Search Results (54)

Introduction: The present study aimed to compare cortical auditory maturation, as reflected by P1 latency of cortical auditory evoked potentials (CAEPs), in children with congenital severe-to-profound sensorineural hearing loss rehabilitated with unilateral cochlear implants (CIs) or bilateral conventional hearing aids (HAs). Materials and Methods: Eighty-five children with congenital severe-to-profound sensorineural hearing loss were included in this retrospective comparative study. Participants were divided into two groups: unilateral CI users (n = 42) and bilateral HA users (n = 43). All children were fitted with their devices before 48 months of age and achieved aided free-field thresholds between 30 and 50 dB HL. CAEPs were recorded using the Fonix^® HEARLab System with speech stimuli (/m/, /g/, /t/) presented at 55 dB SPL. P1 latency values were measured and compared between groups using independent samples t-tests. Correlation analyses were performed to assess the relationship between duration of device use and P1 latency. Results: Eighty-five children were included (CI: n = 42; HA: n = 43). Mean P1 latency values did not differ significantly between groups for the /m/ stimulus (126.4 ± 29.13 ms vs. 126.4 ± 29.28 ms, p = 1.00), /g/ stimulus (106.5 ± 26.46 ms vs. 110.1 ± 29.49 ms, p = 0.55), or /t/ stimulus (114.7 ± 22.93 ms vs. 118.5 ± 27.19 ms, p = 0.48). Age at device fitting was comparable between groups (27.95 ± 9.10 vs. 26.88 ± 14.15 months, p = 0.68). The duration of device use was significantly longer in the HA group (48.02 ± 28.39 months) compared to the CI group (26.00 ± 15.92 months) (p < 0.001). Correlation analysis revealed no significant association between duration of device use and P1 latency for any stimulus (/m/: p = 0.28; /g/: p = 0.17; /t/: p = 0.09). Conclusions: When devices were fitted before 48 months of age and aided thresholds were optimized, unilateral cochlear implantation and bilateral conventional hearing aids showed comparable P1 latency values as an index of cortical auditory maturation. These findings suggest that early and adequate auditory stimulation may play an important role in supporting cortical auditory development in children with congenital hearing loss, although results should be interpreted within the context of individualized clinical management. Full article

Pediatric episodic vestibular syndrome (pEVS) is a frequent source of diagnostic uncertainty because recurrent vertigo, dizziness, and unsteadiness in children may arise from disorders with markedly different mechanisms, prognostic implications, and management pathways. Symptom descriptions are often imprecise, interictal examination may be normal, and similar recurrent attack patterns may reflect spontaneous, triggered, neurologic, autonomic, audiovestibular, or extravestibular conditions. This Perspective proposes a clinician-oriented, phenotype-first framework for the practical evaluation of pEVS, grounded in the International Classification of Vestibular Disorders and Bárány Society consensus criteria where available. The proposed approach begins with structured history taking and focused bedside examination, emphasizing the core symptom category, attack duration, trigger profile, and associated migraine, auditory, autonomic, and neurologic features. Recurrent attacks are then organized into clinically recognizable phenotypes, including spontaneous non-migraine and migraine-related presentations, auditory phenotypes, ultrabrief stereotyped attacks, trigger-related attacks, orthostatic/autonomic phenotypes, motion- or visually-triggered dizziness, episodic vertigo with transient neurologic signs, and anxiety-related presentations. Rather than providing an exhaustive etiologic review, this framework is intended to support bedside classification, guide selective ancillary testing, and facilitate longitudinal reassessment, as diagnostic reclassification may occur over time. A phenotype-driven approach may improve diagnostic reasoning, support more rational use of ancillary testing, and facilitate earlier recognition of both common and less frequent but clinically important disorders. Full article

