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Health Visitor delivered Newborn Hearing Screening program-performance assessment and applicability Syamaprasad Basu1, Kate Evans1, Marie Owen2, Trish Harbottle3 1 ENT, Gloucester Royal Hospital, Gloucester; 2 Paediatrics, Gloucester Royal Hospital, Gloucester; 3 Gloucestershire Primary Care Trust Introduction The Newborn Hearing Screening Program (NHSP) was introduced in England in 2001 to detect congenital hearing loss in the newborn. The screen is either hospital or community based. This is the first large scale study of community based NHSP published in the United Kingdom which aims to evaluate the performance of the community based screen and compare it against national targets for NHSP and the outcome of national pilot projects. Method Hearing screening data recorded for 10,074 well babies between March 2004 and December 2005 were analysed. Babies who were admitted to the Special Care Baby Unit were excluded. The case notes of all children who failed the initial hearing screen, either unilateral or bilateral, were reviewed retrospectively. Specific performance measures include coverage rate, referral rate and yield. Reasons for failure to complete the screen were identified. Result The community program met all the standards set by the NHSP and the results are comparable with the average of the pilot sites reported in 2004. Conclusion The data demonstrate that a community based hearing screening program conducted by Health Visitors meets all the current National standards and could be implemented across wider areas in this country. Its advantages include a low false positive rate and convenience for parents living in rural areas. The babies identified can be diagnosed and rehabilitated in a time which meets National standards. Ethical Approval Approved by Lead of Newborn Hearing Program at Gloucestershire Primary Care Trust. Newcastle upon Tyne BAHA experience Naveed Kara, Denise Leese, Suzanne Harley, Tom Davison, Ian Johnson Newcastle upon Tyne BAHA Programme, Freeman Hospital Introduction Bone anchored hearing aids (BAHA!) are a well established method of treating deafness. BAHA can either be implanted (osseointegrated for long term aiding) or applied using a Softband (for aiding on a short term). A review of the paediatric programme from this major tertiary referral centre has been undertaken and presented with suggestions for further indications. Methods A prospective database was collated of all patients who were fitted with either a Softband or implanted BAHA over an eleven year period. All Softband patients (tympanogram proven OME with approximately 30dB loss) were assessed by LSQ (Listening Situation Questionnaire) and The Freeman questionnaires. Diagnostic categories were correlated with outcome measures. Results A total of 71 children were aided in the programme: 45 female and 26 male patients. Mean age overall was 12 years. Two significant groups are present: 37 formal BAHA patients with a median age of 15 years and 34 Softband patients with a median age of 9 years. Approximately one third had associated congenital syndromes within both sub-groups. In the Softband group the mean LSQ score was 14, significantly below the interventional score of 22 – demonstrating good benefit. Conclusion Children with refractory glue ear benefit from Softbands, with good educational scores and avoiding further surgery. Significant benefit has been shown with the BAHA group especially with children who have additional anatomical or functional problems. There is a significant under-utilisation of BAHA in children with skull/congenital abnormalities and this group would advocate BAHA implantation within this area. Ethical approval Not applicable
Bone Anchored Hearing Aids in very young children AL McDermott, C Panagamuwa, J Williams, MJ Kuo, AP Reid, DW Proops Birmingham Children’s Hospital, Steelhouse Lane, Birmingham Introduction The Baha® is a well described and accepted form of auditory rehabilitation. Controversy surrounds some aspects of Baha® in children, in particular the timing of implantation. When is the best time to implant children? Obviously, the aim is to restore hearing as soon as possible in order for the child to achieve their full potential. The Birmingham paediatric Baha® programme began in 1992 and children as young as 2 years of age were included. This study evaluates the outcomes of these very young children with a Baha®. Methods Retrospective case analysis. All children below the age of 5 years who received a Bone anchored hearing aid from 1992 to 2007. Results 39 patients aged less than 5 years at the time of implantation. The age range was 2 years to 4years11 months.25 cases had a diagnosed