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
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