Background/Objectives: Temporal bone surgery in children is technically challenging due to their smaller anatomical structures, developmental differences, and the closer proximity of critical neurovascular structures. The limited availability of conventional training materials and pediatric cadaveric specimens has led to greater enthusiasm for simulation-based methods. The aim of this systematic review was to identify existing otologic simulation models and evaluate their anatomical accuracy, teaching effectiveness, and supporting evidence. Methods: In accordance with PRISMA guidelines, the PubMed, Embase, Scopus, and Cochrane Library databases were searched for studies reporting simulation tools for pediatric otologic surgery. Articles describing three-dimensional printed (3DP) models, virtual reality (VR) platforms, cadaver specimens, and animal models were included. Studies focusing on children and providing educational outcomes were selected. The extracted data were synthetized and analytically discussed. Results: Thirteen studies met the inclusion criteria: nine on 3DP models and four on VR environments. No research involving cadavers or animals was identified. 3DP models exhibited consistent anatomical accuracy and notable educational advantages. Five studies used surveys for their evaluations, and three relied on expert observer assessments. The studies including validation analyses showed a high correlation between printed models and computed tomography (CT) images. VR systems supported anatomical reconstruction and segmentation tasks, as well as guided simulation exercises. However, most of the research consisted of feasibility studies with limited participant groups. Conclusions: Simulation-based training with 3DP and VR models could be ethical and accurate methods for obtaining relevant skills in pediatric otologic surgery. The reviewed data suggest that these tools may be suitable as a first-line step within an integrated, multimodal training pathway prior to direct patient contact. Full article

Background/Objectives: Although genetic testing is recommended for pediatric hearing loss, referral rates within otology and audiology practices remain low. This study evaluated referral rates, referral pathways, and genetics appointment completion before and after implementation of a quality improvement (QI) referral protocol in an ethnically diverse pediatric cohort. Methods: Phase 1 (January–August 2023) included chart reviews of 88 pediatric patients with hearing loss to assess whether genetics referrals were made and completed. Data collected included demographics, referral modality (clinical note documentation, routed note to genetics, or direct referral order), and appointment status. In Phase 2 (September 2023–September 2024), a standardized referral protocol was implemented requiring all newly diagnosed patients to be referred using one of three predefined pathways. Providers received brief training and reminder cards. Chart reviews were then conducted for an additional 114 patients. Results: A total of 202 patients were included (Phase 1: n = 88; Phase 2: n = 114). Following protocol implementation, the proportion of patients with any documented genetics referral increased significantly (35.2% vs. 68.4%, χ² = 22.03, p < 0.001). Referral order placement, documentation, and note routing increased across all referral modalities (all p < 0.001). Genetics appointment completion also improved significantly, from 11.4% in Phase 1 to 38.6% in Phase 2 (p < 0.001). Conclusions: Genetic referrals for pediatric hearing loss remain underutilized but improved substantially following implementation of a standardized referral protocol. These findings highlight the importance of optimizing referral pathways and providing ongoing provider education. QI initiatives represent a practical strategy to enhance access to genetic evaluation and support precision care. Full article

Background/Objectives: Congenital cytomegalovirus (cCMV) is a leading non-genetic cause of childhood sensorineural hearing loss (SNHL), characterized by heterogeneous and dynamic hearing outcomes. Hearing impairment may be present at birth or emerge later in childhood. This study aimed to characterize hearing trajectories and laterality patterns in children with cCMV, with emphasis on congenital versus delayed-onset SNHL. Methods: We conducted a retrospective study of children with confirmed cCMV who underwent longitudinal audiologic follow-up. Hearing loss was classified as congenital SNHL or delayed-onset SNHL. Better- and poorer-ear thresholds, bilateral involvement, longitudinal changes, and follow-up duration were analyzed. Results: Of 195 included children, 59 (30%) developed SNHL. Congenital SNHL was present in 34 children (17%), while delayed-onset SNHL developed in 25 of 161 children (16%) who were born with normal hearing. Of these delayed-onset cases, 20 (80%) were asymptomatic at birth, while 5 (20%) presented with non-audiological neonatal symptoms. Longitudinal observation of the delayed-onset subgroup revealed that 36 ears developed SNHL during follow-up, spanning infancy through later childhood, including one case identified in early adulthood. Better-ear thresholds were significantly better preserved in delayed-onset SNHL, while poorer-ear thresholds were comparable across groups. Children with SNHL had substantially longer follow-up duration (60 ± 44.5 months) compared with those with normal hearing (37 ± 24.4 months). Conclusions: Children with cCMV-related SNHL exhibit dynamic and asymmetric hearing trajectories with clinically relevant differences between congenital and delayed-onset SNHL. These findings underscore the necessity of a risk-stratified, long-term surveillance framework that ensures individualized long-term monitoring and promotes sustained adherence to follow-up. Full article