syndrome. A total of 63 loaded fixtures were implanted in this group. There were a total of 25(40%) fixture failures in this young patient group. Mean age of the fixture failure group was 3.5 years. Significant skin reactions were encountered in 17(44%) cases. Conclusions The use of the Baha® in children under 5 has previously been controversial. In the Birmingham series, there was an increase in morbidity in this young patient group. Fixture failure rate was high as was revision surgery for skin reactions. In 2002, the Baha Softband® was introduced. In Birmingham, the treatment of choice for children under 3 years of age is the Softband® until the child is older and more ready for surgery. Speech in Noise Audiometry Pre and Post Grommet Insertion Victoria Possamai, Andrew Scott, Derek Skinner Royal Shrewsbury Hospital Introduction Grommet insertion has become controversial, and has been described by some as a “non-essential” procedure. There is a need to provide evidence of its efficacy. The hearing outcome following grommet insertion is usually measured by pure tone audiometry. Speech in noise testing is a better test of real life hearing and therefore more accurately reflects auditory disability. We designed a study to assess speech in noise in a small group of children prior to and after grommet insertion. Methods 12 children aged 6-9 years undergoing grommet insertion were identified. They had speech in noise testing performed within three weeks pre and 6-11 weeks post grommet insertion. This was tested using AB word lists in four listening conditions – quiet, 50dB, 60dB and 70dB of background noise. Each word list consists of 30 phonemes giving a score out of 30 for each list. Statistical significance was tested using the Mann Whitney U test. Results The mean phoneme score under quiet conditions was 28.1 pre-op and 30 post-op (p=0.04). The mean score in 50dB background noise was 24.2 pre-op and 29 post-op (p<0.01) while in 60dB background noise the score was 22.6 pre-op and 27.5 post-op (p=0.06). Finally the mean score in 70dB background noise was 13.9 pre-op and 21 post-op (p=0.05). Conclusion This small study suggests that children experience a marked significant improvement in speech in noise scores post grommet insertion. This is likely to translate into a significant advantage in the educational environment. Streamlining follow up consultations following grommet insertion in children using tympanometry and otoacoustic emission testing Harris RL BSc MSc FRCS(ORL-HNS), Daya H FRCS(ORL-HNS) St. George’s Hospital Introduction Post ventilation tube insertion follow up is necessary to ensure that the grommet is in situ and patent and that there is not an underlying sensorineural hearing loss. Typically follow up involves an appointment with an ENT surgeon and behavioural testing with an audiologist. Children under 3 frequently require more lengthy distraction tests. Methods 47 consecutive children were followed up at 2 weeks post grommet insertion with an audiological scientist who performed a tympanogram and otoacoustic emmission test!to assess the grommet patency and ensure there is normal cochlear function. Patients were seen by an ENT consultant at the same visit if there were any concerns. Results 9 patients were also seen by a consultant Conclusion By adopting this pilot ‘1-stop’ follow up service we have created additional capacity in ENT and audiology clinics. Antibiotic Usage and Paediatric Acute Mastoiditis Jerome Lim, Tahir Mirza, Samuel Leong, Hamid Daya St George’s Hospital, London Introduction Acute coalescent mastoiditis is an uncommon complication of acute otitis media. The use of antibiotics to prevent serious complications of acute otitis media is the subject of debate, and we were interested to review our experience of antibiotic usage in acute mastoiditis. Methods We undertook a retrospective review of children admitted with acute mastoiditis to our institution over a ten year period. Results Thirty seven patients were identified. Patients presented with a number of different symptoms and signs with only eight patients presenting with the classical triad of a post auricular swelling, protrusion of the pinna and pyrexia. Sixteen patients had received oral antibiotics prior to their admission, and seventeen patients had not received any systemic antibiotic treatment. We will discuss the clinical course and outcomes of these two groups of patients. Conclusion Antibiotics probably provide a modest beneficial effect on the clinical course of acute otitis media, but their ability to prevent the development of acute mastoiditis is uncertain. We found no evidence in our study group that antibacterial treatment of acute otitis media prevented the development