ABSTRACT
En la última década hemos asistido a un rápido y tremendo progreso en el desarrollo de los sistemas de diagnóstico y tratamiento precoz de la hipoacusia infantil dentro de programas de salud pública. El porcentaje de niños cribados anualmente en España se ha incrementado significativamente al haberse extendido los programas de atención al déficit auditivo infantil a todas las autonomías. Históricamente, los indicadores de alto riesgo han sido empleados para la identificación de los niños que debían ser evaluados audiológicamente por vivir en áreas remotas donde los programas de cribado no existían, para ayudar a identificar aquellos niños que, aunque hayan pasado el cribado, siguen presentando riesgo de desarrollar una hipoacusia diferida y para identificar los niños que presentan hipoacusias permanentes leves no detectadas en el cribado. En esta revisión se analizan los indicadores de riesgo de hipoacusia y se identifican los factores que se asocian a sus formas de presentación diferida. La recomendación establecida es que se lleve a cabo al menos una revisión audiológica entre los 24 y los 30 meses de edad en los niños con un indicador de bajo riesgo. Sin embargo, para aquellos que presenten factores de alto riesgo como la infección por citomegalovirus o antecedentes familiares de hipoacusia es apropiado realizar un seguimiento más frecuente y temprano. Para todos los niños, incluidos los que carecen de indicadores de riesgo, se debería comprobar su desarrollo global con una herramienta validada a los 8, 18, 24 y 30 meses de edad o antes si existe preocupación de los padres o cuidadores(AU)
In the last decade, tremendous progress has been made very rapidly in the development of Early Hearing Detection and Intervention (EHDI) systems as a major public health initiative. The percentage of infants screened annually in Spain has increased significantly since the EHDI systems have expanded to all autonomic regions. Historically, high risk indicators have been used for the identification of infants who should receive audio logical evaluation but who live in geographic locations where universal hearing screening is not yet available, to help identify infants who pass neonatal screening but are at risk of developing delayed-onset hearing loss and to identify infants who may have passed neonatal screening but have mild forms of permanent hearing loss. In this review, the standard risk factors for hearing loss are analysed and the risk factors known to be associated with late onset or progressive hearing loss are identified. The recommendation for infants with a risk factor that may be considered as low risk is to perform at least one audiology assessment by 24-30 months. In contrast, for an infant with risk factors known to be associated with late onset or progressive hearing loss (such as cytomegalovirus infection or family history), early and more frequent assessment is appropriate. All infants should have an objective standardised screening of global development with a validated assessment tool at 9, 18 and 24-30 months of age or at any time if the health care professional or the family is concerned(AU)
Subject(s)
Humans , Male , Female , Infant , Hearing Loss, Sensorineural/epidemiology , Early Diagnosis , Mass Screening/methods , Risk FactorsABSTRACT
In the last decade, tremendous progress has been made very rapidly in the development of Early Hearing Detection and Intervention (EHDI) systems as a major public health initiative. The percentage of infants screened annually in Spain has increased significantly since the EHDI systems have expanded to all autonomic regions. Historically, high risk indicators have been used for the identification of infants who should receive audiological evaluation but who live in geographic locations where universal hearing screening is not yet available, to help identify infants who pass neonatal screening but are at risk of developing delayed-onset hearing loss and to identify infants who may have passed neonatal screening but have mild forms of permanent hearing loss. In this review, the standard risk factors for hearing loss are analysed and the risk factors known to be associated with late onset or progressive hearing loss are identified. The recommendation for infants with a risk factor that may be considered as low risk is to perform at least one audiology assessment by 24-30 months. In contrast, for an infant with risk factors known to be associated with late onset or progressive hearing loss (such as cytomegalovirus infection or family history), early and more frequent assessment is appropriate. All infants should have an objective standardised screening of global development with a validated assessment tool at 9, 18 and 24-30 months of age or at any time if the health care professional or the family is concerned.