Background: Laryngomalacia is the most common cause of inspiratory stridor in infancy. While most mild cases resolve spontaneously, severe cases may require surgical intervention. We report a case of severe laryngomalacia successfully treated with correction of glosso-larynx (CGL), a surgical procedure originally developed for ankyloglossia with deviation of the epiglottis and larynx (ADEL). Methods: A 2-month-old infant with severe symptoms was evaluated using objective anatomical and functional metrics. The patient underwent CGL under local anesthesia to release restrictive tension on the hyoid-larynx complex. Results: The patient showed rapid and sustained improvement in respiratory symptoms. At the one-month follow-up, endoscopic examination confirmed functional airway expansion with limited to no morbidity. Conclusions: This case demonstrates that CGL may represent a feasible and minimally invasive therapeutic option for selected cases of severe laryngomalacia, particularly those involving complex tongue–larynx dynamics. Full article

Objectives: This study aimed to evaluate auditory cortical maturation in pediatric cochlear implant (CI) users using speech-evoked cortical auditory evoked potentials (CAEPs) and to compare P1 latency responses with age-matched normal-hearing (NH) peers. Secondary objectives included examining the relationship between P1 latency, age, and duration of implant use to assess experience-dependent cortical plasticity. Materials and Methods: Seventy children were enrolled, including 40 prelingually deaf CI users and 30 NH controls matched for age and sex. CAEPs were recorded using the HEARLab system with three speech tokens representing low (/m/), mid (/g/), and high (/t/) frequencies, presented at 55 dB SPL in a free-field setup. The P1 component was identified as the first positive deflection between 50 and 150 ms after stimulus onset. Group comparisons were performed using Student’s t-test, and correlations between P1 latency, age, and implant-use duration were analyzed using the Pearson correlation test (p < 0.05). Results: Mean P1 latencies were significantly longer in CI users than in NH peers for the /m/ and /t/ stimuli (p = 0.036 and p = 0.045, respectively), while no significant difference was found for /g/ (p = 0.542). In NH children, P1 latency negatively correlated with age (r = −0.44, p < 0.05), indicating maturation-related shortening. Among CI users, longer implant-use duration was associated with shorter P1 latencies across all speech tokens (/m/: r = −0.37; /g/: r = −0.49; /t/: r = −0.43; p < 0.05 for all). Conclusions: Speech-evoked CAEPs provide a sensitive and objective measure of auditory cortical development in children with cochlear implants. P1 latency reflects both chronological and hearing-age-related maturation, supporting its clinical use as a biomarker for cortical plasticity and rehabilitation progress in pediatric CI care. Full article

Background/Objectives: Amblyaudia (AMB) and dichotic dysaudia (DD) are distinct subtypes of dichotic listening deficits characterized by different behavioral profiles. AMB is associated with marked interaural asymmetry, whereas DD is defined by bilaterally poor but relatively symmetric performance. The present study investigated whether these behavioral distinctions are reflected in the auditory middle latency response (MLR). Specifically, we examined whether children with AMB exhibit asymmetric MLR patterns and whether children with DD demonstrate more symmetric responses, relative to typically performing (TYP) peers. Methods: Thirty-seven children aged 9–12 years with normal peripheral hearing were recruited through clinical referrals and community outreach. Participants were classified as AMB, DD, or TYP based on performance on standardized dichotic listening measures. MLRs were recorded in response to monaural click stimulation delivered to each ear at both slow and fast presentation rates. Peak-to-peak Na–Pa amplitude and latency were analyzed to assess ear- and electrode-related effects across groups. Results: Children with AMB showed significant ear effects, with larger Na–Pa amplitudes elicited by left-ear stimulation, particularly at electrode C4, consistent with their behavioral asymmetry. In contrast, the DD group exhibited minimal amplitude asymmetry but showed prolonged Na–Pa latencies for right-ear stimulation at faster presentation rates. TYP children demonstrated small, expected asymmetries without significant latency delays. No reliable electrode effects were observed across groups. Conclusions: The MLR differentiated between subtypes of dichotic listening deficits in ways that paralleled behavioral performance, with amplitude asymmetry characterizing AMB and rate-dependent latency differences observed in DD. These findings suggest that the MLR may provide complementary, objective information relevant to the characterization of distinct dichotic listening profiles in children. Full article

