Transcript Document
WHO schema for disablements Aetiology - eg. Meningitis Pathology - Hair cell damage Impairment - Hearing loss Disability - Speech and Language disorder Handicap- Inability to lead a normal life Early identification of Impairment Early intervention Reduces Disability i.e development of normal speech and language Prevents Handicap i.e able to lead a normal communal life Aim -A Team that is led by a consultant paediatrician in Audiological medicine to deliver to the children aged 0-16 (?19yrs soon) a service that concerns itself with disorders of • Peripheral hearing – sensori-neural hearing loss, conductive hearing loss etc. • Pure Neural Hearing loss - Auditory Neuropathy • Increased hearing sensitivity - Hyperacuisis • Tinnitus • Vestibular System - screen and refer to GOSH if further assessment is indicated. • Auditory processing – not commissioned yet! • Non organic or functional hearing loss It also concerns itself with • Diagnosis of Normal Hearing in children with special needs - This can be a challenge needing special skills • Diagnosis and management hearing impairment in children who have other special needs - 40% of children with SNHL have other problems Early Identification Need to do active case finding • Promote awareness – Parents – Professionals • Screening at different ages Screening at different ages • Neonatal - electrophysiological tests (OAE and AABR) – universal - training of screening staff • 5 years - performance test – universal – training of school nurses and continued updating Referral reasons to the Audiolgy Service Between and after Routine Screening Ages 1. Any child with a supected hearing problem i.e hearing loss Hyperacuisis Tinnitus 2. Meningitis 3. Mumps 4. Measles 5. Head Injury 6. Exposure to noise, blast injury etc. 7. Treatment with Ototoxic agents eg. Aminoglycosides, cytotoxtic agents - cis espplatinum 8. Family history of sensori-neural hearing loss 9. Syndromes & dysmorphic featues diagnosed after the neonatal neonatal period 10. Cranio-facial abnormalities also refer:severe visual handicap delayed speech and language development learning difficuties behavioural problems parental concerns child not understanding or misunderstanding Therefore referrals are received from the •Newborn screening teams at birth •school screening service at 5 years of age •from professionals - Acute Paediatricians Community paediatricians, General practitioners, ENT surgeon, School Health/Child Health personnel . After diagnosis of Permanent hearing loss • Anatomical diagnosis • Aetiological diagnosis • Multi-disciplinary management programme Otitis Media with Effusion also known as “glue ear” “secretory otitis media” “serous otitis media” New NICE guidance available February 2008 Nice Guidance - 3 care pathways 1) Children with suspected OME 2) Children with Down’s Syndrome 3) Children with Cleft palate “OTITIS MEDIA WITH EFFUSION” Assessment of disability, Monitoring Assessment for referral for surgery - work closely with ENT Conservative Management • advice on management in classroom • Hearing aids fitting Do not offer the following for the Rx of OME Antibiotics Antihistamines Decongestants Steroids Homeopathy Cranial osteopathy Acupuncture Dietary Modification Massage Human Communication is action. It is culture. It is the fabric of all society It is the history of man. Its absence negates man’s existence commissioning policy Parental re referrals ?? Guidance for referrals – discuss document