHA, 40.4 percent using POGT, and 12.8 percent using PAB. The concordance of hearing loss was weak for POGT and PAB (k=0.36) and for PAB and ASHA (k=0.33). The concordance between ASHA and POGT was almost perfect (k=0.96). CONCLUSIONS: Hearing loss is an important side effect of the treatment of cancer in children. Periodic audiology monitoring is recommended to detect early hearing loss and to revise the treatment if necessary. Adoption of a classification system that detects mild hearing loss (ASHA) is recommended.

Hearing loss among construction workers in Edmonton, Alberta, Canada.

Hearing acuity among electricians, plumbers and pipefitters, and boilermakers with > or = 20 years of union membership was compared with that of telephone workers. Automated pure tone audiometry was performed and a questionnaire was administered. Most construction workers were exposed to occupational noise and wore hearing protection. Median thresholds for electricians and telephone workers were comparable. Thresholds of plumbers and pipefitters were higher but comparable to expected values. Boilermakers had high levels of hearing loss. Thresholds at 4000 Hz among older workers were similar for all groups and were above expected values, suggesting a cohort effect. Audiometric screening seems to be warranted for some construction workers.

[Objective audiologic assessment of children treated with amikacin]. / Amikacinnal kezelt gyermekek objektív audiológiai vizsgálata.

Hearing assessment of 14 children suffered from urinary tract infection and treated by amikacin is reported. The dosage of amikacin was 7.5 mg/kg/daily for 10 days and the serum level of amikacin not exceeded the 35 mcg/ml. The aim of the study was on the one hand to determine the hearing damaging side effect of amikacin and on the other to assess the usefulness of objective methods for detection of hearing loss in this population. Authors used for screening a transient otoacoustic emission (TEOAE) during and after (2-4 weeks) therapy. If subjective and objective (TEOAE) methods gave a good result, no further checkup has considered as necessary, but if there were no evoked emission, acoustic brainstem response audiometry has been carried out for verification. It result no hearing loss could be detected in the measured specimen. In conclusion it has been stated that by proper dosage and serum level screening amikacin may no lead to hearing loss in children, and objective methods are valuable for hearing screening and monitoring of such population of children.

Morbilidad de los defectos auditivos en comunidades rurales de ocho estados de la República Mexicana / Morbidity of hearing impairment in rural communities of eight states of Mexico

Se efectuó in estudio transversal, descriptivo y observacional en muestreo de defectos auditivos en comunidades rurales de 8 Estados de la República Mexicana. Se encontró un incidencia global de 21.07 por ciento, con una alta incidencia de hipoacusias profundas (10.31 por ciento) y severas (6.39 por ciento). Se hizo en análisis de los defectos auditivos según la edad, el tipo de hipoacusia y la patología.

Children's health outcomes in six different ambulatory care delivery systems.

This study assesses health outcomes across six widely varying delivery settings within one population sample, describing differences between actual and expected illness prevalences among children using each type of setting as a regular source. Illness measures are from independent clinical examinations of the children for anemia, acute and chronic ear problems, hearing loss and vision disorders. Comparisons of actual with expected prevalences based on each setting's patient clientele reveal three systematic patterns: children using solo practitioners had generally higher-than-expected illness prevalences, while those using the prepaid group and hospital outpatient departments had uniformly lower-than-expected prevalences. These differentials were not related to patients' economic status or to selection of providers according to recent children's health problems, and, for the prepaid group and solo practice, they were generally stronger among more exclusive users of each setting. Thus, the illness differentials appeared to represent outcomes related to system differences in quality of care. Although the differentials were small and not all were statistically signifiant, they may have substantial policy significance. Some unusual as well as characteristic features of each setting are discussed which may explain these system differentials.