September 2019 HSC Section 1 Congenital and Pediatric Problems

B.J. Liming et al. / International Journal of Pediatric Otorhinolaryngology 90 (2016) 251 e 258

4. Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252 5. Recommendations and justification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252 Disclaimer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252 Section 1: Diagnostic considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252 Section 2 : Newborn screening and initial workup of the patient with hearing loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252 Section 3: Workup of child with auditory neuropathy spectrum disorder (ANSD) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253 Section 4: Workup of child with sensorineural hearing loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255 Section 5: Workup of child with conductive or mixed hearing loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257 Author notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258 Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258

1. Consensus objectives

Disclaimer

To make recommendations on the routine work-up for pediatric patients with hearing loss.

This report has been prepared by the members of the Interna- tional Pediatric ORL Group (IPOG). Consensus recommendations are based on the collective opinion of the members of the group. Any person seeking to apply or consult the report is expected to use independent medical judgment in the context of individual patient and institutional circumstances.

2. Target population

Infants and children with hearing loss.

3. Intended users

Section 1: Diagnostic considerations

These consensus recommendations are targeted for:

The members of the IPOG identi fi ed six frequently debated considerations in the management of pediatric hearing loss. Vari- ation in practice among the current group members remains, and the purpose of this section is to provide a list of reasonable options based on expert opinion. Consensus was quanti fi ed as a percentage of authors who agree or partially agree ( Table 1 ).

1 Primary care providers and otolaryngologists who take care of children with hearing loss.

4. Methods

Expert opinion by the members of the International Pediatric Otolaryngology Group (IPOG). The mission of the IPOG is to develop expertise-based consensus recommendations for the management of pediatric otolaryngologic disorders with the goal of improving patient care. The consensus recommendations herein represent the third publication by the group. To re fl ect the variability in practice patterns present among experts in the fi eld, the degree of consensus was quanti fi ed by presenting the per- centage of above authors who agree or partially agree with each statement.

Section 2 : Newborn screening and initial workup of the patient with hearing loss

The screening and initial workup algorithm is designed to guide the evaluation of all newborns with suspected hearing loss based on initial screening methodologies. Screening protocols recommended herein are generally derived from consensus rec- ommendations such as those issued by the Joint Committee on Infant Hearing [5] . Protocols may vary slightly between in- stitutions. In general, infants meeting criteria for increased risk for congenital hearing loss should be screened with both OAEs and an automated ABR in order to capture infants with ANSD. Infants not within the high risk category can be screened with a two stage procedure that utilizes OAEs alone as the initial screening test, with an automated ABR for absent or diminished OAE responses. Some institutions no longer stratify based on risk and instead screen all infants with aABR in order to detect all cases of ANSD. A child who fails screening protocols should un- dergo a con fi rmatory ABR after an otologic examination to rule out middle ear effusion.

5. Recommendations and justi fi cation

The recommendations are outlined in the following sections.

! Section 1: Diagnostic considerations ! Section 2: Newborn screening and initial workup of the patient with hearing loss ! Section 3: Workup of child with auditory neuropathy spectrum disorder (ANSD) ! Section 4 : Workup of child with sensorineural hearing loss ! Section 5: Workup of child with conductive or mixed hearing loss

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