Ear In Children Research Articles

Considerations in early amplification: Selection, fitting, validation, counseling

The implementation of universal newborn hearing screening programs has increased the number of infants diagnosed with hearing loss and referred for amplification in the first few weeks of life. There is compelling evidence that children born with hearing loss who have been identified and begun intervention by 6 months of age will have significantly better language development than their later-identified peers. 1-3 The challenges of fitting appropriate amplification on this population include limited behavioral response to sound, possible complicating middle ear fluid, parental uncertainties, possible existence of additional handicaps, and limited resources to support and pay for hearing aids. Despite these issues, there is consensus that the diagnosis of congenital hearing loss should be completed in the first 3 months of life and be followed immediately with the consideration of hearing aid use. 4 As access to follow-up from newborn hearing screening improves, pediatric audiologists are faced with recommending technology for infants during their early weeks of life. The options available to them are expanding rapidly as amplification technology grows and diversifies. Outcome studies of children fitted with advanced amplification features are not common and cannot keep up with the features being introduced to the market. Most infants are fitted with the goal of providing audibility for environmental speech to enhance speech and language development and with the expectation that patients will use their hearing aids daily. The pediatric audiologist’s role is to share information on hearing loss and available amplification technology with the parents and their medical and support team. Parents depend on various professionals to acquire the information and tools they need to become empowered, informed consumers. Reaching decisions about the choice of technology for an infant includes examining available features and selecting what might be the best fit for the infant given all the available information and circumstances.

Anthropometry of the External Ear in Children With Cleft Lip and Palate in Comparison to Age-Matched Controls

Comprehensive anthropometric measures in children with cleft lip (CL) and cleft palate (CP) have suggested that similar qualitative growth disturbances may be present in the auricle. We propose a study to evaluate and better understand auricular development in nonsyndromic children born with CL/CP. Our institution is a tertiary referral center for children with craniofacial anomalies. During a 4-year period, we randomly selected 50 nonsyndromic children, aged 5 to 18 years, with CL or CP. Fifty age-matched control children without craniofacial anomalies were selected as a control group. Anthropometric measurement analysis was conducted to compare auricular length (sa-sba), width (pra-pa), attachment to the cranium (obs-obi), and degree protrusion. Auricular index was also calculated for each group. Using a multivariate analysis of variance, statistical analysis with a P < 0.001 demonstrates group differences when comparing ear length and ear protrusion in nonsyndromic children with CL/CP to age-matched controls. Ear length was greater in the control group, whereas ear protrusion (distance from the mastoid process to helical rim) was found to be decreased in the experimental group. Age and sex did not demonstrate significant differences in ear protrusion or length between the control and experimental groups. In nonsyndromic children with CL/CP, greater sensitivity should be given to the timing of auricular surgery. Comparisons of age-matched auricular measurements suggest that ear development may be altered in children with CL or CP. Further research is needed to investigate anthropological differences between nonsyndromic children with cleft and the normal population.

Medicine as performance: what can magicians teach doctors?

‘Mystery, magic and medicine: in the beginning they were one and the same’. So starts Howard Haggard's little book on the rise of scientific medicine.1 In centuries past, a medicine man in some aboriginal tribe might have extracted an unwelcome stone or bone from a patient after showing his hands empty, much as a modern day magician would pluck a sponge ball from a child's ear.2 Today, doctors and magicians have largely parted ways, operating in different environments and sharing only the ambition to leave the ‘client’ better off than when the two parties met. The doctor strives to improve health or prevent further deterioration, the magician to raise the spectator's spirits or instil a pleasurable sense of wonder. In this article, I ask if contemporary magicians still have something to teach doctors. In particular, I identify several key components of the art of magic and suggest that looking at doctoring through the lens of the magician may provide insights for the practising clinician.

