Prevalence and reasons for non-follow-up of newborns with "refer" results on initial hearing screening

OBJECTIVE: To determine the prevalence rate of follow-up among infants who had a "refer" result on initial newborn hearing screening and to identify reasons for default by parents or guardians.METHODS:Design: Cross-Sectional StudySetting: Tertiary National University HospitalParticipants: 79 parents or guardians whose newborns obtained a "refer" result on initial hearing screening were interviewed over the phone.RESULTS: Among those babies who had a "refer" result on initial hearing screening, 51% followed up for repeat testing. The most common reasons for non-follow up by parents or guardians include being busy, distance from the hospital and baby's health condition.CONCLUSIONS: The follow-up rate in this study is higher compared to previous figures (27%), but is still below target. The reasons for non-follow-up obtained suggest problems may exist on all levels of the healthcare system. Appropriate solutions to address these problems should be explored.

Prevalence of sensorineural hearing loss and its association with glycemic control in Filipino patients with diabetes at the Philippine General Hospital / Journal of the ASEAN Federation of Endocrine Societies

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Sensorineural hearing loss (SNHL) is a form of diabetic neuropathy. Its prevalence rate varies from 21.7-73.3% among different populations. The association of this complication with long-term glycemic control has not been described extensively.<br /><strong>OBJECTIVES:</strong> The study aims to determine the prevalence of SNHL in Filipino patients with diabetes consulting in a tertiary hospital; and to determine the association of SNHL with the degree of blood sugar control as measured by the mean hemoglobin bA1c (HbA1c) for the last five years.<br /><strong>METHODOLOGY</strong>: A cross-sectional study of 128 patients in a tertiary hospital was done. Patients were recruited via stratified random sampling with the different clinics as the stratifying variable. They underwent physical examination and pure tone audiometry (PTA) to detect presence of SNHL and presence of distal peripheral neuropathy. Chart review was done to gather the HbA1c levels for the last five years, as well as data on the presence of retinopathy and nephropathy. The average HbA1c levels, and other clinical and demographic factors and their association with SNHL were analyzed using logistic regression.<br /><strong>RESULTS:</strong> The prevalence of SNHL among patients with diabetes is 45.31%. Glycemic control does not seem to be associated with SNHL (p value 0.451, OR 1.447). Age was found to be significantly associated with SNHL (p value=0.046, OR=1.035). Among patients age 60 years old and below, retinopathy was significantly associated with SNHL (p value 0.023, OR=3.564). Multivariate analysis did not show any significant predictor for SNHL. There was no observed difference in the proportion of patients with SNHL among males (48.94%) compared to females (43.21%), p value of 0.530. A more advanced age is associated with SNHL among males (p value 0.024, OR=1.095) and a family history of hearing loss is an independent predictor of SNHL (p value 0.047, OR=1.088).<br /><strong>CONCLUSION:</strong> There is a high prevalence rate of SNHL among Filipino patients with diabetes. SNHL does not seem to be associated with glycemic control. Screening for SNHL maybe warranted for patients with diabetes due to its high prevalence rate regardless of glycemic control. Hearing care, focusing on prevention of hearing loss, should be advocated for patients with diabetes mellitus</p>

The voice test for newborn hearing screening

OBJECTIVES. The goal of the study is to find a reasonable aIternative test that can be utilized in the Philippine setting to operationalize the Universal Newborn Hearing Screening Act. Thus the components of the Voice Test were studied. The objectives of the study are to determine: (1) which of the two words "Baah" and "Psst" is better for newborn hearing screening rocedure as far as their physical characteristics are concerned, ~) how do the two words "Baah" and Psst" differ between genders and distance from sound source, (3) to determine the proportion of the participants who could recite the words at intensity of 80db or louder. METHODS. Frequency characteristics and sound intensity differences of two words "Baah" and "Psst" were determined and ompared. RESULTS. The word "Baah" exhibited more favorable physical attributes over the word 'Psst" for purposes of being a screening tool for newborn hearing assessment. CONCLUSION. This study reports the results of an initial step in the search for an inexpensive, feasible, and valid tool for neonatal earing screening. Correlation studies with speech developmental milestones may eventually enhance the usefulness of the voice test.

