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.

OUTCOME OF THE DIX - HALLPIKE MANEUVER AND THE BRIEF HEAD TURN MANEUVER IN BENIGN PAROX YSMAL

To review the outcome of the Dix-Hallpike maneuver (DHM) and the brief head turn maneuver (BHTM) in patients who had typical history of benign paroxysmal positional vertigo (BPPV).  Methods Sixty patients who presented with typical history of BPPV from December 2003- November 2004 were retrospective review. All patients were tested with the DHM and/or the BHTM and were divided into 2 groups, according to positive or negative test result. Analysis the data was done using Statistical package for Social Science (SPSS) version 11. Results The age of the patients ranged from 24-69 years with men to women ratio of 1: 1.7. The onset of symptom prior to treatment varied from 1 hour- to 3.5 years. The range of duration of vertigo in each episode was 1 seconds to 5 minutes. There is no statistical significant difference between positive and negative groups in all of the above parameters. Twenty-eight percent (17 cases) of the patients showed positive test. Eight and five cases had positive only in the DHM or the BHTM respectively. Four cases had positive in both tests. Conclusions Patients who had typical history of BPPV should be evaluated with both DHM and BHTM to localized the affected ear and clearify the underlying pathology. With positive result, specific treatment can be performed. Chiang Mai Med Bull 2005;44(3):101-106.