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Evidence-based algorithm for the evaluation of a child with bilateral sensorineural hearing loss
Sanjay Morzaria1, Brian D Westerberg, Frederick K Kozak
1Division of Otolaryngology, University of British Columbia.
The Journal of Otolaryngology
|September 27, 2005
Summary
This study presents an evidence-based algorithm to identify causes of bilateral sensorineural hearing loss in children. Key diagnostic tools include genetic testing for connexin mutations and CT scans of the temporal bones.
Area of Science:
- Pediatrics
- Genetics
- Otolaryngology
Background:
- Bilateral sensorineural hearing loss (SNHL) in children presents a diagnostic challenge.
- Identifying the specific etiology is crucial for appropriate management and genetic counseling.
Purpose of the Study:
- To develop an evidence-based algorithm for diagnosing the causes of bilateral SNHL in pediatric patients.
- To guide clinicians in selecting the most effective diagnostic investigations.
Main Methods:
- Systematic literature review (1940-2003) to determine the frequency of SNHL etiologies.
- Analysis of diagnostic accuracy for various investigations relevant to clinical presentations.
Main Results:
- Connexin mutation testing demonstrates high sensitivity and specificity.
- CT scans of temporal bones are valuable for detecting inner ear malformations.
- ECG is useful with specific clinical indicators; routine labs, urinalysis, and thyroid studies have limited diagnostic value.
Conclusions:
- An algorithm incorporating history, physical, audiological, and ophthalmological evaluations was developed.
- Directed investigations include genetic testing (Cx26), CT temporal bones, ECG, and urinalysis based on clinical suspicion.