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Hearing & Visual Impairment - Coggle Diagram
Hearing & Visual Impairment
Hearing
should be assessed in any child with delayed SAL, learning difficulties or behavioural problems
sensorineural
uncommon
1 in 1000
usually presents @ birth or develops in 1st few months of life
irreversible
can be of any severity
Hearing aid use
cochlear implants when hearing aids give insufficient amplification
causes
usually genetic
congenital infection
preterm
HIE
hyperbilirubinaemia
meningitis/encephalitis
head injury
drugs
neurodegenerative disorders
conductive
due to middle ear disease
OM with effusion (glue ear)
ET dysfunction
wax
usually mild, moderate or transient
more common than SN
risk factors = Down's, cleft palate, atopy, Pierre Robin sequence (glossoptosis, micrognathia, cleft palate), mid facial hypoplasia
tx = conservative, antibiotics, amplification or surgery (grommets or adenoid removal)
impedance audiometry tests measure pressure in middle ear + TM compliance
severity
mild: 20-39 dB HL
moderate: 40-69 dB HL
severe: 70-94 dB HL
profound: >95 dB HL
Vision
Presentation
loss of red reflex (cataract)
white reflex
Rb
cataract
ROP
not smiling responsively by 6wks
lack of eye contact
visual inattention
random eye movements
nystagmus
squint
photophobia
Strabismus (squint)
misalignment of visual axes
often intermittent
often family hx
transient up to 3mo common, >3mo old should have ophthalmic review
causes: refractive errors, cataracts, Rb
types
concomitant (non-paralytic)
common
usually due to refractive error
paralytic
rare
paralysis of motor Ns
can be due to SOL e.g. brain tumour
do corneal light reflex test + cover test (squinting eye moves up to take up fixation)
Causes of visual impairment
genetic
cataract
albinism
retinal dystrophy
Rb
antenatal / perinatal
congenital infection
ROP
HIE
cerebral abnormality/damage
optic N hypoplasia
postnatal
trauma
infection
JIA
refractive errors
hypermetropia
most common error in young children
correct early to avoid amblyopia
myopia
uncommon in young children
less likely to cause amblyopia
astigmatism
amblyopia
potentially permanent loss of VA
affects 2-3%
causes by refractive errors, squint, visual deprivation
patch good eye
tx before 7y/o
Severe visual impairment
often due to extreme prematurity
in developed countries cause usually genetic
in developing countries cause usually acquired (e.g. infection)
tx: low vision aids (magnifier, telescope), Braille