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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4612_Библиотеки_им_академика_М_И_Перельмана
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ENT referral
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TABR & NABR:
ELECTRO-
PHYSIOLOGY INTERVENTION
SPEECH
AUDIOMETRY
PURE-TONE
AUDIOMETRY
absolute latencies
SRT-PTA
match
CHL or
mixed; max
Retest after
medical
management
prolonged; normal
interpeak latencies;
reduced amplitudes
ECOG: WNT;
Good to
excellent WRS
conductive
component of
60 dB HL
ENT referral
Retest after
medical
reduced to absent
SP/AP
TABR & NABR:
absolute latencies
prolonged; normal
SRT-PTA
match
Good to
CHL or
mixed; max
conductive
management
reduced to absent
interpeak latencies;
reduced amplitudes
SP/AP
ECOG: WNT;
excellent WRS
component of
60 dB HL
ENT referral
Retest after
medical
management
TABR & NABR:
absolute latencies
prolonged; normal
interpeak latencies;
reduced amplitudes
SRT-PTA
match
Good to
excellent WRS
CHL; max
conductive
component of
60 dB HL
WNT;
reduced to absent
SP/AP
ECOG:
COMPLAINTS/
Reduced
Tymp: Type
Red EC and
Aural fullness;
HISTORY OTOSCOPY IMMITTANCE OAES
to absent
As or B
tympanogram
with normal
ECV
TM; no
landmarks
visualized;
air bubbles;
otalgia;
drainage,
decreased
hearing; foul
Decay: WNT
MEMR: WNT
debris in EC
smell; tinnitus
Reduced
to absent
WNT
Tymp: Type B
tympanogram
with large ECV
MEMR:
Red EC;
visualize
perforation;
debris in EC
Aural fullness;
otalgia;
drainage,
decreased
Decay: WNT
(may be
related to
OME or
hearing;
tinnitus
OE)
Reduced
to absent
Tympanogram:
Type A or Ad
MEMR: WNT
Decay: WNT
Generally
normal
Decreased
hearing;
possible
previous trauma
APPENDIX 5 –B. continued
Tympanic
Membrane
PATHOLOGY
Otitis Media
with Effusion
(OME)
Perforation
242
Ossicular
Chain
Disarticulation
ENT referral
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TABR & NABR:
ELECTRO-
PHYSIOLOGY INTERVENTION
SPEECH
AUDIOMETRY
PURE-TONE
AUDIOMETRY
absolute latencies
SRT-PTA
match
CHL; max
conductive
Retest after
medical
management
prolonged; normal
interpeak latencies;
reduced amplitudes
ECOG: WNT;
Good to
excellent WRS
component of
60 dB HL
Carhart’s
notch noted in
ENT/
mental health
professional
reduced to absent
SP/AP
TABR & NABR:
dependent
on degree/
SRT-PTA
match
Poor to
BC at 2 kHz
Normal to
SNHL
referral
Tinnitus
therapies
configuration of HL
normal to absent
ECOG: WNT;
excellent WRS
(dependent on
degree of HL)
SP/AP
ENT referral
NABR: absolute
SRT-PTA
Hearing
Retest after
medical
management
Amplification/
latencies prolonged;
normal interpeak
latencies; reduced
amplitude
match
Good to
excellent WRS
loss with
ABG; max
conductive
component of
60 dB HL
cochlear
implant/OID
ECOG: reduced to
absent SP/AP
continues
COMPLAINTS/
Reduced
to absent
Tympanogram:
Type A or As
Generally
normal
HISTORY OTOSCOPY IMMITTANCE OAES
hearing; aural
MEMR: WNT
fullness
Decay: WNT
Normal
to absent
Generally
normal
Generally
normal
noise; decreased
hearing
MEMR:
normal to
absent
Decay: normal
to abnormal
Reduced
to absent
any type
Tymp:
depending on
pathology
Normal to
abnormal
depending
on
Decreased
hearing; aural
fullness
MEMR:
normal to
absent
pathology
normal
Decay:
to abnormal
PATHOLOGY
Otosclerosis Decreased
Tinnitus Perception of
243
Conductive
Hearing Loss
ENT referral
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Retest after
medical
management
ENT referral
for unilateral/
asymmetrical
—
findings
Amplification/
cochlear
implant
ENT referral
for unilateral/
asymmetrical
findings
Amplification/
cochlear
implant
latencies prolonged;
ELECTRO-
SPEECH
PURE-TONE
NABR: absolute
PHYSIOLOGY INTERVENTION
SRT-PTA
AUDIOMETRY
AUDIOMETRY
match
