Current Opportunities in Pediatric Hearing Loss Douglas D. Backous, MD, FACS Otology, Neurotology, Skull Base Surgery Medi...
Overview <ul><li>Discuss the options for hearing restoration for differing levels of hearing loss </li></ul><ul><ul><li>In...
Disclosures <ul><li>Cochlear Corporation: Surgical Advisory Board </li></ul><ul><li>Medtronics Neurotechnologies: Consulta...
The Problem <ul><li>Hearing Loss in Children </li></ul><ul><ul><li>3-4/1000 live births have HL >30dB </li></ul></ul><ul><...
Change in Prevalence of Hearing Loss in US Adolescents ( Shargorodsky J.  JAMA 2010;304(7):772-78) <ul><li>NHANES data com...
Severe to Profound Hearing Loss on Reading Comprehension Schildroth and Karchmer 1986
Educational Impact of Unilateral Loss Hearing Loss White K. (2004) Am J Med Genetics
Severe to Profound Hearing Loss  on Income Project Hope, 2001 proportion (%)
Severe to Profound Hearing Loss Costs to Society <ul><li>For all individuals, </li></ul><ul><ul><li>Estimated additional $...
 
Newborn Hearing Screening (Early Hearing Loss Detection, Diagnosis and Intervention Program) www.doh.wa.gov/cfh/mch/geneti...
Risk Factors <ul><li>NICU stay </li></ul><ul><li>Positive family history </li></ul><ul><ul><li>Genetic losses </li></ul></...
Left bone Right  air Left  air 100% 100% Right  bone Understanding the Audiogram Normal Mild Hearing Loss Moderate Hearing...
Hearing Aids
Baha System <ul><li>Detachable Sound  Processor </li></ul><ul><li>External Abutment  </li></ul><ul><li>Titanium implan t <...
Baha
Left  air CNE CNE Right air Severe to Profound Hearing Loss 49 year old white male with progressive  hearing loss < >
Candidacy Criteria Adults Adults/children 2+  Adults/children 1+ Speech recognition criteria Adults : < 50% sentences in e...
Tonotopic Organization
Cochlear Implant System An internal implant placed just under the skin, behind the ear 1 And an external sound processor 2
Hearing loss in the U.S.  1.Kochkin, S.  The Hearing Review,(2005); July. 2.Blanchfield, B.B.. JAAA. (2001);12: 183-189. 3...
Prenvar 13 <ul><li>Licensed by FDA on February 24, 2010 </li></ul><ul><ul><li>Approved for children 6 weeks to 71 months <...
Vaccine Recommendations (www.cdc.gov/mmwr/preview/mmwrthml/mmm5909a2.htm) <ul><li>Chronic heart or lung disease, Diabetes,...
Vaccine Recommendations (www.cdc.gov/mmwr/preview/mmwrthml/mmm5909a2.htm) <ul><li>2-6 months: 3 doses PCV 13  plus booster...
Conclusions <ul><li>Technological interventions are now available for defects at each level of the auditory pathway </li><...
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Opportunities for kids with Hearing loss

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This is a short review of new opportunities for children with hearing loss aimed at primary care doctors. Parents can learn from it as well. Presented at the Swedish Pediatric education 1/21/11.

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  • A sound processor picks up sound vibrations. An abutment transfers sound from the Baha device to the implant. A small titanium implant transfers the sound vibrations via the skull bone to the functioning cochlea.
  • Typical audiogram ranges
  • Patients currently being helped: &lt; 10% cochlear implant &lt; 1% Baha implant
  • Opportunities for kids with Hearing loss