The ubiquitous TB otitis media: A review of diagnosis and treatment outcomes

OBJECTIVE: The purpose of this review is to improve the detection of TB otitis media cases and its treatment outcome by describing the varied clinical presentations, discussing the importance, limitations and frontiers of possible diagnostic tests and illustrating the roles of medical and surgical interventions METHOD: A review of available literature was done. The search included published researches on TB Otitis Media and related articles on tuberculosis. RESULTS: The review included aspects of the clinical presentation, diagnostic considerations, and treatment options, both medical and surgical, of tuberculous otitis media. CONCLUSION: Tuberculous otitis media presents with a variety of clinical features so that a high index of suspicion is very important. Diagnostic examinations are available but are varied depending on the clinical presentation. Definitive treatment is mainly medical with anti- Koch's medications.

Auditory brainstem response latencies of infants and maternal eposure to environmental toxic product

OBJECTIVE: To explore the effects of pesticide exposure on the auditory system, specifically on hearing status based on auditory brainstem responses. METHODS: A cohort of pregnant women was identified in several communities in a rural area from April 2002 to February 2003 and followed up until delivery. Mother-infant dyads were assessed for exposure to pesticides. Maternal and fetal exposures to environmental toxic products were determined by measuring levels in maternal hair and blood, and infant cord blood, hair, and meconium, respectively. Hearing status was measured using otoacoustic emissions (OAE) and confirmed by diagnostic auditory brainstem responses (ABR) measured at 80, 60, and 40 decibels. Waves I, III, V were identified and absolute latencies measured, including inter-peak latencies from waves 11III, I-V, and III-V. Pesticide exposure was then correlated with latencies of Waves I, III, V, and interpeak latencies of waves I-III, IIV, and III-V. Hearing loss and pesticide exposures were correlated with Griffiths Mental Development Scores (GMDS). RESULTS: Significant delays in the ABR wave latencies were noted in the group with exposure to pesticides. Propoxur was the most common toxic product detected in infants and meconium the best substrate for its detection. There was a 1.4% risk of hearing loss with exposure to propoxur (RR=0.52 (0.12-2.30), p = 0.06), a 6.25% risk with cypermethrin exposure (RR= 4.53 (0.61133.64), P = 0.10) and 6.25% risk with pretilachlor exposure (3.13 (0.44-22.30), p = 0.07). Griffith's Mental Developmental Scale scores (GMDS- hearing and speech subscale and general quotient scores) were not significantly different between exposed and unexposed groups. However, three infants with positive exposures and hearing loss had below average, or low to average scores using this scale. CONCLUSION: Maternal exposure to environmental toxic products may affect the auditory pathway in infants at birth. Pregnant women should limit their exposure to such toxic products in order to avoid neurodevelopmental effects particularly on hearing because this is very important in the critical stage of language and speech development.

Training of nurses in ear examination and hearing screening in the school setting.

The objectives of this study were to determine the agreement between the ear examination findings of the otorhinolaryngologist (trainer) and the elementary school nurse (trainee) after training with the use of a penlight and to determine the mean sound pressure level (SPL) produced by school nurses as a standard parameter for hearing screening using a 512 tuning fork after training on tuning fork testing by the otorhinolaryngologist. Training workshops in ear examination using a penlight and hearing screening using a 512 tuning fork were conducted for school nurses. Data for assessment of ear examination skills and production of SPL were collected by questionnaire and observation of performance. Kappa statistics were used to assess agreement between trainees' and trainer's responses. Mean and standard deviation were determined for the assessment of the SPL produced. Results showed an excellent agreement between the school nurses' and otorhinolaryngologist's observations on ear examination. These included observations of the ear canal, visualization of the tympanic membrane and identification of unusual findings such as wax and discharge. The majority of nurses responded positively in terms of the ease and confidence in performance of the procedure. Regarding tuning fork testing, the nurses were able to produce significant SPL. The mean SPL produced by the nurses using a 512 tuning fork was 56.316 dB.