Background: Although significant progress has been made in Neonatal Hearing Screening (NHS) over the past two decades, the available data on Universal Neonatal Hearing Screening (UNHS) practices across Asia remain limited. The aim of this scoping review was therefore twofold: (a) to identify and synthesize the most recent literature (within the past 20 years) concerning NHS/UNHS programs in Asian states, and (b) to summarize evidence on screening procedures, the intervention strategies, and the estimated prevalence of congenital hearing loss (HL), with particular attention to cases of bilateral impairment. Methods: In line with previous reports from our group on the screening practices in Europe and in Africa, queries were conducted via the PubMed, Scopus and Google Scholar databases for the time window of 2005–2025. The Mesh terms used were “Otoacoustic Emissions (OAE)”, “Universal Neonatal Hearing Screening”, “congenital hearing loss”, “well babies” and “ASIA”, as well as all 50 Asian state names. Only research articles and review papers were considered as good candidates. The standard English language filter was used. Results: To maintain homogeneity in terms of state area and population, the studies conducted in China and India were excluded from this report and will be the focus of a dedicated paper. Data from 31 papers were considered, reflecting the neonatal hearing practices of 17 Asian states, of which in 12, UNHS programs are considered mandatory. Conclusions: The information on the Asian NHS is limited to a low percentage of Asian states. The available data strongly suggest that audiologists and other hearing professionals, involved in regional or national screening initiatives, should collect systematically and disseminate the screening information through peer-reviewed scientific publications. The latter will contribute to a broader understanding of program effectiveness and will facilitate international benchmarking. Full article

Background/Objectives: Multidisciplinary care is the gold-standard approach for delivering comprehensive pediatric healthcare. For children undergoing cochlear implant (CI) evaluation, multiple appointments are required to assess candidacy, set realistic expectations, and counsel families on rehabilitation and the psychosocial impact of hearing loss. Established pediatric CI users also need coordinated follow-up to address ongoing auditory, educational, and psychosocial needs. This study evaluated the satisfaction and family perspectives of the implementation of a virtual, team-based multidisciplinary model for both CI candidates and established CI users. Methods: Thirty-nine children and their families participated in discipline-specific telehealth consultations, including audiology, listening and spoken language (LSL) therapy, psychology, and educational services, followed by a 60 min multidisciplinary team meeting. Team meetings occurred during pre-implantation and at six months post-activation for CI candidates. Team meetings for established CI users were scheduled following completion of individual consultations. Providers summarized findings from their individual visits before transitioning to a caregiver-led discussion. Post-visit surveys assessed satisfaction and perceived benefit from the multidisciplinary model. Results: Thirty-nine dyads were enrolled (11 Pre-CI; 28 Established CI). Caregivers were predominantly mothers (89.7%), most identified as Hispanic (55.3%) and White (71.1%). Over half of children identified as Hispanic (59%) and White (71.8%); most were diagnosed with hearing loss at birth (55.9%). Satisfaction with the virtual model was uniformly high: 100% of caregivers were satisfied or very satisfied, and most rated care quality as “very good” or “excellent.” LSL therapy was most frequently rated as the most beneficial visit (70% Pre-CI; 45% Established CI). Caregivers strongly preferred ongoing team-based care, with 55–80% reporting that they would like it to occur every six months and 95–100% preferring remote meetings. Conclusions: A virtual multidisciplinary model offers a high-quality, family-centered approach for both CI evaluations and ongoing management of established CI users. By integrating simultaneous team-based sessions, this model not only supports the ‘whole child’ but also strengthens the family system by improving communication, streamlining care, and reducing the burden of multiple in-person appointments. Families consistently report high levels of satisfaction with the convenience, clarity, and collaboration provided through virtual team visits. Incorporating routine check-ins with families is essential to ensure their needs are addressed, reinforce progress, and guide timely, targeted interventions that maximize each child’s developmental outcomes. Full article