    1. 1. Current Opportunities in Pediatric Hearing Loss Douglas D. Backous, MD, FACS Otology, Neurotology, Skull Base Surgery Medical Director, Swedish Center for Hearing and Skull Base Surgery Seventh Annual Pediatric Specialty Update for the Primary Care Physician Swedish Medical Center January 21, 2011
    2. 2. Overview <ul><li>Discuss the options for hearing restoration for differing levels of hearing loss </li></ul><ul><ul><li>Introductory talk </li></ul></ul><ul><li>Be able to access information for early hearing loss detection </li></ul><ul><li>Outline CDC recommendations for immunizations in children with hearing loss </li></ul>
    3. 3. Disclosures <ul><li>Cochlear Corporation: Surgical Advisory Board </li></ul><ul><li>Medtronics Neurotechnologies: Consultant </li></ul>
    4. 4. The Problem <ul><li>Hearing Loss in Children </li></ul><ul><ul><li>3-4/1000 live births have HL >30dB </li></ul></ul><ul><ul><li>1/1000 profound hearing loss </li></ul></ul><ul><ul><li>Post-natal hearing loss (2-25%) </li></ul></ul><ul><ul><li>>95% born to 2 normal hearing parents </li></ul></ul><ul><ul><li>MP3 players are definitely having an effect on youths </li></ul></ul><ul><ul><li>- Levey S, Levey T, Fligor BJ J. Speech Lang Hear Res 2010 </li></ul></ul><ul><ul><li>-McNeill K, Keith SE, Feder K, et al. J Acoust Soc Am 2010 </li></ul></ul>
    5. 5. Change in Prevalence of Hearing Loss in US Adolescents ( Shargorodsky J. JAMA 2010;304(7):772-78) <ul><li>NHANES data comparing 1988-94 to 2005-06 </li></ul><ul><li>1771 subjects between 12-19 years </li></ul><ul><li>Increase from 14.9% to 19.5% </li></ul><ul><li>Etiologies not well described </li></ul><ul><li>Mostly unilateral hearing loss </li></ul>
    6. 6. Severe to Profound Hearing Loss on Reading Comprehension Schildroth and Karchmer 1986
    7. 7. Educational Impact of Unilateral Loss Hearing Loss White K. (2004) Am J Med Genetics
    8. 8. Severe to Profound Hearing Loss on Income Project Hope, 2001 proportion (%)
    9. 9. Severe to Profound Hearing Loss Costs to Society <ul><li>For all individuals, </li></ul><ul><ul><li>Estimated additional $297,000 over lifetime </li></ul></ul><ul><ul><li>67% of loss are in reduced work productivity </li></ul></ul><ul><li>For children, </li></ul><ul><ul><li>Significant costs of education (boarding, special services, etc.) </li></ul></ul><ul><ul><li>Estimated life time costs >$1 million dollars </li></ul></ul>Int J Technol Assess Health Care 2000
    10. 11. Newborn Hearing Screening (Early Hearing Loss Detection, Diagnosis and Intervention Program) www.doh.wa.gov/cfh/mch/genetics/ehddi/providers.htm <ul><li>Screened for hearing loss before hospital discharge and no later than 1 month of age </li></ul><ul><ul><li>OAE or ABR </li></ul></ul><ul><li>Audiologists evaluation by 3 months of age </li></ul><ul><ul><li>ABR </li></ul></ul><ul><ul><li>Hearing aids </li></ul></ul><ul><li>Enrolled in intervention services by 6 months of age </li></ul>
    11. 12. Risk Factors <ul><li>NICU stay </li></ul><ul><li>Positive family history </li></ul><ul><ul><li>Genetic losses </li></ul></ul><ul><li>Craniofacial abnormalities </li></ul><ul><li>In-utero infections </li></ul><ul><ul><li>CMV </li></ul></ul><ul><li>Syndromes </li></ul><ul><li>Elevated bilirubin </li></ul>
    12. 13. Left bone Right air Left air 100% 100% Right bone Understanding the Audiogram Normal Mild Hearing Loss Moderate Hearing Loss Severe Hearing Loss Profound Hearing Loss < > O X
    13. 14. Hearing Aids
    14. 15. Baha System <ul><li>Detachable Sound Processor </li></ul><ul><li>External Abutment </li></ul><ul><li>Titanium implan t </li></ul>
    15. 16. Baha
    16. 17. Left air CNE CNE Right air Severe to Profound Hearing Loss 49 year old white male with progressive hearing loss < >
    17. 18. Candidacy Criteria Adults Adults/children 2+ Adults/children 1+ Speech recognition criteria Adults : < 50% sentences in ear to be implanted < 60% bilaterally (best aided condition) Children: <30% MLNT or LNT best aided Frequency (Hz)
    18. 19. Tonotopic Organization
    19. 20. Cochlear Implant System An internal implant placed just under the skin, behind the ear 1 And an external sound processor 2
    20. 21. Hearing loss in the U.S. 1.Kochkin, S. The Hearing Review,(2005); July. 2.Blanchfield, B.B.. JAAA. (2001);12: 183-189. 3.Available Mkt- National Institute on Deafness & Communication Disorders (NIDCD) 2004 4. Recipients– Internal Cochlear data Total hearing loss 1 1.6% annual growth rate 32m Potential device candidates 2,3 1 - 1.2 million severe-profound and profound 1 million SSD, mixed and conductive ~2m Total implanted population 4 10% Cochlear Implant /1% Baha <200k
    21. 22. Prenvar 13 <ul><li>Licensed by FDA on February 24, 2010 </li></ul><ul><ul><li>Approved for children 6 weeks to 71 months </li></ul></ul><ul><li>Replaces Prenvar 7 </li></ul><ul><ul><li>Streptococcus pneumoniae (1,3,4,5,6A,7F,9V,14,18C,19A,19F,23F) </li></ul></ul>
    22. 23. Vaccine Recommendations (www.cdc.gov/mmwr/preview/mmwrthml/mmm5909a2.htm) <ul><li>Chronic heart or lung disease, Diabetes, CSF leaks, Cochlear implants </li></ul><ul><li>Asplenia: sickle cell disease, splenic dysfunction </li></ul><ul><li>Immunocompromised: HIV, Renal failure, nephrotic syndrome </li></ul>
    23. 24. Vaccine Recommendations (www.cdc.gov/mmwr/preview/mmwrthml/mmm5909a2.htm) <ul><li>2-6 months: 3 doses PCV 13 plus booster at 12-15 months </li></ul><ul><li>7-11 months: 2 doses PCV 13 plus booster at 12-15 months </li></ul><ul><li>12-23 months: 2 doses PCV 13 and no booster </li></ul><ul><li>24-59 (healthy children): one dose PCV 13 </li></ul><ul><li>24-71 months (chronic disease): 2 doses PCV 13 </li></ul><ul><li>Adults and chldren over 6 years: Pneumovax (23 valent) </li></ul>
    24. 25. Conclusions <ul><li>Technological interventions are now available for defects at each level of the auditory pathway </li></ul><ul><li>Newborn hearing screening is now available and will identify more children at earlier ages </li></ul><ul><ul><li>Primary care key </li></ul></ul><ul><li>Early intervention is critical to long-term outcome </li></ul><ul><li>Immunization schedules are continually being updated by the CDC </li></ul>
    25. 26. Thank you

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