In reference to The Erasmus Atelectasis Classification: Proposal of a New Classification for Atelectasis of the Middle Ear in Children

The LaryngoscopeVolume 118, Issue 3 p. 569-569 Article In reference to The Erasmus Atelectasis Classification: Proposal of a New Classification for Atelectasis of the Middle Ear in Children Ali Eftekharian MD, Ali Eftekharian MD Department of Otolaryngology–Head and Neck Surgery; Loghman Hospital, Shaheed-Beheshti University of Medical Sciences; Tehran, IranSearch for more papers by this author Ali Eftekharian MD, Ali Eftekharian MD Department of Otolaryngology–Head and Neck Surgery; Loghman Hospital, Shaheed-Beheshti University of Medical Sciences; Tehran, IranSearch for more papers by this author First published: 02 January 2009 https://doi.org/10.1097/MLG.0b013e31815bf9d8Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume118, Issue3March 2008Pages 569-569 RelatedInformation

In reference to The Erasmus Atelectasis Classification: Proposal of a New Classification for Atelectasis of the Middle Ear in Children

<i>In reference to</i> The Erasmus Atelectasis Classification: Proposal of a New Classification for Atelectasis of the Middle Ear in Children

Selecting the Optimal FM System for Children With Cochlear Implants

Children who use cochlear implants experience significant difficulty hearing speech in the presence of background noise, such as in the classroom. To address these difficulties, audiologists often recommend frequency-modulated (FM) systems for children with cochlear implants. The purpose of this article is to examine current empirical research in the area of FM systems and cochlear implants. Discussion topics will include selecting the optimal type of FM receiver, benefits of binaural FM-system input, importance of DAI receiver-gain settings, and effects of speech-processor programming on speech recognition. FM systems significantly improve the signal-to-noise ratio at the child's ear through the use of three types of FM receivers: mounted speakers, desktop speakers, or direct-audio input (DAI). This discussion will aid audiologists in making evidence-based recommendations for children using cochlear implants and FM systems.

In Reference to The Erasmus Atelectasis Classification: Proposal of a New Classification for Atelectasis of the Middle Ear in Children

In Reference to <i>The Erasmus Atelectasis Classification: Proposal of a New Classification for Atelectasis of the Middle Ear in Children</i>

In Reference to The Erasmus Atelectasis Classification: Proposal of a New Classification for Atelectasis of the Middle Ear in Children

In Reference to <i>The Erasmus Atelectasis Classification: Proposal of a New Classification for Atelectasis of the Middle Ear in Children</i>

A Nurseʼs Perspective on Retail Health Clinics

UTILIZING NURSE PRACTITIONERS (NPs) to staff retail health clinics is a concept whose time has come. Nurse practitioners, with a minimum of six years of education and holding consistently the highest levels of public trust of any profession, are the key to the successful mixing of retail and healthcare (Grady 2005). The unique partnership between retail clinics and nurse practitioners did not happen overnight. It can be traced back over more than 40 years, to 1965. Four contributing factors happened that year: (a) the emergence of the nurse practitioner role, (b) the appearance of federally sponsored community health centers, (c) the passage of the 1965 Medicare and Medicaid legislation that created a new demand for healthcare services, and (d) the modern movement to establish nursing centers. By the time the first retail clinic opened in 2000, these nursing centers from 1965 were still struggling for survival. They could document excellent health outcomes and cost effectiveness, but lacked the financial viability and political prowess necessary to move them into the mainstream of healthcare delivery. Change, mostly from outside the traditional healthcare system, was needed to transform these nursing centers into the concept of retail (i.e., convenient care) health clinics. This change came from financial analysts who specialize in fast food and retail supermarket chains, and who were dually frustrated as healthcare consumers. This change was also guided by the strategic leadership of the National Nursing Centers Consortium (NNCC). This group, established in 1996, provided the same visionary leadership when the Convenient Care Clinic Association (CCCA) was established a decade later. The largest retail chain, MinuteClinic, was founded after a father had to wait two hours for a basic diagnosis and antibiotic prescription for his child's minor ear infection. When a second son presented with the exact same symptoms a few days later, the father knew what the child needed but was helpless to access the needed services without another two-hour wait. He felt there had to be a better way to deliver basic healthcare. Other healthcare leaders agreed, and the retail clinic movement was born. Since then, retail clinics-once taunted as fast, cheap, and out of control-have become a tsunami that seems unstoppable. Some media sources are classifying them as disruptive innovations expected to profoundly affect healthcare delivery. The clinics are consumer driven and serve as a response to many healthcare patients who are frustrated with the conventional healthcare delivery system, which often provides little access to basic healthcare services when people need it the most. This explosion has also positioned nurse practitioners to become more mainstream and influential within the healthcare delivery system. Nurse practitioners are the right people to run retail clinics. I'm grateful that MeritCare Health System in North Dakota and Geisinger Health System in Pennsylvania had leadership strong enough to take the plunge and be willing to embrace and experiment with this new emerging consumerism model. Retail clinics would not exist if people had access to the kind of care they need. The companies featured in this issue are not unique; numerous companies, medical providers, and health systems have and are asking the same questions. It is my sincere hope that as MeritCare and Care Works Convenient Healthcare continue to grow their retail healthcare businesses, they will continue to rely on the superior clinical care that advanced practice nurses provide. UNWARRANTED FEARS The fear that nurse practitioners and retail clinics may have a negative effect on a company's brand or even cheapen a certain brand of healthcare, should prove to be unwarranted as the model of retail healthcare continues to fully establish itself. Nurse practitioners (NPs) are respectful of established healthcare relationships that patients have with other medical providers, and promote and encourage patients to establish a medical home for ongoing and future health needs. …

