Jolanta Jadczyszyn, Karolina Raczkowska-Łabuda, Małgorzata Dębska-Rutkowska, *Lidia Zawadzka-Głos
Sudden bilateral deep hearing loss in a child – case study
Nagły obustronny niedosłuch w stopniu głębokim u dziecka – studium przypadku
Department of Pediatric Otolaryngology, Medical University of Warsaw, Poland
Head of Department: Associate Professor Lidia Zawadzka-Głos, MD, PhD
Wstęp. Nagły obustronny niedosłuch u dziecka w stopniu głębokim jest bardzo rzadko spotykany. Szacuje się, że może występować w około 2% przypadków niedosłuchu u dzieci. Przyczyną nagłego obustronnego niedosłuchu może być ostry uraz akustyczny, zaburzenia unaczynienia ucha wewnętrznego, nagła infekcja wirusowa lub bakteryjna czy urazy ucha wewnętrznego. Hałas jest obecnie ważnym czynnikiem uszkodzenia słuchu. Grupami szczególnie narażonym na uszkodzenie zdrowia w wyniku hałasu są dzieci i młodzi dorośli. Skutkiem hałasu są różnego stopnia zaburzenia słuchu oraz coraz częściej rozpoznawane efekty pozasłuchowe w postaci uczucia niepokoju, drażliwości, zaburzeń zdolności poznawczych, obniżonej sprawności intelektualnej, utrudnionego zasypiania, zaburzeń w układzie krążenia, zaburzeń hormonalnych czy zmiany zachowań społecznych.
Opis przypadku. Zaprezentowany został przypadek 9-letniej dziewczynki, u której wystąpił nagły obustronny niedosłuch. Czynnikiem uszkadzającym słuch był głośny dźwięk dzwonka szkolnego podczas przerwy lekcyjnej. Po 6 tygodniach od wystąpienia epizodu nagłego lewostronnego niedosłuchu, dołączył się niedosłuch po stronie prawej o nieznanej etiologii. Przy przyjęciu stan ogólny dziewczynki był dobry, nie obserwowano zawrotów głowy i zaburzeń równowagi. W badaniu audiometrii tonalnej stwierdzono obustronny niedosłuch mieszany w stopniu głębokim. Leczenie w szpitalu obejmowało wykonanie zabiegu operacyjnego w postaci obustronnej tympanotomii eksploratywnej ucha środkowego z tympanocentezą przednią i obustronnym drenażem wentylacyjnym oraz leczenie zachowawcze: deksametazon, wipocentyna, piracetam, witaminy z grupy B, ksylometazolinę oraz hiperbarię tlenową. Hospitalizacja trwała 14 dni. Uzyskano całkowitą poprawę słuchu.
Wnioski. Nagły obustronny niedosłuch u dziecka w stopniu głębokim może być spowodowany ostrym urazem akustycznym. Badania wykazują, że hałas stanowi ważny czynnik uciążliwy w środowisku szkolnym i może być czynnikiem szkodliwym. Poziomy hałasu rzędu 80-85dB mierzone w korytarzach podczas przerw szkolnych i w salach gimnastycznych mogą powodować ryzyko uszkodzenia słuchu. Następstwa urazu spowodowane hałasem u dzieci są bardzo trudne do przewid
Introduction. Sudden bilateral deep hearing loss is very rare in children. Its estimated prevalence is 2% among children with hearing loss. The causes include acute acoustic trauma, vascular disorders of the inner ear, sudden viral or bacterial infection, and trauma of the inner ear. Noise is currently an important risk factor for hearing impairment. Groups that are particularly vulnerable to noise damage include children and young adults. The effects of noise include hearing impairment of different degree and the more and more commonly diagnosed extra auditory effects of noise in the form of anxiety, irritability, cognitive impairment, reduced intellectual ability, difficulty in falling asleep, circulatory disorders, hormonal disorders, and changes in social behavior.
Case report. We present a case of a 9-year-old girl who experienced sudden bilateral deep hearing loss of the left ear, which was caused by a school bell during a school break. Six weeks after the sudden hearing loss in the left ear, hearing loss in the right ear of the unknown etiology appeared. The girl was in good general condition, no vertigo and balance impairment were observed. In the tonal audiometry, bilateral deep mixed hearing loss was observed. The treatment in the hospital included surgery in the form of bilateral explorative tympanotomy of the middle ear with anterior tympanocentesis and tube insertion, as well as conservative treatment: dexamethasone, vipocentin, piracetam, B vitamins, xylometazoline, and hyperbaric oxygen therapy. Hospitalization lasted 14 days. A complete recovery of hearing was achieved.
Conclusion. Sudden bilateral deep hearing loss in children can be caused by an acute acoustic trauma. Studies show that noise is an important disturbing factor in the school environment and may be harmful. Noise levels of ca. 80-85 dB measured in corridors during school breaks and in sports halls may pose a risk of hearing impairment. The consequences of trauma caused by noise in children are very difficult to predict. It is important to recognize the problem early, as well as to introduce a proper diagnostic process and implement the treatment quickly, wh
Sudden bilateral deep hearing loss rarely occurs in children. It is estimated that it occurs in about 2% of cases of hearing impairment (1). The etiology of the sudden bilateral hearing loss is still not fully understood. The probable factors include vascular disorders of the inner ear, infections – mostly viral, trauma of the temporal bone, and, occurring more and more often, acoustic trauma (2). Noise is one of the most oppressive harmful environmental factors, and with the civilizational progress, noise exposure has been increasing. Excessive exposure may lead to health hazards (3).
