WHO schema for disablements

Aetiology - eg. Meningitis

Pathology - Hair cell damage

Impairment - Hearing loss

Disability - Speech and Language disorder

Handicap- Inability to lead a normal life

Early identification of

Impairment

Reduces

Disability

Prevents

Handicap

Early intervention

i.e development of normal speechand language

i.e able to lead a normalcommunal life

Aim -A Team that is led by a consultant paediatrician in Audiological medicine to deliver

to the children aged 0-16 (?19yrs soon) a service that concerns itself with disorders of

• Peripheral hearing – sensori-neural hearing loss, conductive hearing loss etc.

• Pure Neural Hearing loss - Auditory Neuropathy• Increased hearing sensitivity - Hyperacuisis• Tinnitus• Vestibular System - screen and refer to GOSH if

further assessment is indicated.• Auditory processing – not commissioned yet!• Non organic or functional hearing loss

It also concerns itself with

• Diagnosis of Normal Hearing in children with special needs - This can be a challenge needing special skills

• Diagnosis and management hearing impairment in children who have other special needs - 40% of children with SNHL have other problems

Early Identification Need to do active case finding

• Promote awareness – Parents– Professionals

• Screening at different ages

Screening at different ages

• Neonatal - electrophysiological tests (OAE and AABR)– universal - training of screening staff

• 5 years - performance test– universal – training of school nurses and

continued updating

Referral reasons to the Audiolgy ServiceBetween and after Routine

Screening Ages

1. Any child with a supected hearing problem i.e hearing loss

Hyperacuisis

Tinnitus

2. Meningitis

3. Mumps

4. Measles

5. Head Injury

6. Exposure to noise, blast injury etc.

7. Treatment with Ototoxic agents eg. Aminoglycosides, cytotoxtic

agents - esp cis platinum

8. Family history of sensori-neural hearing loss

9. Syndromes & dysmorphic featues diagnosed after the neonatal neonatal period 10. Cranio-facial abnormalities

also refer:-severe visual handicapdelayed speech and language development

learning difficuties

behavioural problems

parental concerns

child not understanding or misunderstanding

Therefore referrals are received from the

•Newborn screening teams at birth

•school screening service at 5 years of age

•from professionals - Acute Paediatricians Community paediatricians, General practitioners, ENT surgeon, School Health/Child Health personnel

.

After diagnosis of Permanent hearing loss

• Anatomical diagnosis

• Aetiological diagnosis

• Multi-disciplinary management programme

Otitis Media with Effusion

also known as“glue ear”

“secretory otitis media”“serous otitis media”

New NICE guidance availableFebruary 2008

Nice Guidance - 3 care pathways

1) Children with suspected OME

2) Children with Down’s Syndrome

3) Children with Cleft palate

“OTITIS MEDIA WITH EFFUSION”

Assessment of disability, Monitoring

Assessment for referral for surgery - work closely with ENT

Conservative Management

• advice on management in classroom

• Hearing aids fitting

Do not offer the following for the Rx of OME

Antibiotics

Antihistamines

Decongestants

Steroids

Homeopathy

Cranial osteopathy

Acupuncture

Dietary Modification

Massage

Human Communication is action. It is culture. It is the fabric of all society It is the history of man. Its absence negates man’s existence

commissioning policy

Parental re referrals ??

Guidance for referrals – discuss document