Successful microsurgical replantation of a child's completely amputated ear

We present a case of a 9-year old boy who underwent successful replantation of a completely amputated ear. Few reports have been published on replantation of children's ears that are completely avulsed. Venous drainage is a well-known factor contributing to the failure of completely amputated ear replantation. In this case, we used a technique of transillumination to examine the amputated ear, and selected veins for exploration. Finally, a suitable vein was found and anastomosed to the one on the recipient side. The ear seemed to be completely viable once the problems of arterial blood supply and venous drainage were solved. A 4-year follow-up was conducted, and the result was satisfactory. The technique of transillumination is recommended in similar cases to solve the problem of venous drainage and to improve the survival rate of replanted ears.

The Erasmus Atelectasis Classification: Proposal of a New Classification for Atelectasis of the Middle Ear in Children

Atelectasis presents a challenging, often progressive, problem in children. Because of the lack of a clinically practical classification, we introduce a new classification, which in our opinion is more useful in the pediatric age group. This alternative classification enables a more clinically relevant correlation between stage of disease and clinical sequelae and technical difficulty at surgery. Observational study of patients seen and operated at the Sophia Children's Hospital in Rotterdam, The Netherlands between 1989 and 2005. Based on clinical appearance, each ear was placed into one of the five groups of the proposed classification and into one of the four stages of Sadé's classification. Preoperative air and bone conduction thresholds and air-bone gaps (ABG) were calculated using the four-tone pure-tone (500, 1,000, 2,000, and 4,000 Hz) averages for bone and air conduction. : Of the 248 ears in the study group, 72 were in stage I, with an ABG of 18.2 +/- 12.3 dB. Twenty-two were in stage II, with an ABG of 12.9 +/- 9.5 dB. In stage III, there were 32 ears, with an ABG of 11.6 +/- 10.0 dB. Thirty-one ears were in stage IV, with an ABG of 16.1 +/- 11.5 dB. Eighty-five ears were in stage V, with an ABG of 26.1 +/- 13.3 dB. When grouped according to Sadé's classification, 92 ears could not be classified. We found the currently proposed classification more useful in that it follows the natural progression of the disease and is more practical in determining operative procedures at each stage.