Hearing impairment may be caused by a single exposure to noise or by a long-term exposure (4). Acute acoustic trauma is caused by a noise of a very high sound pressure level that usually exceeds the threshold of pain (120-140 dB). The effect of such stimulus is a sudden (temporary or permanent) sensorineural hearing impairment, often unilateral, sometimes accompanied by tinnitus. If the structures of outer and middle ear are simultaneously affected, the hearing impairment may have a mixed character (4).
The following types of noise causing acoustic trauma can be enumerated: pure tone sound, street and industrial noise, shooting noise, and explosion (5).
The degree of hearing loss depends on the intensity of the noise, the duration of exposure on a given day, as well as lifetime exposure, the frequency of the sound, the type of the noise (intermittent, continuous, pulse), age and sex of the patient, as well as individual ear sensitivity, which is difficult to define and is probably affected by some innate features of the middle and inner ear, determining, among others, the efficacy of sound conduction, as well as the blood supply and oxygenation of the cochlea (5, 6).
The most common type of the hearing loss is the sudden unilateral sensineural hearing loss in the high frequencies with accompanying tinnitus.
Children and adolescents are considered to be particularly vulnerable to noise-induced hearing loss (4).
The risk of sudden hearing loss in children is increased by, among others, available toys (whistles, trumpets, music toys, toy guns – ca. 100-135 dB) and fireworks explosions (ca. 145-160 dB) (7). However, the biggest threat is posed by discos (92-111 dB), rock music concerts (ca. 90 dB), listening to music (ca. 86 dB), motorsports (ca. 80 dB), and shooting sports (ca. 170 dB) (8, 9).
A nine-year-old girl was admitted on an emergency basis to the Department of Pediatric Laryngology of the Medical University of Warsaw because of bilateral mixed hearing loss. Approximately 6 weeks before the admission, the patient experienced an acoustic trauma in her school due to school bell ringing during school break. Since that time, she had experienced hearing impairment in her left ear, however, she had not told her parents about it. Therefore, she had not been examined by a pediatrician or a laryngologist, nor had she been referred to a hospital or received any treatment. It was only the occurrence of bilateral hearing impairment that prompted the girl’s parents to consult a laryngologist and to report to the hospital. The day before the admission, a minor viral infection of the upper respiratory tract occurred, accompanied by sudden hearing loss in the right ear. On admission in the emergency room, no findings in the general physical examination were observed – lymph nodes were not enlarged, normal vesicular sound was heard over the lungs, no arrhythmias were detected, abdominal organs were not enlarged, meningeal signs were negative. On admission to the Department of Pediatric Laryngology, the general condition of the patient was good. She did not report tinnitus or vertigo. Medical history collected from the mother included hearing loss since the day before – the girl had not been responding to commands and had been asking to repeat phrases. In the otoscopy, tympanic membranes were gray, pale, without signs of perforation, slightly drawn in the direction of the tympanic cavity, with a trace of exudate in the left tympanic cavity, without signs of acute inflammation in any of the ears. In the endoscopic examination, a minor adenoid hypertrophy was identified nasopharyngeal lumen was wide, pharyngeal openings of the auditory tubes were slightly swollen. In the hearing test: Weber was lateralized to the left ear, and in the Rinne test, the duration of air conduction was shorter than the bone conduction (Rinne negative). On tonal audiometry performed on an outpatient basis on admission, a bilateral mixed deep hearing impairment was detected (fig. 1). In the laboratory tests, no raised inflammatory markers were observed tab. 1. Due to the medical history and abnormal hearing examination, the girl was qualified for surgery on an emergency basis. In general anesthesia, explorative tympanotomy was performed and a normal ossicular chain was found, without damage to the joints and ossicles, no perilymph fistula of the inner ear was found. On the right side, the tympanic membrane was pulled into the epitympanum and overlayed the ossicular chain. On the left side. a trace amount of exudate was observed in the tympanic cavity, and the pathological secretion was removed. On both sides, 2 mg of Dexaven were administered into the tympanic cavity. Subsequently, bilateral tympanocentesis with tube insertion was performed. Conservative treatment included dexamethasone, vipocentin, piracetam, B vitamins, and xylometazoline. Due to the bilateral deep hearing loss and no signs of otitis media, it was decided to implement hyperbaric oxygen therapy. The hospitalization lasted 14 days. During the hospital stay, the patient felt well, no adverse effects of medication nor of the hyperbaric oxygen therapy were observed. The control tonal audiometry was performed after one day of treatment (fig. 2), and after 10 days of treatment (fig. 3), with satisfactory results.
Fig. 1. Audiometry performed on the admission day
Fig. 2. Audiometry performed in the first day of treatment
Fig. 3. Audiometry performed in the 10th day of treatment
Tab. 1. Laboratory findings on admission
|WBC||9.57 thousands/mL||4.0-12.0 thousands/mL|
|RBC||4.29 mln/mL||4.5-5.5 mln/mL|
|HGB||12.2 g/dL||12-15.5 g/dL|
|PLT ||266 thousands/mL|| 150-400 thousands/mL|
|CRP||< 0.5 mg/dL||0-1 mg/dL|
|total calcium||10.2mg/dL||8.9-10.1 mg/dL|
|natrium||142 mmol/L||132-145 mmol/L|
|kalium||3.7 mmol/L||3.5-5.1 mmol/L|
|phosphorus||4.8 mg/dL||3.7-5.6 mg/dL|
|magnesium||2.0 mg/dL||1.6-2.3 mg/dL|
|APTT||26.67 s.||28-40 s.|
|fibrinogen||2.53 g/L||1.8-3.5 g/L|
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