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Online EHDI Case 4 (Part 1 With Answers)

 Online EHDI Case 4 - A Child with Unilateral Hearing Loss

Part 1

History: Sarah Ramey is a 2.5 month old child. She was born after an uncomplicated delivery at term. She is the 4th child of a 28-year old single women. During her neonatal hospital stay, the staff neonatologist provided care. Her primary care physician was not identified on any hospital records.

After hospital discharge, Ms. Ramey took Sarah to your office because you serve as primary care for the entire family. At the 2-week visit Hepatitis B immunization was given. When Sarah was 2 months of age she came for a second well child visit, including immunizations. 

Her mother calls the office very upset because she has been contacted by a representative of the State Department of Health. Sarah did not pass her newborn hearing screening in the one ear. Her mother failed to go for follow-up testing and is now worried that they want to take her baby
away from her.

1. What is your impression of the child’s condition?

• Sarah did not pass the newborn hearing screening in one ear. The hearing sensitivity in that ear needs to be re-evaluated.
• As her primary care office, you should have received the information from the birthing hospital regarding newborn hearing screening. However, if your name was not included on the forms, the information may not have made it to your office.
• Sarah could have a unilateral loss in that ear. Unilateral hearing loss is associated with problems in understanding speech and language, particularly in acoustically challenging environments such as when there is a lot of background noise. Unilateral hearing loss may also affect a child’s rate of language learning.
• Many people do not understand the importance of evaluating the ear that did not pass the screening. They assume that development will not be affected, even if that ear has a problem with hearing sensitivity.

2. How and why would state officials become involved?

• Universal Newborn Hearing Screening is dictated by state law.
• According to PA regulations, the Department of Health is notified when a child is screened and thus about the result of that screening. If a child does not pass the initial screening in the hospital, the State obtains the results of subsequent screens or definitive testing. They follow children with hearing loss until they are enrolled into early intervention.
• The Department of Health is also informed when a child does not show up for subsequent evaluations.
• The role of the members of the Department of Health is to be supportive and not punitive. They can assist the family in following up on the referral. They can provide other supports as needed.

3. What would you recommend?

• Sarah’s hearing definitely needs to be assessed. She needs to see an audiologist for that assessment.
• Provide Ms. Ramey with information on why this is very important for Sarah to have this test done. []
• Determine what Ms. Ramey might need to follow through on further testing. In particular, discuss transportation to the visit, child care for the other children, finances and other options if these issues are a problem. 

Additional Info

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