Caregiver well-being and child quality of life

To describe the impact of otitis media on the child's family and caregiver, and how this impact influences the caregiver's perception of child's quality of life (QOL) and functional health status (FHS). Prospective study of children aged 6 months to 12 years with recurrent or chronic otitis media recruited from a primary care pediatrics practice and a referral-based pediatric otolaryngology practice. Survey measures were assessed for test-retest reliability, internal consistency, and validity. Multiple regression analysis was used to explore relationships. We enrolled 159 families, with mean age of 3.3 years for the child and 34 years for the caregiver. Most caregivers attended college (80%) and 64% were employed. The Caregiver Impact Questionnaire (CIQ) had good test-retest reliability (r=0.83), internal consistency (alpha=0.88), and construct validity (r=0.37 to 0.62). Most caregivers (52%) were nervous or agitated at least "some of the time" because of their child's ear problems, 29% lost sleep "a good bit of time," and 56% had to change daily activities. Multivariate analysis showed that caregiver QOL explained 62% of variability in child disease-specific QOL, and that caregiver FHS explained up to 45% of the variability in child FHS. The 6-item CIQ survey permits a valid and reliable assessment of otitis media impact on caregivers and family functioning. Caregiver ratings of child QOL and FHS are largely influenced by caregiver perceptions of their own personal situation. The caregiver QOL and FHS should be considered when using proxy-completed surveys to assess the impact of otitis media on children.

Ear canal dynamics

Ear canal dynamics

Otologic Manifestations of Malignant Osteopetrosis

To determine the incidence of hearing loss and describe the neurotologic manifestations over time in a large series of patients with malignant osteopetrosis. Longitudinal study. Tertiary care referral center. Thirty-two patients, including 19 infants (< 1 yr of age at initial visit) and 13 children (aged 1-7.6 yr at initial visit), with autosomal recessive osteopetrosis were followed-up during a 10-year period from 1991 to 2001. The average length of follow-up was 2.5 years (range, 0-9.1 yr). Patients underwent annual otologic evaluations including clinical examination, audiologic evaluation (auditory brainstem response, pure-tone thresholds, speech discrimination scores, and tympanograms), and high-resolution computed tomography of the temporal bone. Incidence of hearing loss, otitis media, and facial paralysis. Serial changes in temporal bone anatomy by computed tomographic scan. Twenty-six percent of infants' ears demonstrated hearing loss during the first year of life, and 78% of children's ears demonstrated hearing loss during the study period. Of the children's ears with hearing loss, 100% had a conductive component and 26% had an additional sensorineural component (mixed hearing loss); VIIIth nerve conduction was normal in 100% of infants and 78% of children. Five patients (16%) had unilateral facial nerve palsy. Common temporal bone findings included thickening and sclerosis of the calvarium; poor pneumatization of the mastoid bone; and narrowing of the external auditory canal, eustachian tube, and internal auditory canal. Otologic manifestations are common in malignant osteopetrosis secondary to the formation of dense, brittle bone. Frequent findings include external auditory canal stenosis, otitis media, conductive and sensorineural hearing loss, and facial nerve paralysis.

Hierarchical models for repeated binary data using the IBF sampler

Hierarchical models have emerged as a promising tool for the analysis of repeated binary data. However, the computational complexity in these models have limited their applications in practice. Several approaches have been proposed in the literature to overcome the computational difficulties including maximum likelihood estimation from a frequentist perspective (e.g., J. Amer. Statist. Assoc. 89 (1994) 330–335) and Markov chain Monte Carlo (MCMC) methods from a Bayesian perspective (e.g., Generalized Linear Models: A Bayesian Perspective, Marcel Dekker, New York, pp. 113–131). Although MCMC methods provide the whole posterior of the parameter of interest, the convergence diagnostics problem of the Markov chain and the slow convergence problem owing to the introduction of too many Gaussian latent variables are still unresolved. Recently, Tan et al. (Statist. Sinica 13 (2003) 625–639) proposed a noniterative sampling approach, the inverse Bayes formulae (IBF) sampler, for computing posteriors in the structure of EM algorithm. This article develops the IBF sampler in the structure of Monte Carlo EM (MCEM) for the hierarchical model with repeated binary data for which current methods encounter difficulty. An efficient IBF sampler is implemented by utilizing the estimated posterior modes obtained via MCEM algorithm. The proposed method generates independent and identically distributed (iid) samples approximately from the observed posterior distribution and thus alleviates the convergence problem associated with the MCMC methods. In addition, the slow convergence problem in Gibbs sampler can be bypassed in the noniterative IBF sampler via running some fast EM-type algorithm. Real datasets from six cities children's wheeze study and children's ear fluid study illustrate the proposed methods.