Background: Congenital hearing loss affects 1–3 per 1000 newborns and requires early detection to prevent developmental delays. Although Thailand implements universal screening, fragmented data systems limit effectiveness. To address this, Chiangrai Prachanukroh Hospital introduced a dedicated newborn hearing screening (NHS) database in 2023 to improve tracking, coordination, and monitoring in a resource-limited setting. Objectives: To evaluate the advantages and limitations of NHS database integration on screening coverage, referral rates, follow-up completion, and diagnostic timeliness. Methods: A retrospective analytic study was conducted over 24 months, comparing outcomes before (July 2022–June 2023) and after (July 2023–June 2024) database implementation. Key indicators included screening coverage, follow-up attendance, diagnostic ABR completion, and workflow efficiency, with the study period also encompassing the implementation of the database and adaptations to the screening algorithm. Data were analyzed using the chi-square test and fisher’s exact tests, supplemented by qualitative observations of system performance. Results: Among 8290 newborns, screening coverage before one month increased from 83.47% to 96.64% (p < 0.001), while referral rates decreased from 18.44% to 6.47% (p < 0.001). Diagnostic ABR completion improved from 7.41% to 52.63% within three months (p < 0.001) and from 59.26% to 84.21% within six months (p = 0.06). The database improved workflow coordination, but challenges persisted, including incomplete data, limited interoperability, caregiver-related follow-up barriers, and low hearing-aid uptake. Conclusions: Integration of the NHS database, as well as protocol changes, improved screening coverage, referral accuracy, and diagnostic timeliness, but follow-up and early intervention barriers persisted. Continued progress will require stronger interoperability, improved family engagement, and digital infrastructure investment, with tele-audiology and decision-support tools helping expand access and efficiency. Full article

Background/Objectives: Conventional curettage adenoidectomy is widely performed but may leave residual tissue in anatomically hidden nasopharyngeal areas. We evaluated the impact of age and revision status on residual adenoidal tissue after conventional adenoidectomy and assessed outcomes following endoscopic completion. Methods: A prospective cohort study included 178 patients undergoing conventional adenoidectomy followed by intraoperative nasal endoscopy. Residual tissue in the nasopharyngeal roof, Fossa of Rosenmüller, and around the Eustachian tube was resected using a microdebrider. Patients were categorized into four groups based on age (<9 or ≥9 years) and surgical history (primary vs. revision). Pediatric Sleep Questionnaire (PSQ) or STOP-BANG scores were collected pre- and postoperatively. Receiver operating characteristic (ROC) and logistic regression analyses were used to identify predictors of residual tissue. Results: Residual adenoid tissue was detected in 61.8% of patients after conventional adenoidectomy, highest among those ≥9 years undergoing revision (36.4%). Age ≥ 7.5 years and revision status predicted residual tissue (AUC = 0.71). Significant postoperative symptom improvement was observed (PSQ and STOP-BANG, p < 0.001). Complication rates were low (13.5%), with no recurrences reported. Conclusions: Conventional curettage often leaves residual adenoidal tissue in older and revision cases. Endoscopic completion improves outcomes. Primary endoscopic adenoidectomy is recommended for patients aged ≥7.5 years and those undergoing revision procedures. Full article

