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Fluctuating and/or progressive sensorineural hearing loss in children
P E Brookhouser1, D W Worthington, W J Kelly
1Boys Town National Research Hospital, Omaha, Neb. 68131.
Insights
Sensorineural hearing loss (SNHL) in children can fluctuate or worsen over time, impacting management and education. This study analyzed threshold variations in 229 children, finding significant progression and fluctuation patterns.
Area of Science:
- Pediatric Audiology
- Otolaryngology
- Developmental Pediatrics
Background:
- Sensorineural hearing loss (SNHL) in children presents challenges for medical management, hearing aid selection, and educational planning.
- Progressive or fluctuating hearing loss can continue despite multidisciplinary interventions.
- Variations in audiologic techniques and middle ear issues can influence threshold measurements.
Purpose of the Study:
- To analyze the patterns of threshold variation in pediatric sensorineural hearing loss.
- To identify the prevalence of progressive and fluctuating SNHL in children.
- To explore predictors of hearing threshold fluctuation and progression.
Main Methods:
- Retrospective analysis of audiometric data from 229 children (ages 1-19.9) with SNHL.
- Inclusion criteria: mild SNHL, threshold variation ≥10 dB, no concurrent middle ear disease.
- Follow-up averaged 4.9 years with a mean of 10.3 audiograms per child.
Main Results:
- Of 365 ears with significant variation, 6% showed purely progressive loss, 57% fluctuating with progression, and 37% intermittent fluctuation.
- Contralateral fluctuation occurred in 91% of cases if one ear fluctuated.
- Contralateral progressive SNHL occurred in 67% of cases if one ear progressed.
Conclusions:
- Pediatric SNHL frequently exhibits fluctuating or progressive patterns, necessitating careful monitoring.
- Hearing loss in one ear is a strong predictor of similar changes in the contralateral ear.
- Further research into demographic and audiometric predictors is warranted for personalized intervention strategies.
Abstract:
Sensorineural hearing loss (SNHL) which is sudden in onset, fluctuating, and/or progressive complicates medical management, hearing aid selection, and individualized educational planning for a hearing-impaired child. In spite of multidisciplinary evaluation and intervention, a gradual decrease in auditory acuity may continue unabated in a significant number of cases. Intercurrent middle ear disease and inconsistent audiologic technique can account for threshold variation in some cases. The study population consisted of 229 children (132 boys; 97 girls) aged 1 to 19.9 years at first audiogram which revealed at least a mild degree of sensorineural hearing loss in one or both ears (35 unilateral), and who demonstrated threshold variation of 10 dB or more in at least one ear at one or more of the standard audiometric test frequencies (250, 500, 1000, 2000, 4000, and 8000 Hz) and were without concurrent middle ear disease (mean length of follow-up, 4.9 years; mean number of audiograms, 10.3). Of 365 ears demonstrating threshold variation of 10 dB or more, 22 (6%) had purely progressive losses without intercurrent upward fluctuation, 208 (57%) had fluctuating thresholds with gradually progressive losses, and 135 (37%) had intermittent threshold fluctuation without permanent deterioration. The probability of contralateral threshold fluctuation if one ear fluctuated was 0.91, while the probability of contralateral progressive SNHL if one ear progressed was 0.67. Demographic data, presumptive etiology, degree of initial SNHL, audiometric configuration, and symmetry of threshold variation were considered as potential predictors of the likelihood of threshold fluctuation and/or progression.