Subject(s)
Hearing Loss, Sensorineural/epidemiology , Age of Onset , Appointments and Schedules , Audiometry , Child, Preschool , Craniocerebral Trauma/epidemiology , Craniofacial Abnormalities/epidemiology , Disease Progression , Drug-Related Side Effects and Adverse Reactions/epidemiology , Early Diagnosis , Female , Fetal Diseases/epidemiology , Genetic Diseases, Inborn/epidemiology , Hearing Loss, Sensorineural/diagnosis , Hearing Loss, Sensorineural/etiology , Humans , Infant , Infant, Newborn , Infant, Newborn, Diseases/epidemiology , Male , Mass Screening/standards , Neonatal Screening/standards , Neurodegenerative Diseases/epidemiology , Otitis Media with Effusion/epidemiology , Practice Guidelines as Topic , Risk FactorsABSTRACT
Actualmente, el cribado auditivo neonatal se lleva a cabo de forma rutinaria en muchos de los sistemas de salud autonómicos en España. A pesar de la importante expansión del cribado de la hipoacusia desde 2000, su viabilidad y los beneficios de la identificación e intervención tempranas, aún existen importantes retos. En este artículo, la CODEPEH actualiza las recomendaciones que se consideran importantes para el futuro desarrollo de los sistemas de detección e intervención precoz en los siguientes puntos: 1. Protocolos de cribado: se recomienda seguir distintos protocolos para los niños ingresados en cuidados intensivos neonatales y los procedentes de maternidad. 2. Evaluación audiológica: se precisa contar con profesionales con experiencia en evaluación de recién nacidos y niños pequeños para completar tanto el diagnóstico como para la selección y adaptación de audioprótesis. 3. Evaluación médica: los factores de riesgo para la hipoacusia neonatal y adquirida se recogen en una única lista en lugar de estar agrupados por el momento de su aparición. Un protocolo de diagnóstico paso a paso es más eficiente y de coste efectivo que efectuar todas las pruebas simultáneamente. 4. Intervención temprana y seguimiento: todos los profesionales que atienden a niños con hipoacusia deberían contar con un entrenamiento especializado y experiencia en la audición, el habla y el lenguaje. Debe realizarse un control periódico del desarrollo de las habilidades auditivas, si existen sospechas paternas y del estado del oído medio. 5. Control de calidad: la gestión de la información como parte integral del sistema es importante para monitorizar y mejorar la calidad del servicio (AU)
Newborn hearing screening is currently performed routinely in many regional health-care systems in Spain. Despite the remarkable expansion in newborn hearing screening since 2000, its feasibility and the benefits of early identification and intervention, many major challenges still remain. In this article, the Committee for the Early Detection of Hearing Loss (Comisión para la Detección Precoz de la Hipoacusia, CODEPEH) updates the recommendations that are considered important for the future development of early hearing detection and intervention (EDHI) systems in the following points: 1. Screening protocols: Separate protocols are recommended for NICU (Neonatal Intensive Care Units) and well-infant nurseries. 2. Diagnostic audiology evaluation. Professionals with skills and expertise in evaluating newborn and young infants should provide diagnosis, selection and fitting of amplification devices. 3. Medical evaluation. Risk factors for congenital and acquired hearing loss have been combined in a single list rather than grouped by time of onset. A stepwise diagnostic paradigm is diagnostically more efficient and cost-effective than a simultaneous testing approach. 4. Early intervention and surveillance. All individuals providing services to infants with hearing loss should have specialized training and expertise in the development of audition, speech and language. Regular surveillance should be performed on developmental milestones, auditory skills, parental concerns, and middle ear status. 5. Quality control. Data management as part of an integrated system is important to monitor and improve the quality of EDHI services (AU)
Subject(s)
Humans , Male , Female , Hearing Loss/complications , Hearing Loss/epidemiology , Commission on Professional and Hospital Activities/trends , Early Diagnosis , Auditory Perceptual Disorders/epidemiology , Hearing/physiology , Hearing Disorders/epidemiology , Hearing Loss/prevention & control , Hearing Disorders/prevention & control , Mass Screening/methods , Quality ControlABSTRACT
Newborn hearing screening is currently performed routinely in many regional health-care systems in Spain. Despite the remarkable expansion in newborn hearing screening since 2000, its feasibility and the benefits of early identification and intervention, many major challenges still remain. In this article, the Committee for the Early Detection of Hearing Loss (Comisión para la Detección Precoz de la Hipoacusia, CODEPEH) updates the recommendations that are considered important for the future development of early hearing detection and intervention (EDHI) systems in the following points: 1. Screening protocols: Separate protocols are recommended for NICU (Neonatal Intensive Care Units) and well-infant nurseries. 2. Diagnostic audiology evaluation. Professionals with skills and expertise in evaluating newborn and young infants should provide diagnosis, selection and fitting of amplification devices. 3. Medical evaluation. Risk factors for congenital and acquired hearing loss have been combined in a single list rather than grouped by time of onset. A stepwise diagnostic paradigm is diagnostically more efficient and cost-effective than a simultaneous testing approach. 4. Early intervention and surveillance. All individuals providing services to infants with hearing loss should have specialized training and expertise in the development of audition, speech and language. Regular surveillance should be performed on developmental milestones, auditory skills, parental concerns, and middle ear status. 5. Quality control. Data management as part of an integrated system is important to monitor and improve the quality of EDHI services.
