Achamma Balraj

Neonatal screening for hearing loss: pilot study from a tertiary care centre

Many developed countries have well established universal neonatal hearing screening programs. In India, the viability of such a program, in an already overburdened health system is indeed a challenge. This cross sectional study was undertaken to evaluate the possible burden of hearing loss among neonates born at a tertiary care hospital in Southern India. Five hundred neonates were screened with automated distortion product otoacoustic emission (aDPOAE) for hearing loss, 9.2% of whom had one or more high risk factors. Although 6.4% had hearing loss at initial assessment, only 1.6% had hearing loss on retesting with aDPOAE. Retesting with OAE before an automated Auditory brainstem response (aABR) helped to exclude patients without hearing loss. The frequency of moderate to moderately severe hearing loss in this study was 0.6%. This pilot study underscores the importance of the introduction of screening for congenital deafness in specialized centers in India, despite its challenges.

Neonatal hearing screening — Experience from a tertiary care hospital in Southern India

ObjectiveTo implement a neonatal hearing screening program using automated auditory brainstem response audiometry in a tertiary care set-up and assess the prevalence of neonatal hearing loss.DesignDescriptive study.SettingTertiary care hospital in Southern India.Participants9448 babies born in the hospital over a period of 11 months.InterventionThe neonates were subjected to a two stage sequential screening using the BERAphone. Neonates suspected of hearing loss underwent confirmatory testing using auditory steady state response audiometry. In addition, serological testing for TORCH infections, and connexin 26 gene was done.Main outcome measuresFeasibility of the screening program, prevalence of neonatal hearing loss and risk factors found in association with neonatal hearing loss.Results164 babies were identified as suspected for hearing loss, but of which, only 58 visited the audiovestibular clinic. Among 45 babies who had confirmatory testing, 39 were confirmed to have hearing loss and were rehabilitated appropriately. 30 babies had one or more risk factors; 6 had evidence of TORCH infection and 1 had connexin 26 gene mutation.ConclusionNeonatal hearing screening using BERA phone is a feasible service. The estimated prevalence of confirmed hearing loss was comparable to that in literature. Overcoming the large numbers of loss to follow-up proves to be a challenge in the implementation of such a program.

Malignant otitis externa in an infant with selective IgA deficiency: a case report.

The occurrence of malignant otitis externa (MOE) in infancy is rare. We report a case of MOE in a neonate who was later identified to have selective IgA deficiency. She was successfully treated with oral ciprofloxacin, but developed external auditory canal stenosis, a deformed pinna, persistent facial nerve palsy, temporal bone erosion and hearing loss. No cases of MOE in selective IgA deficiency have been reported in literature. This is also the first report on the use of ciprofloxacin in infants with MOE.

Costs and health effects of screening and delivery of hearing aids in Tamil Nadu, India: an observational study

BackgroundThe burden of disease of hearing disorders among adults is high, but a significant part goes undetected. Screening programs in combination with the delivery of hearing aids can alleviate this situation, but the economic attractiveness of such programs is unknown. This study aims to evaluate the population-level costs, effects and cost-effectiveness of alternative delivering hearing aids models in Tamil Nadu, IndiaMethodsIn an observational study design, we estimated total costs and effects of two active screening programs in the community in combination with the provision of hearing aids at secondary care level, and the costs and effects of the provision of hearing aids at tertiary care level. Screening and hearing aid delivery costs were estimated on the basis of program records and an empirical assessment of health personnel time input. Household costs for seeking and undergoing hearing health care were collected with a questionnaire (see Additional file 2). Health effects were estimated on the basis of compliance with the hearing aid, and associated changes in disability, and were expressed in disability-adjusted life years (DALYs) averted.ResultsActive screening and provision of hearing aids at the secondary care level costs around Rs.7,000 (US

Auditory neuropathy spectrum disorder with Brown-Vialetto-Van Laere syndrome: challenges in hearing rehabilitation.

152) per patient, whereas provision of hearing aids at the tertiary care level costs Rs 5,693 (US

Subjective Visual Vertical and Horizontal in Vestibular Migraine

122) per patient. The cost per DALY averted was around RS 42,200 (US

Subjective visual vertical and horizontal: Normative values using a software-based test in the Indian population

900) at secondary care level and Rs 33,900 (US

Neurological associations in auditory neuropathy spectrum disorder: Results from a tertiary hospital in South India

720) at tertiary care level. The majority of people did consult other providers before being screened in the community. Costs of food and transport ranged between Rs. 2 (US

Laryngeal movements in stutterers

0,04) and Rs. 39 (US

Vestibular evoked myogenic potential in sudden sensorineural hearing loss

0,83).ConclusionActive screening and provision of hearing aids at the secondary care level is slightly more costly than passive screening and fitting of hearing aids at the tertiary care level, but seems also able to reach a higher coverage of hearing aids services. Although crude estimates indicate that both passive and active screening programs can be cautiously considered as cost-effective according to international thresholds, important questions remain regarding the implementation of the latter.