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.

ISOLATED SPHENOIDITIS

Solitary infection of the sphenoid sinus is an uncommon condition. A series of 13 patients with isolated sphenoid sinusitis was reported. A retrospective chart review was performed with special attention given to patients who presented signs, symptoms, culture results and radiographic findings. There were five patients with acute infection and eight with chronic infection. The predominant presenting symptoms were severe unexplained headache, cranial nerve palsies and visual impairment. Eight patients had underlying diseases. Computerized tomography and sinus endoscopy proved to be most useful diagnostic studies. Staphylococcus spp. and Gram negative organisms were responsible. Eleven patients were improved or cured. One patient died from septicemia. Early diagnosis and aggressive therapy, including surgical drainage, were important in preventing fatal complications and should not be delayed. Chiang Mai Med Bull 2545;41(1):1-6.