Subject(s)
Hearing Loss/diagnosis , Diagnostic Imaging , Early Diagnosis , Early Intervention, Educational/organization & administration , Early Intervention, Educational/standards , Evoked Potentials, Auditory , Hearing Aids , Hearing Loss/etiology , Hearing Loss/rehabilitation , Hearing Tests/economics , Hearing Tests/methods , Hearing Tests/statistics & numerical data , Humans , Infant, Newborn , Intensive Care Units, Neonatal , Neonatal Screening/economics , Neonatal Screening/methods , Neonatal Screening/statistics & numerical data , Nurseries, Hospital , Otoacoustic Emissions, Spontaneous , Program Evaluation , Quality Assurance, Health CareABSTRACT
Los cuerpos extraños bronquiales son una patología relativamente frecuente en niños pero se dan con carácter muy ocasional en adultos. Presentamos una revisión propia de 4 pacientes (3 mujeres y 1 varón) , ingresados en nuestro hospital, con diferente sintomatología clínica y aspectos radiológicos derivados principalmente de la naturaleza y tiempo de evolución del cuerpo extraño desde su aspiración hasta su diagnóstico final. En dos casos la radiografía de tórax fue normal; en un paciente mostraba claros signos de atelectasia pulmonar y en otro un síndrome de Jano. Describimos el tratamiento efectuado en cada caso clínico y su evolución posterior para realizar finalmente una revisión bibliográfica sobre esta entidad (AU)
Subject(s)
Aged , Female , Male , Middle Aged , Humans , Foreign Bodies/diagnosis , Bronchi/surgery , Bronchi , Pulmonary Atelectasis/complications , Pulmonary Atelectasis/diagnosis , Inhalation/physiology , Thorax , Dyspnea/complications , Dyspnea/diagnosis , Cough/complications , Cough/diagnosis , Asphyxia/complications , Asphyxia/diagnosis , Cyanosis/complications , Cyanosis/diagnosis , Bronchitis/complications , Bronchitis/diagnosis , Bronchiectasis/diagnosis , Bronchiectasis/complications , Pneumonia/complications , Pneumonia/diagnosisABSTRACT
Enterobacter engloba a diferentes especies bacterianas que junto con Pseudomona son responsables de infecciones oportunistas, especialmente en enfermos hospitalizados. Presentamos 3 casos de otitis externa aguda debidos a Enterobacter cloacae que correspondían a 2 varones y 1 mujer, sin antecedentes personales de interés, atendidos en Urgencias de nuestro hospital. El Laboratorio de Microbiología al que remitimos las muestras óticas nos confirmó el aislamiento de este germen, poco frecuente como causa de otitis externa en la literatura y más aún en ausencia de inmunodepresión u hospitalización previa. La evolución de todos los pacientes fue satisfactoria tras el tratamiento. Realizamos una revisión de la literatura al respecto (AU)