SNHL with
ABG
Reduced
to absent
prolonged interpeak
latencies; reduced
small — no wave I;
Poor to
amplitude
excellent
(dependent
on degree of
ECOG: reduced to
absent SP/AP
SNHL)
absolute
latencies normal to
prolonged; small
no wave I; normal
NABR:
SRT-PTA
match
HL with no
ABG
Reduced
to
interpeak latencies;
Poor to
excellent
(dependent on
Absent
Type A
reduced to
reduced amplitude;
poor morphology
ECOG:
degree of HL)
absolute
absent SP/AP
NABR:
SRT-PTA
SNHL with
Reduced
normal
latencies normal to
prolonged; small —
no wave I; normal
interpeak latencies;
reduced amplitude;
poor morphology
match
Poor to
excellent
(dependent on
degree of HL)
notch at 3–4
kHz
to absent
ECOG: reduced to
absent SP/AP
normal
COMPLAINTS/
APPENDIX 5 –B. continued
HISTORY OTOSCOPY IMMITTANCE OAES
PATHOLOGY
Tymp: any type
(depending on
pathology)
Normal to
abnormal
depending
on
Decreased
hearing; aural
fullness
Mixed
Hearing Loss
MEMR:
normal to
absent
pathology
Decay: normal
to abnormal
MEMR:
normal
to absent
Normal Tymp:
Decreased
hearing;
tinnitus;
poor word
Sensorineural
Hearing Loss
244
(depending on
degree of HL)
Decay:
to abnormal
understanding;
difficulty
communicating
Normal Tymp: Type A
Decreased
hearing;
Noise-
Induced
MEMR:
normal
to absent
tinnitus;
poor word
understanding;
Hearing Loss
(NIHL)
(depending on
degree of HL)
Decay:
to abnormal
difficulty
communicating;
noise exposure
Immediate
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ENT referral
Should be seen
within 48 hours
of onset of
complaints
ENT referral
latencies normal to
ELECTRO-
SPEECH
PURE-TONE
NABR: absolute
PHYSIOLOGY INTERVENTION
SRT-PTA
AUDIOMETRY
AUDIOMETRY
match
HL with no
ABG
Reduced
to absent
prolonged; small —
no wave I; normal
interpeak latencies;
reduced amplitude;
Poor to good
(dependent on
degree of HL)
reduced to
poor morphology
ECOG:
prolonged
absent SP/AP
Wave III, V, and/
NABR:
SRT-PTA
match
SNHL
Normal Normal to
or interpeak
absence of waves
WavesI–V
•
Poor to fair
(dependent on
pathology)
interaural
differences
significant
• poor morphology
•
WRS is often
poorer than
expected with
degree of HL
COMPLAINTS/
Normal Tymp: Type A
Sudden HL;
HISTORY OTOSCOPY IMMITTANCE OAES
PATHOLOGY
Sudden
MEMR:
normal
to absent
(depending on
tinnitus
Sensorineural
Hearing Loss
(SSHL)
degree of HL)
Decay: normal
to abnormal
245
MEMR:
elevated to
Normal Tymp: Type A
Decreased
hearing;
tinnitus;
Retrocochlear
Pathology
absent
Decay:
Abnormal
poor word
understanding;
difficulty
communicating
Note. WNT: would not test; PTA: pure-tone average; WRS: word recognition score; TABR: threshold ABR; NABR: neurodiagnostic ABR.
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Audiology Review: Preparing for the Praxis and Comprehensive Examinations
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247
Pediatric Assessment and
Differential Diagnosis
Tori J. S. Gustafson and Candace Bourland Hicks
Case History Considerations
Chapter 6
The case history is an important part of a pediatric audiological evaluation, one that provides information that the audiologist must consider related to risk factors for hearing loss and developmental
factors. The case history assists the audiologist in planning or modifying plans for testing, along with
assisting with recommendations and referrals following the testing.
Parent/Caregiver Concerns
The audiologist can gauge the parent/caregiver concerns by starting with a general question (e.g., what
do you think of your child’s hearing?). This provides a way to determine concerns without leading them
to answer a certain way (e.g., only answering the specific questions given by the clinician, which may
not relate to the true concern) or to answer only yes/no.
