Spring 08 Week 2

A woman from the local group home came in for a hearing evaluation. The caregiver reported that the client had bilateral perforated tympanic membranes (TM), due to ear infections as a child, and a longstanding history of significant hearing loss. However, she can verbalize some words but chooses to do so with her mother only. A previous surgical attempt to repair the right TM was reportedly made but was unsuccessful. The caregiver also stated that she had a recent ear infection that was being treated with antibiotics. She has a history of mental retardation and seizure disorder.

Otoscopy revealed a perforated left TM. A potentially infected green substance was observed in both auditory canals. Immittance testing revealed flat, Type B, tympanograms bilaterally. The volume of the right ear was normal at 1.92 mL while the left ear was large at 2.76 mL. Visual reinforcement audiometry (VRA), using insert earphones, revealed fairly consistent behavioral responses to narrow band noise in the moderate to severe hearing loss range at 1000 and 2000 Hz. Additional testing could not be tested due to client noncompliance. Speech awareness thresholds were found for the right ear at 70 dB HL and for the left ear at 60 dB HL. Speech recognition thresholds could not be obtained. Otoacoustic emissions were not attempted due to abnormal Type B tympanograms bilaterally. Although specific thresholds could not be obtained, behavioral results revealed a bilateral moderate to severe hearing loss in the mid frequency range. Communication strategies were discussed with the caregiver.

I found an article that discussed the prevalence of viruses and bacteria after PE tubes were placed. In this instance, the patient had subsequent perforated tympanic membranes which allows more bacteria to build. In the study, at least 1 respiratory tract pathogen was noted in 76 children (96%). Bacteria were found in 73 cases (92%), and viruses were found in 55 (70%). In 52 patients (66%), both bacteria and viruses were found. Bacteria typical of AOM were detected in 86% of patients. Picornaviruses accounted for 60% of all viral findings.

Ruohola, A. et. al (2006) Microbiology of acute otitis media in children with tympanostomy tubes: Prevalences of bacteria and viruses. Clinical Infectious Diseases; 43.

http://web.ebscohost.com/ehost/pdf?vid=1&hid=104&sid=66bae850-ccf5-4eb8-9475-4aea16cc1f3a%40sessionmgr109