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- To: hari prakash <h.prakash.p@xxxxxxxxx>
- Subject: Re: case report
- From: Kartik Narayanan <akartik1@xxxxxxxxx>
- Date: Sat, 24 Feb 2007 15:52:28 -0800 (PST)
- In-reply-to: <email@example.com>Dear Hari,There have been many such devaint cases noted in literature, where CI is not an obvious choice as per candidacy guidelines. i think we should follow the following steps:1. The child must be given a fair hearing aid trial for suspected hearing loss. The reason for this being that there are two schools of thought w.r.t. Hg aid utility in clients with auditory neuropathy. So, we are giving equal priority to both schools.2. There should be an evaluation repeated after 6- 8 months post-amplification (trial). If the client is a case of auditory maturational delay, it would definitely avoid missing the sensitivity period/ critical age benefits. And, hearig aid would be an obvious choice or he could even be an individual with normal hearing sensitivity (at a later evaluation).3. And if there is no post-amplificatory benefits found, then it would leave us exactly at FDA guidelines (i.e. 18 months) for implantation to take place.I think this would be the safest means of making sure that we are making the right decision.Awaiting to hear soem comments from other members of the community.Kartik
hari prakash <h.prakash.p@xxxxxxxxx> wrote:
Dear list,Greetings from India.Here I report a child with Auditory Neuropathy... please give ur suggestions regarding Cochlear ImplantThe 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 - absentOAE - present in one ear and absent in other earCM - 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 cellsIf 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 HLL - Profound HLSI - 0% in both earsABR - Absent in both earsOAE - present in both earsCM - 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 belowPTA - UnchangedSI - 85%ABR - V peaks occurs consistently but prolonged, earlier peaks absent.OAE - PresentCM - presentLLR - 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
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