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case report

Dear list,


          Greetings from India.


    Here I report a child with Auditory Neuropathy... please give ur suggestions regarding Cochlear Implant


 The child had HyperBillirubinemia and blood transfusion was done, following which he developed stiffness and developmental delay. When the child was 4 months he was evaluated for Hearing... the results were...


BOA  -  40 dB for speech stimuli.

ABR  - absent

OAE  - present in one ear and absent in other ear

CM    - Robust in one ear and feeble in other (polarity reversal)

LLR   - Present but prolonged.


Second evaluation was after a period of 6 months, and the results of the second evaluations shadows the first.


Now can we suggest cochlear Implant for this child? Is there any pediatric Auditory neuropathy been implanted earlier with similar cause? Before implantation what tests can be used to confirm the functional ability of the spiral ganglion cells


If u still has patience to read, here is another interesting case of auditory neuropathy...


A 30 year old female had metastatic adenocarcinoma with unknown primary. CT and MRI showed, a ring enhancing lesion in the occipital lobe, but increased intracranial pressure was not present. Surgery was done to remove only the largest tumor on the occipital lobe. 


       After the surgery she came for Audiological evaluation to establish a base line audiogram before chemotherapy was started. Audiological evaluation showed the following...


PTA   -    R - moderate sloping HL

                L -   Profound HL


SI     -     0% in both ears


ABR  -  Absent in both ears


OAE  - present in both ears


CM    - enhanced in both ears (polarity reversal)


LLR   - P1-N1-P2-N2 with very good morphology, amplitude and well within normal latencies.


Diagnosis: Auditory Dsynchrony.



The second evaluation was done after one month and results are shown below



PTA  - Unchanged


SI     - 85%


ABR  - V peaks occurs consistently but prolonged, earlier peaks absent.


OAE  - Present


CM    - present


LLR   - same as that of first evaluation.



What would be cause for such a reversible AN in this patient? we delineated hypothermia, anoxia, TIA, etc....

But either that cause has not incurred in this case or that possible conditions will not correlate with present findings.Have any one encounter such a case? Is there any other causes?



Hari Prakash.P. Msc Audiology.
Lecturer, Dept. of Speech and Hearing
Manipal - 4
mobile - +91 9886135522