Hearing loss screening tool (COBRA score) for newborns in primary care setting / 소아과

PURPOSE: To develop and evaluate a simple screening tool to assess hearing loss in newborns. A derived score was compared with the standard clinical practice tool. METHODS: This cohort study was designed to screen the hearing of newborns using transiently evoked otoacoustic emission and auditory brain stem response, and to determine the risk factors associated with hearing loss of newborns in 3 tertiary hospitals in Northern Thailand. Data were prospectively collected from November 1, 2010 to May 31, 2012. To develop the risk score, clinical-risk indicators were measured by Poisson risk regression. The regression coefficients were transformed into item scores dividing each regression-coefficient with the smallest coefficient in the model, rounding the number to its nearest integer, and adding up to a total score. RESULTS: Five clinical risk factors (Craniofacial anomaly, Ototoxicity, Birth weight, family history [Relative] of congenital sensorineural hearing loss, and Apgar score) were included in our COBRA score. The screening tool detected, by area under the receiver operating characteristic curve, more than 80% of existing hearing loss. The positive-likelihood ratio of hearing loss in patients with scores of 4, 6, and 8 were 25.21 (95% confidence interval [CI], 14.69–43.26), 58.52 (95% CI, 36.26–94.44), and 51.56 (95% CI, 33.74–78.82), respectively. This result was similar to the standard tool (The Joint Committee on Infant Hearing) of 26.72 (95% CI, 20.59–34.66). CONCLUSION: A simple screening tool of five predictors provides good prediction indices for newborn hearing loss, which may motivate parents to bring children for further appropriate testing and investigations.

Success and Key Success factors of Myringoplasty in Uttaradit Regional Hospital

PROBLEM/BACKGROUND: Tympanic membrane perforation is the complication of various diseases or conditions. It may occur with middle ear infection. Myringoplasty or tympanoplasty type I was invented to repair the perforated tympanic membrane and to improve the hearing result. Theoretically, key success factors are eustachian tube function, nasal function, atopy, nasopharyngeal abnormalities and severity of infection. OBJECTIVE: To reveal the outcomes of myringoplasty and key success factors of this operation. RESEARCH DESIGN: Retrospective analytic study. SETTING: Department of Otolaryngology, Uttaradit Regional Hospital. MATERIALS and METHOD: The documents of patients receiving myringoplasty at Department of Otolaryngology, Uttaradit Regional Hospital between 1st January 1996 and 31st December 2006 were reviewed. The obtained data was analyzed about the outcomes of myringoplasty and key success factors. Data analysis was done by paired sample t test and chi-square test with significant level at 0.05. RESULTS: The success rate of myringoplasty was 81.2 percent and hearing gain was statistically improved after the operation. No key success factor, even the surgeon factor, affected the tympanic membrane healing. In other way; age, size of perforation along with other middle ear infection had statistically impact to the hearing result (p=0.027, 0.001, 0.032 respectively). CONCLUSIONS: From this study, the outcomes of myringoplasty both in perforated tympanic membrane healing and hearing improvement meet the theoretical standard and are similar to international studies. This suggests that the treatment of perforated tympanic membrane in Department of Otolaryngology, Uttaradit Regional Hospital has good quality and standard.