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Online EHDI Case 3 (Case Questions Without Answers)

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

Part 1

History: Maria Cortez is a 7½-month old child who is new to your practice. She is the youngest of three children. Her older brothers and her father speak Spanish and English. Mrs. Cortez communicates exclusively in Spanish. Both parents come to this visit and Mr. Cortez serves as translator for Mrs. Cortez. 

You learn that Maria was 8 pound 15 ounces at birth. The pregnancy, labor, and delivery were normal. Prior to discharge from the hospital, the family was told that Maria did not pass her newborn hearing screening. As per the instructions, the family went to their primary care physician when Maria was 2 weeks old for a well child visit and follow-up of her hearing screening. The primary care physician found fluid in the middle ear and referred the child to an otolaryngologist (ENT). 

According to the parents, they were able to get into see the ENT doctor when Maria was one month old. He corroborated the presence of fluid, prescribed 10 days of antibiotics, and scheduled a return visit for 6 weeks later.

Maria was 2½ months of age at the return visit. The ENT doctor again found middle ear fluid. He decided to wait another 6 weeks to see if the effusion cleared. The family returned to the primary care physician when Maria was 4 months of age for a well child care visit. He again saw middle ear effusion, treated the infant with antibiotics, and scheduled her for a return visit at 6 months of age. The family then moved. They are now interested in establishing another primary care physician for Maria.

Mrs. Cortez is very worried about Maria. She fears the child is deaf or has a serious underlying condition that causes the persistent middle ear effusion. She acknowledges that the child is well developed, well nourished, sitting without support, smiling at her parents and fearful of strangers. She does some reciprocal cooing.

On today’s examination, you find evidence of middle ear effusion again and a tympanogram is flat.

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1. What is your impression about Maria?

2. How does middle ear effusion impact hearing?

3. What is your impression about the family?

Click <HERE> for answers to Part 1

 

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?

2. What would you recommend to the family?

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

Click <HERE> for answers to Part 2

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