Pregnancy/Birth
Case history questions should address pregnancy, including maternal sicknesses and exposure to drugs
or alcohol. Questions related to pregnancy can provide the audiologist with considerations for embryological development of infant in the womb.
n
For a review of embryological development, see Chapter 2 of this text or Hill (2017).
Insults during the first trimester lead to greater risk for development of the inner ear.
Depending on timing of fetal insult, may lead to a lack of development of portions of the
ear. Examples of inner ear aplasia (which would lead to sensorineural hearing loss) include:
●
Michel Aplasia/Complete Labyrinthine Aplasia: inner ear does not develop; insult in
third week of pregnancy
●
Common cavity: aplasia with a single auditory/vestibular cavity; insult in fourth week
●
Mondini’s Aplasia/Incomplete Partition: small cochlea, 1 to 1.5 cochlear turns (classical
Mondini’s); insult in seventh week (Jackler et al., 1987)
247
Audiology Review: Preparing for the Praxis and Comprehensive Examinations
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248
Maturation continues into the second and third trimesters.
n
Ask questions related to the birth, including information such as:
Premature birth
Gestational age at birth
Birth weight
Neonatal intensive care unit (NICU) stay
●
If yes, how long was the stay and what type of treatments did the child receive?
These questions can provide insight into other possible developmental delays and comorbidities the
child may have.
Risk Factors for Hearing Loss
Questions should also address risk factors for hearing loss (Joint Committee on Infant Hearing, 2019),
such as anoxia, NICU stay of > 5 days, hyperbilirubinemia treated with exchange transfusion, syndromes associated with hearing loss, craniofacial anomalies, and ototoxic medications.
n
Consider risk factors of delayed onset or progressive hearing loss, such as family history of
progressive or delayed-onset childhood hearing loss, extracorporeal membrane oxygenation
(ECMO), and (s)TORCH infections.
n
Always consider caregiver concern for hearing or speech-language development.
n
Another risk factor is a family history of permanent childhood hearing loss; see Chapter 2 for
a review of genetic disorders and patterns.
n
Questions for the family should include if loss is potentially progressive.
Medical History
In planning testing and prioritizing the ordering of testing, the medical history is an important part
of the pediatric audiologic assessment. The medical history includes both otologic-related history and
general medical history.
n
Otitis media (ear infections)
Gather information on how many infections the child has had in various age ranges, how
these infections were treated, and when the most recent infection was.
Treatment questions can include whether the child received pressure equalization (PE)
tubes. If so, questions would relate to when the PE tubes were received, how many sets the
child has had, and if they know if the PE tubes are still in place.
Information regarding otitis media can assist with the testing plan by allowing the
audiologist to consider if the child may have sensitivity to having their ears touched,
to consider if drainage may be present that could impact the transducer chosen, and to
consider if the order of testing needs to be modified to prioritize collecting of low-frequency
thresholds.
n
Hospitalizations and reasons
Questions can address areas such as if head trauma was present and if treatment included
use of ototoxic medications.
CHAPTER 6 Pediatric Assessment and Differential Diagnosis
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n
Other diagnoses
Some diagnoses could show a connection to hearing loss.
●
Craniofacial disorders — often associated with conductive hearing loss
●
Certain syndromes associated with sensorineural hearing loss (e.g., Waardenburg)
●
See Etiology of Pediatric Hearing Loss section later in this chapter for additional
information.
Some diagnoses could impact the plan of testing.
●
Syndromes associated with atresia can impact plan of testing (e.g., which transducer
to use).
●
Visual impairment can change the plan for visual reinforcement audiometry (VRA) and
conditioned play audiometry (CPA) testing.
●
Children with anxiety and sensory sensitivities may need adjustments to testing
approaches.
Other Developmental Areas
n
Speech-language development, which is often a primary concern for toddlers who are seen for
audiological testing
249
Inquire about information about expressive and receptive abilities, including questions such
as what percentage of the child’s speech is understandable to a familiar adult (e.g., a parent)
and for an unfamiliar adult. Questions can also include if the child can understand one- or
two-step directions.
Ask if certain sounds or concepts are missing.
Speech-language ability could also impact the plan of testing. For example, is the child’s
language appropriate for the word recognition list chosen based on developmental age
rather than chronological age? Is the child’s speech intelligible, which could impact if you
choose a word repetition versus a picture-pointing task?
