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Online EHDI Case 3 (Part 2 With Answers)

Online EHDI Case 3: A Baby with Persistent Middle Ear Effusion

Part 2

You make a referral to an audiologist in the area. You explain that since Maria is far beyond the age at which a definitive hearing test should be completed, you would like him to do the full battery of tests, even if a tympanogram is abnormal. You recommend that testing include air and bone conduction.

Two weeks later, when she is 8 months old, the audiologist calls you with a report on Maria. The tympanogram was flat, as you had suspected. The child did not cooperate for behavioral testing. ABR responses to click stimuli were obtained down to 60 dB and bone conduction response levels were observed down to 40 dB. These results indicate a mixed conductive and sensorineural impairment.
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1. How do you interpret these results?

• Maria has evidence of a mixed hearing loss. She has a sensori-neural component and also a conductive component.
• The sensorineural component is of sufficient magnitude that hearing aids should be prescribed.
• The conductive component should be evaluated by an otolaryngologist. Imaging of the middle and inner ear using Computerized Tomography or Magnetic Resonance Imaging is probably warranted.
• The ENT evaluation of the middle ear should not delay this child receiving hearing aids for the sensorineural component of the hearing loss.

2. What would you recommend to the family?

• Proceed as if the child’s hearing loss had been discovered before she was 2 months of age.
• Encourage her to return to the audiologist for a fitting for hearing aids.
• Advise the family about how to obtain Medical Assistance for the hearing aids.
[http://www.phlp.org/Loophole%20guide%202-04.pdf]
• Provide the family with information. In this case, Mrs. Cortez may need information in Spanish. Information is available. Sources include the following:
[http://www.audiology.org/consumer/guides/giving-sp.php http://www.newbornhearing-
screening.org/pdf/referral_spanish.pdf ]
• In addition, the cause of the persistent effusion should be addressed. Refer to an otolaryngologist.
• Also, referral to a geneticist is advisable to determine if the cause of the hearing loss is genetic and whether if these parents have other children that may be affected as well.
• Finally, discuss strategies for improving Maria’s responsiveness to sound.

3. What are the implications of the bilingual household for Maria?

• The child is being exposed to two different languages—Spanish and English.
    o We do not know on the basis of research what exactly to recommend to families in bilingual environments about the best way to support language development in children with hearing loss, cochlear implants, or other disabilities.
    o In general, for children developing typically, a bilingual environment may slightly slow the initial phases of language development, but children quickly catch on. They may show language mixing initially, but their rate of development is normal.
    o Exposure to one language is probably a good idea for Maria at these early stages.
• The very challenging situation is that Mrs. Cortez does not know English. To have comfortable exchanges with her daughter, she must use Spanish. On this basis, the entire family may choose to speak Spanish to Maria.

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