Week 8, Spring 2008

The client, who was 5 years old, visited the clinic for an audiometric re-evaluation, following medical evaluation. Previous case history information indicated that she was referred for a hearing evaluation by her classroom teacher. Her mother reported that professionals at the child’s school have documented articulation errors, including omission of initial and final /s/, and have attributed hearing loss as a possible cause. The client’s mother also reported that she has noticed her daughter listening to the television at loud levels and expressed concerns that she may not be hearing normally. One recent ear infection, as well as five ear infections from ages 0 to 1, were noted. Normal newborn hearing screening results and no other outstanding medical or developmental problems were reported. The child's physical development appeared to be normal, and the length and complexity of her utterances were age-appropriate. She presented as an energetic, happy child, and she was able to attend to directions and tasks.

At the current visit, information obtained, approximately five weeks prior, from a medical evaluation by an ear, nose, and throat (ENT) physician was discussed. Reports from the client’s mother indicated that the ENT believed that the client had Eustachian tube dysfunction. This information was consistent with previous audiometric results which suggested suspected middle ear involvement when the client was evaluated previously at our clinic. In addition, the client’s mother also reported that her daughter was recently disciplined at school because she did not follow oral directions; however, she believed that the child may not have heard the directions due to transient hearing loss.

Otoscopy revealed normal ear canals and visible, intact tympanic membranes bilaterally. Abnormal tympanometric results were observed bilaterally. A Type B tympanogram in the right ear and a Type C tympanogram in the left ear were recorded.

Pure tone air conduction and bone conduction thresholds were obtained at 500, 1000, and 2000, and 4000 Hz using a conditioned play response mode. Pure tone audiometry revealed a moderate rising to normal configuration in the right ear and a slight rising to normal configuration in the left ear. Despite normal air conduction thresholds at some test frequencies, a conductive component (10 to 20 dB HL) was evident bilaterally at all test frequencies. Speech recognition thresholds (SRT) were 20 dB in the right ear and 30 dB in the left ear and were consistent with pure tone averages bilaterally. All audiometric results were found with excellent reliability.

At the child's last evaluation, auditory sensitivity was worse in the right ear than in the left ear; however, at the current evaluation, the left ear was most involved which is highly suggestive of a fluctuating conductive disorder. Bilateral conductive hearing loss and abnormal tympanometry along with extensive case history reports indicate middle ear involvement.

Results were discussed with the client’s family. Continued medical evaluation from an ENT was strongly encouraged in order to pursue treatment for Eustachian tube dysfunction and resultant bilateral conductive hearing loss. An audiometric re-evaluation was advised, following medical treatment so that audiological treatment, including potential use of an FM system, and aural rehabilitation strategies may be discussed in detail. Biannual hearing evaluations were also encouraged in order to monitor the status of the middle ear.

Since behavior problems at school had been noted by my client's teacher, I chose an article that addressed parent, teacher, and ENT perceptions of children with OME. This article, Parent Parent Versus Professional Views of the Developmental Impact of a Multi-Faceted Condition at School Age: Otitis Media with Effusion (‘glue ear’) by Josephine Higson and Mark Haggard.

Otitis media with effusion (OME) occurs in 5–10% of 5 year old children and in 10-20%from the late fall into the spring. For the most part, OME resolves on its own; however, in about 50% of cases, it does not.

In this study, questionnaires were mailed to parents, teachers, and ENT physicians of children with OME. Each questionnaire covered seven concern areas: presentation/ illness, hearing, behavior, balance, speech and language, concentration, and education. The questionnaire emphasized that the family impact of OME was being examined, and respondents were asked to consider symptoms that were observed in children, ages 3-7, with OME.

The questionnaire results indicated that teachers rated language and education much higher than ENT specialists and parents do. Parents rated hearing most highly. Teachers also give behavior a higher weight than ENT specialists do. Behavior and balance problems show the least differences between groups. Teachers and parents
display similar patterns with respect to behavior problems and balance problems by rating them both slightly lower than ENTs did.

This information emphasized the importance of getting input from all stakeholders in a child's life. It also emphasized the need for a multidisciplinary team.

http://search.ebscohost.com/login.aspx?direct=true&db=eric&AN=EJ722135&site=ehost-live

http://web.ebscohost.com.www.libproxy.wvu.edu/ehost/pdf?vid=5&hid=101&sid=5077a623-7531-4b3a-a840-604f8d099f9b%40sessionmgr106