Management of the Draining Ear in Children

There are a variety of causes of otorrhea in children. The most important factor in reaching the proper diagnosis and providing relief of the problem is aural toilet. Once adequate debridement has been performed, the diagnosis is usually clearer, and treatment with ototopicals is significantly more effective. Most cases of otorrhea are due to infection or granulation tissue and can be managed initially with appropriately selected ototopical medication, thereby avoiding the risks and side effects of systemic therapy and the need for referral to a specialist. However, otorrhea in children that is refractory to medical therapy may be due to retained tympanostomy tubes or insidious pathology such as cholesteatoma or malignancy. In such cases, prompt referral to the otolaryngologist can facilitate accurate diagnosis and successful management.

Technique Crucial When Evaluating Children's Ears

Technique Crucial When Evaluating Children's Ears

Aboriginal perspective on middle ear disease in the arid zone of Western Australia.

To explore perceptions, knowledge and experience of otitis media (OM) and barriers to compliance with treatment among Aboriginal people of the Kalgoorlie-Boulder area, Western Australia. This qualitative applied research study is based on a holistic design. We conducted structured interviews with three community focus groups, 56 key informants, and 22 mothers of babies known to have suffered from OM. Written records of interviews were checked with participants. The three sources of data enabled comparison and verification of results. People were concerned about serious consequences of OM, especially deafness and learning difficulties. Since early disease may have no localizing symptoms, not surprisingly, people had limited understanding of the aetiology of OM and were often only aware of disease once ear discharge was visible. Nevertheless, they usually sought treatment for non-specific symptoms. Competing demands in people's daily lives and the unpleasant, intensive nature of treatment result in families becoming resigned to a child's chronic ear discharge. Someone other than the biological mother within the extended family may be responsible for administering treatments. Half the carers thought passive smoking may predispose children to OM and 70% suggested clearing the nasal passages to prevent OM. Results of surgery were viewed positively but specialist services were not always readily accessible. Since responsibility for treatment may not lie with the biological mother, awareness campaigns must target the entire community. As early OM may be asymptomatic, health personnel should be encouraged to do otoscopy on all children with non-specific symptoms.

Family/Tort Law - Through the Eyes and Ears of Children: A Significant Advance for Third Parties Exposed to Domestic Violence. Bevan v. Fix, 42 P.3d 1013 (Wyo. 2002)

Family/Tort Law - Through the Eyes and Ears of Children: A Significant Advance for Third Parties Exposed to Domestic Violence. Bevan v. Fix, 42 P.3d 1013 (Wyo. 2002)

Quality-of-life outcomes after surgical intervention for otitis media.

To assess the change in disease-specific quality of life in children with recurrent acute otitis media and/or chronic otitis media with effusion treated with surgical intervention. Prospective questionnaire-based outcome study. An academic pediatric otolaryngology practice. Consecutive series of 123 children referred for surgical treatment of recurrent acute otitis media and/or chronic otitis media with effusion. Surgery included bilateral myringotomy and tympanostomy tube placement either alone or with adenoidectomy. An otitis media disease-specific questionnaire was administered before and after surgical intervention. Comparison of the mean percentage change in total ear symptom score between presurgery and postsurgery scores at 1 and 6 months after surgery. The mean percentage change in total ear symptom score was a 74.5% improvement (P<.001) at the 1-month follow-up and a 59.8% improvement (P<.001) at the 6-month follow-up. Parental worry related to the child's ear problems was also significantly decreased, with a mean otitis media disease-specific questionnaire score of 3.43 (P<.001) at 1 month and 2.64 (P<.001) at 6 months after surgery. When caregivers were asked if they would have their child undergo tympanostomy tube placement if they had to make the decision again, 91% and 84% responded yes at the 1- and 6-month follow-up, respectively. The disease-specific quality of life of children with recurrent acute otitis media and/or chronic otitis media with effusion with appropriate surgical indications significantly improved after surgical intervention. The amount of parental worry concerning their children's ear problems also significantly improved following surgery, and most caregivers would opt again for tube placement.