Objective: Children with cleft lip and/or palate (CLP) commonly present with otitis media with effusion (OME), with increased referrals for newborn hearing screening (NHS). Auditory brainstem response (ABR) testing with OME may mimic sensorineural hearing loss. This study evaluated NHS and ABR findings on and optimal timing for ABR reassessment after tympanostomy in patients with CLP. Methods: We conducted a retrospective study reviewing 271 CLP cases at our institution. The data included the cleft type, NHS results, ABR findings, OME incidence, and tympanostomy rate. Subgroup analyses compared ABR results before and after tympanostomy and via postoperative timing. Statistical comparisons were performed using the Mann–Whitney U test and Fisher’s exact test. Results: The NHS referral rate was 14.0%, and the OME incidence was 48.7%. These cases occurred in patients with cleft palate involvement, with an OME prevalence of 73.4%. Tympanostomy was performed in 72.6% of cases. Among 36 ears tested pre- and post-tympanostomy, wave V thresholds improved from 61.67 ± 16.08 to 34.72 ± 6.54 dBnHL (p < 0.0001), and wave I latency decreased from 2.27 ± 0.36 to 1.76 ± 0.12 ms (p < 0.0001). Postoperative wave V thresholds were significantly better in the ≥15-day group (p = 0.037), with 65% (17/26) of ears showing thresholds <40 dBnHL compared to 25% (3/12) in the <15-day group (p = 0.035). No timing-related differences were found regarding wave I latency. Conclusions: Tympanostomy significantly improved the ABR results in children with CLP and OME. Reassessment on or after postoperative day 15 may yield more accurate results and may help to reduce parental anxiety. Full article

Background/Objectives: Temperament is an innate personality trait, influenced by genetic, biological, and environmental factors. Hearing loss, particularly during the critical period of auditory development, can influence cognitive and temperamental development. This study aims to assess the impact of hearing loss on temperamental development in infants aged between 1 and 12 months. Methods: A cross-sectional study of a sample of 132 pediatric patients from the infant hearing screening program was conducted from June 2023 to June 2024. The infants were divided into two groups based on hearing status and the presence of risk factors; cognitive and temperamental parameters were assessed using the QUIT questionnaire. Results: No significant differences were found between infants with and without hearing loss when also considering the infants without risk factors. Normal temperament was found in infants with and without hearing loss, considering both risk and non-risk factors. Finally, no relationship between hearing loss degree and temperament type, considering both the absence and presence of risk factors, was observed. Conclusions: In the early months of an infant’s life, hearing loss does not appear to significantly affect temperamental development. Only through the monitoring of these hearing-impaired infants to detect more severe hearing loss and/or in the presence of other risk factors can deviant development be hypothesized. In this regard, multidisciplinary evaluations may be crucial for the early detection and correction of dysfunctional behaviors. Full article

Background/Objective: Adequate serum vitamin D levels are essential for overall health, particularly in preventing oropharyngeal infections. This study aims to explore the relationship between serum vitamin D (25(OH)D3) levels and the prevalence of oropharyngeal diseases—specifically rhinosinusitis, otitis media, and nasopharyngitis—in patients at a private specialist medical clinic. Materials and Methods: The study involved 311 patients with an average age of 15.96 ± 15.06 years. Statistical analyses, including Student’s t-test and chi-square test, were conducted to evaluate the significance of the findings. Results: Nasopharyngitis was highly prevalent, affecting 83.27% of participants, with higher recurrence rates in those with lower vitamin D levels (p = 0.001). Otitis media was present in 53.37% of cases, while rhinosinusitis was less common and more frequently associated with higher vitamin D levels. Patients with behavioral disorders had significantly higher mean vitamin D levels (34.82 ng/mL ± 11.85) compared to those without (28.49 ng/mL ± 14.37) (p = 0.001). Conclusions: A subgroup of children with neutropenia (ANC < 1500/μL) exhibited significantly lower vitamin D levels and higher infection recurrence rates, underscoring their heightened vulnerability. This study highlights the importance of maintaining optimal vitamin D levels for pediatric health and suggests that higher vitamin D levels may reduce the risk of oropharyngeal infections. Full article