The age of diagnosis of sensorineural hearing impairment in children.

OBJECTIVE: To identify factors responsible for delays in diagnosis and treatment of pediatric sensorineural hearing impairment (SNHI), and to assess the thoroughness of medical evaluation in these children. DESIGN: Retrospective analysis. SETTING: State-supported school for the deaf. PATIENTS AND OTHER PARTICIPANTS: 291 children with SNHI, the bast majority of whom are profoundly hearing impaired. Data were collected from the school's database, individual student records, and a parental questionnaire. MAIN OUTCOME MEASURES: (1) The age of diagnosis and treatment of SNHI; (2) actors leading to a delay in diagnosis; (3) current medical evaluations used to determine the etiology of SNHI; and (4) the level of parental satisfaction with the evaluation process. RESULTS: Many children with SNHI experience delays in diagnosis from the time of first suspicion of hearing loss. Children with a risk factor for SNHI are diagnosed no earlier than children without a risk factor. Caucasian children are diagnosed significantly earlier than either Black or Hispanic children, regardless of socioeconomic status. Inconsistent medical evaluation ensues following the diagnosis of SNHI, and parental satisfaction with this process is low. CONCLUSIONS: The average age of diagnosis of SNHI remains unacceptably high. There exists a need to enhance physician awareness of childhood deafness and to develop guidelines for the medical evaluation in cases of pediatric SNHI. Lastly, the importance of parental concern regarding a child's hearing or language development must be re-emphasized.

Insurance status as a risk factor for foreign body ingestion or aspiration.

OBJECTIVE: To determine whether the lack of private health insurance places children at increased risk for foreign body ingestion or aspiration. DESIGN: Retrospective review. SETTING: St. Louis Children's Hospital, a tertiary care center. PATIENTS: Consecutive sample of 125 patients with esophageal or airway foreign bodies. RESULTS: Fifty percent of all patients had private health insurance. Fifty-six percent of all preschool patients and 20% of all school-age patients were uninsured (P < 0.01, Fisher's exact test). Eighty-five percent of patients with airway foreign bodies, and 84% of patients with esophageal foreign bodies were in the preschool group. Sixty-one percent of preschool patients and 21% of school-age patients with esophageal foreign bodies were uninsured (P < 0.05). Forty-six percent of preschool patients with food aspiration lacked health insurance (88% of these children were fed the aspirated item). No school-age group was available for comparison. Fifty percent of preschool children with aspiration of non food items were uninsured, as were 16% of their school-age counterparts. CONCLUSIONS: Insurance status must be considered as a risk factor for foreign body aspiration and ingestion. Preschool children are more likely to lack private health insurance than school-age children with the same diagnosis. In a majority of aspiration events, the child was being fed the inappropriate food item, perhaps indicating a lack of caretaker education and anticipatory guidance. A direct focus on 'passive protection', anticipatory guidance in clinics for all patients, and public education with emphasis on preventive care are proposed as means to decrease the incidence of airway and esophageal foreign bodies in children.

Growth of the 2f1-f2 distortion product otoacoustic emission for low-level stimuli in human neonates.

Distortion product otoacoustic emissions (DPOAEs) for low stimulus levels (< 60 dB SPL) have been reported in adult humans under ideal conditions. In neonates, DPOAEs have been reported only for high-level stimuli. The purpose of this paper was to determine characteristics of the 2f1-f2 DPOAE for low-level stimuli in neonates and to assess the feasibility of obtaining such measures in a noisy environment. Subjects were 19 premature neonates presumed to have normal hearing based on systematic pneumatic otoscopy measures and evoked auditory brainstem responses. For stimuli centered at 2000 and 6000 Hz and presented over a range of 30 to 75 dB SPL, DPOAEs were measured employing linear time averaging for up to 128 time frames at each level. In quiescent subjects, the level of the noise floor was as low as that reported in cooperative adults under ideal conditions (approximately -30 dB SPL), and the functions were identical. That is, valid measures were obtained for very low stimulus levels (30 dB SPL), the rate of growth approached 1 dB/dB, and identical nonmonotonicities (saturation, plateaus, and notches) were observed as those reported for adults. When the noise floor was elevated due to subject activity, no valid data could be obtained for low-level stimuli even though the DPOAEs were at expected levels for high-level stimuli. These results have important implications for the use of such measures in this population because the DPOAEs associated with the metabolically active nonlinear cochlear processes at low stimulus levels may be contaminated with DPOAEs associated with other processes at high stimulus levels.

Pediatric sinusitis and subperiosteal orbital abscess formation: diagnosis and treatment.

Twenty-two children with subperiosteal orbital abscesses were treated at St. Louis Children's Hospital between 1983 and 1992. Eighteen patients were otherwise in good health; four patients had cystic fibrosis, mucoceles, or were immunocompromised. All patients were treated with intravenous antibiotics and abscess drainage. CT scans were obtained preoperatively in each case. Ten patients were treated with endoscopic ethmoidectomy and abscess drainage, and 11 were treated with external ethmoidectomy and abscess drainage. One child was initially treated with abscess drainage and an elective endoscopic ethmoidectomy was performed later. There were no cases of permanent visual loss or neurologic sequelae. Culture results were positive in 14 cases and mixed infections were common. Complications included recurrent abscess, cerebritis, and empyema. We recommend combined medical and surgical treatment for all children with subperiosteal orbital abscess. We feel that endoscopic ethmoidectomy and abscess drainage offers some advantages over external ethmoidectomy and abscess drainage.