of acute mastoiditis. Langerhans' cell histiocytosis with unusual bilateral otological presentations in children Biswas D1, Ray J1, Gerrard M2 Department of Otolaryngology1 and Department of Paediatric Oncology2 Sheffield Children Hospital, UK Introduction Temporal bone involvement is found in 15 to 30% of the cases of Langerhans cell histiocytosis (LCH). However, bilateral otological presentation of LCH is extremely rare. Methods Retrospective case note study of the all patients in the Sheffield Children Hospital with LCH presenting with bilateral temporal bone involvement over last 15 years (1993 to 2007). A review of the literature using Medline through Pub Med (1950 – 2007), EMBASE (1980-2007) and Ovid (1958 – 2007) was carried out. Results In this study period, LCH of the temporal bone were diagnosed in 16 patients; however only five patients had bilateral ear involvement. Three presented with the features of acute mastoiditis. One presented with features of bilateral acute otitis media with an element of acute otitis externa. One other patient presented with tender soft tissue swelling over temporal bone simultaneously bilaterally. Conclusion To the best of our knowledge, this is the largest series of bilateral temporal bone LCH. It is difficult to diagnose LCH on basis of clinical features alone. A high index of suspicion is necessary and other associated unusual features in children should trigger further investigations. Bilateral mastoiditis is rare in childhood. This is usually non-resolving in cases with LCH and can also recur after surgical intervention. Antibiotic Prophylaxis for Cochlear Implantation: A review of literature & UK Units’ practice Richard J.D. Hewitt, Rebecca A. Dawson, Michelle E. Wyatt Great Ormond Street Hospital (GOSH), London Introduction There is great variation in the choice of antibiotic and regimen prescribed for patients undergoing cochlear implantation. This presentation analyses the current, and historical, literature and reviews the prescribing protocols and practise of the UK Cochlear Implant Units. Methods A literature review was undertaken and the UK listed Cochlear Implant Units were polled by questionnaire via email or telephone. Results There are a wide variety of recommendations in the current literature and in the Units prescribing habits. Conclusion Infections following Cochlear Implantation are rare but carry a potentially high morbidity. There is no one, single, definitive evidence based antibiotic prophylaxis protocol with some studies recommending no prophylaxis at all. Based on this review GOSH has chosen to adopt the following protocol: Co-amoxiclav (amoxicillin & clavulanic acid), one dose intravenously on induction with two further post operative doses followed by a week of oral administration. Ankyloglossia release in infants with Breast Feeding difficulties Miss Neelam Saroy, Mr Hasan Khan, Miss Victoria Ward, Mrs Susan Clarke Department of Otolaryngology, Pinderfields General Hospital, Wakefield, West Yorkshire Introduction Ankyloglossia, also known as tongue-tie, is a congenital anomaly characterised by an abnormally short lingual frenulum, which may restrict the mobility of the tongue. Many babies with tongue-ties are asymptomatic and have no problems. Some babies however have breast feeding difficulties. Ankyloglossia release can improve breast feeding if performed early by a registered healthcare professional. Objective To review the effect of Ankyloglossia release performed in ENT outpatient’s clinic in infants with Breast Feeding difficulties and the complications of the procedure, from 2006 to 2007 Methods Retrospective review of 20 sets of notes and following up the babies’ progress post procedure via a telephone based questionnaire for their parents Results Sex of baby: Male 10 Female10 Age at frenulotomy: Range 7 days to 4 months Poor latch: 20/20 Sore nipple: 12/20 Continual Feeding: 17/20 Poor weight gain: 6/20 Supplemental feeding, formula or expressed breast milk: 12/20 Tongue motion: 20/20 improved (Feeding before division: BF 18/20 Bottle 9/20) (Feeding after division: BF 15/20 Bottle 8/20) Duration of breast feeding: 1 week to 2+ years Complication: 2/20 haemorrhage Parents’ overall satisfaction with procedure: 90% excellent 5%happy 5% made no difference as procedure delayed Conclusion Ankyloglossia is a relatively safe procedure which can be carried out in an out patient setting and results in an improvement in breast feeding and a high parent satisfaction Parotid duct ligation for the treatment of drooling in children with neurological impairment Rebecca L Heywood, Lesley Anne Cochrane, Benjamin EJ Hartley Great Ormond Street Hospital, London Introduction Multiple surgical procedures have