Child xxx, 3 years old, parents complained that the child did not respond to voice.Medical history: The child was delivered at full term and had a birth weight of 3kg. There was no history of neonatal asphyxia or pathological jaundice after birth.At the age of 3, he still can’t speak and doesn’t respond to voices.The parents denied family history or history of viral infections such as mumps. They were examined in the outside hospital. ABR click 100dB nHL in both ears did not elicit differentiated waveforms. Acoustic reflex examination of 100dB SPL in both ears elicited ipsilateral and contralateral acoustic reflexes.Examination: No obvious abnormalities in both ears and external ears, the external auditory canal is unobstructed, the tympanic membrane is intact, and the light cone is present. ABR inspection: ABR click 70dB nHL in both ears. Differentiation waves can be seen, which can only lead to wave I, which is repetitive.Otoacoustic emission: DPOAE binaural 50dB SPL failed.Acoustic impedance inspection: tympanum diagram with binaural A-shaped curve, with 100dB SPL of acoustic reflection in binaural leads.
Please advise on diagnosis and treatment of the patient.
initial diagnosis:Mild to moderate sensorineural hearing loss in both ears.
handle:Binaural optional small and medium power behind-the-earHearing aid; Soft ear mold with full ear concha cavity; conduct auditory and speech rehabilitation training.
analyze:The A-type curve of the binaural tympanogram of this child, 100dB SPL can elicit acoustic reflexes, which can basically rule out hearing loss caused by middle ear diseases (such as secretory otitis media).From the results of otoacoustic emission and ABR examination, the child does have cochlear disease and posterior cochlear hearing disease, and it is possible that posterior cochlear disease is heavier than cochlear disease.Since 70dBnHL can lead to wave I, it can be considered that the hearing loss is mild to moderate. Therefore, it is consistent with the sound reflection that 100dBSPL can lead.Therefore, it can be initially diagnosed as mild to moderate sensorineural in both earsHearing loss.Those with heavier posterior cochlear lesions have poor speech processing ability, which is basically consistent with their speech development level.Although the child’s hearing loss is mild to moderate, the child’s ear canal grows rapidly.Hearing aid, It is necessary to redo the shell frequently. In addition, from economic considerations, the child is not suitable for wearing ear canal hearing aids. Therefore, it is recommended to choose a BTE hearing aid.In addition, soft ear molds are not easy to cause mechanical damage, and in order to wear comfort, it is appropriate to choose soft ear molds for children.In the adjustment of the hearing aid gain, it should be adjusted appropriately to avoid excessive gain and cause noise-induced hearing loss, and observe its response to the sound, follow up once every two to three months, and adjust the hearing aid in time according to the child’s condition.
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