AUDIOLOGY NUGGET
As a general rule, by 24 months of age, a child should be able to produce 70%
of consonants correctly and will have two- to three-word phrases. The child’s
speech should be 26% to 50% intelligible at this age. By 36 months of age,
speech should be 75% intelligible, and by 48 months of age, speech should be
100% intelligible (Bleile, 2015).
n
Motor and cognitive development
Development of motor or cognitive function may provide clues as to the overall
developmental age of the child. This information helps determine what behavioral testing is
appropriate and what should be included in the test battery.
●
Consider motor problems if picture pointing or body part identification will be part of
speech testing.
Audiology Review: Preparing for the Praxis and Comprehensive Examinations
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250
●
Problems in motor coordination can impact response times for VRA and CPA. If motor
issues are present, care must be taken in the choice of appropriate CPA toys.
●
Cognitive delays can impact the choice of test (i.e., base the test on developmental age)
and may lead to modification of instructions.
n
Other areas of development can impact testing, such as social development. For example,
a child with autism spectrum disorder (ASD) could benefit from a task such as tangible
reinforcement operant conditioning audiometry (TROCA) that provides tangible
reinforcement rather than CPA.
AUDIOLOGY NUGGET
The developmental age of a child, as opposed to chronological age (i.e., birth date
to current date), should be considered in planning for audiological testing. The
parent may be able to report developmental age (for example, from a physician
or from assessments completed by an early intervention program). However, in
many cases, the clinician must estimate developmental age from development in
other areas. Motor and cognitive milestones can provide information, which can
help the audiologist plan testing. Some important milestones from the Centers
for Disease Control and Prevention (CDC, n.d.) include:
n
4 months: when held, the child can hold their head without support.
n
6 months: the child can roll from front to back; the child reaches for
objects.
n
9 months: the child can sit up independently without support and will
look when their name is called.
n
12 months: the child will wave and pull to a standing position; the child
can walk with support.
n
15 months: the child can take steps independently and will try to use
objects in a correct manner.
n
18 months: the child walks independently and can climb (e.g., on
furniture); the child can copy activities and will point at objects to direct
a person’s attention to the object.
n
2 years: the child can run, kick a ball; the child can identify at least two
body parts.
Support Services
n
Early intervention services
Can include speech-language therapy, physical therapy, or occupational therapy
Information can help the audiologist in planning testing
CHAPTER 6 Pediatric Assessment and Differential Diagnosis
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●
Example: if the child cannot sit without support and does not have head/neck control,
testing with VRA may be impacted.
Referrals to early intervention services may be recommended if the child is not receiving
services.
n
Educational services
Can include Individualized Education Program (IEP) or a 504 plan
Ask questions about the educational setting.
●
Daycare; self-contained classroom
Ask questions about the child’s progress in the different academic subjects.
Answers to these questions can lead to additional testing.
●
Is testing in background noise needed to make recommendations for services or for
hearing assistive technology (HAT)?
Answers to these questions can allow the audiologist to consider specific educational
recommendations based on test results.
251
Functional Questionnaires
Functional testing is important in determining impact of hearing loss and in determining if treatment
(hearing aid, cochlear implant, etc.) is providing functional benefit. Examples of functional questionnaires include:
n
Little Ears
Parent questionnaire designed for children birth to 24 months of age
Includes yes/no responses to questions such as children responding to distant sounds or
looking for sound sources
n
Infant-Toddler Meaning Auditory Integration Scale (IT-MAIS)
Parent questionnaire that addresses how/if the child responds spontaneously to sounds
n
PEACH/TEACH
Parents’ Evaluation of Aural/Oral Performance of Children (PEACH)
●
Parents rate the child on communication behaviors in quiet (e.g., responding to their
name in quiet or talking on the telephone) and in noise (e.g., responding to their name
in noise or recognizing environmental sounds in noise).
Teachers’ Evaluation of Aural/Oral Performance of Children (TEACH)
●
Teacher rates the child on communication behaviors in quiet (e.g., responding to their
name in quiet or talking on the telephone) and in noise (e.g., responding to their name
in noise or recognizing environmental sounds in noise).
For additional information, see Bagatto et al. (2011) and Deconde Johnson and Seaton (2021). Functional assessments specific to the academic environment are addressed in the Educational Audiology
section later in this chapter.
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