been advocated for the management of problematic drooling in neurologically impaired children. However, many are prone to significant morbidity. All have variable outcome in the control of sialorroea, and many children thus require more than one surgical intervention. Parotid duct ligation is a quick and simple operation carried out via an intra-oral approach and usually performed simultaneously with other procedures. In this study we aim to evaluate the effectiveness of parotid duct ligation as a discrete entity. Methods All children who underwent bilateral parotid duct ligation as the solitary operative intervention at that time, either as first line surgical management or subsequent to other operations to treat drooling between February 2003 and September 2006 were studied. Assessment of outcome was based on the subjective reports of parents and classified as ‘Much better’, ‘Better’, ‘No change’, or ‘Worse’. Results Ten children were studied. Surgery was successful in 80% of cases. Most patients stayed in hospital for one night post-operatively. One patient (10%) had a postoperative wound infection. Conclusion Bilateral parotid duct ligation is an effective yet conservative operation for drooling in children with neurological impairment. It requires minimal surgical dissection and has low morbidity. It should be considered as a first line procedure in children who aspirate and as a further treatment option in those who continue to drool unacceptably following prior surgical intervention. ENT Paediatric Provision in Southwest Region-A Completed Audit Cycle Jayesh Doshi, Kate Evans Gloucestershire Royal Hospital, UK Introduction The Royal College of Surgeons (England) published a document entitled “Children’s Surgery – a First Class Service” (2000). It reviewed paediatric ENT provision in England and proposed several recommendations. The aim of this audit was to determine if any changes have occurred in paediatric ENT provision in southwest England since publication of this document. Method In 2000, a questionnaire based upon the published report was distributed to the paediatric lead consultant in all ten hospitals in southwest England (cycle 1). The questionnaire was resent in 2007 (cycle 2). Results There was a 70 percent response rate in both cycles. All units had paediatric anaesthetists and staff nurses. There was an improvement in facilities such as dedicated paediatric outpatients, theatres, operating lists and PICU. Access to specialties such as paediatric oncology improved. Less than half of units had departmental clinical guidelines. Not all consultants who operated on children had paediatric life support (PLS) training. Conclusions There have been some improvements in paediatric ENT provision in the southwest of England in line with the published recommendations. However other areas such as departmental guidelines have yet to be introduced to many departments. CERVICOFACIAL NONTUBERCULOUS MYCOBACTERIUM LYMPHADENITIS IN CHILDREN: AN ALGORITHM FOR TREATMENT BASED ON DEPTH AT PRESENTATION Harris RL BSc MSc FRCS(ORL-HNS), Modayil P MRCS, Daya H FRCS(ORL-HNS) St. George’s Hospital Introduction The optimal treatment of nontuberculous mycobacterial lymphadenitis in children is not established. Most published articles didactically recommend complete surgical excision of all infected lymph nodes. In contrast, there are increasing numbers of investigators reporting successful antibiotic treatment and advocating medical therapy as the first line treatment. Methods 18 Children consecutively presenting to a tertiary referral centre over an 8 year period with microbiologically proven nontuberculous mycobacterial lymphadenitis were assessed with MRI. Superficial lesions with skin change were treated preferentially with complete surgical excision of all involved tissue. Children presenting with lymph nodes contained deep to sternocleidmastoid or trapezius muscles or parotid lymphadenopathy without cutaneous involvement were treated preferentially with antibiotics or watchful waiting. The outcome measure for the medically treated deep lymph nodes was resolution without surgical intervention. A literature review was performed selecting cases for comparison by reported depth and position, cutaneous involvement, treatment regimen and response. Results 3 children presented with deep lymphadenopathy. No children presenting with deep lymph node involvement required surgical intervention. No children who underwent surgical excision recurred. Conclusion Morbidity of both the disease and the treatment can be minimised by selecting patients into treatment arms according to the depth of the involved lymph nodes at presentation. We present an algorithm for diagnosis and treatment. |