Forty-nine cases of psychogenic deafness in children were observed from 1998 to 1999 at our institute. The patients consisted of 8 boys and 41 girls. As is generally known, psychogenic deafness is caused by exogenous and endogenous factors. In order to investigate the endogenous factors, a psychological test was given to 29 of the 49 children. The intelligence quotient (IQ) of the children was obtained by WISC (Wechsler intelligence scale for children). The number of children with an IQ over 76 was 20. Of these 20 children,13 had learning disorders. It was thought that the endogenous factors in these deaf children were retardation of school study and poor adaptation to their living environments. As to their audiological courses, the hearing level of children with learning disorders did not improve except for one child. For these children, it is necessary for us to consider their school study and their parents' expectations of their school records.
We experienced a patient who had lost the response to ABR stimulation after weaning from mechanical ventilation. The child had been treated with mechanical ventilation from four months through one month and one year of age and had received pancuronium bromide (PB) during mechanical ventilation. Five children with severe deafness having received PB similar to the patient visited our department. All six cases were affected with tracheomalacia and were given PB consecutively for five to ten months. Our findings obtained from the six young patients suggest a strong correlation between long-term administration of pancuronium bromide and the development of deafness.
e have established an experimental audio-visual stimulator that can manage 8 kinds of stimuli as a combination of sound resource files and PICT files using a personal computer (http: //www. urchin. co. jp). In this study we tested the stimulator for use in the auto-BAEP examination to obtain the IL curve that may be helpful for the diagnosis of hearing impairment deriving from sensorineural or conductive disorder. Latencies for wave-I and wave-V were detected using the autopeak scanning software (Brain Functions Lab Inc. http: //home. ksp. or. jp/bfl). These data were entered in the spreadsheet program and a graph like the IL curve was produced using macro functions. Finally, we obtained more useful results than Argo II, although skillful computer manipulation was required. It will now be necessary to develop our system to enable easier access and availability for actual clinical use.
Eight neonates who were referred and one neonate who was passed by automated ABR were followed up for 5-12 months using ABR, behavioral observation audiometry and conditioned orientation reflex audiometry. All of thirteen ears that were referred showed abnormal ABR at the first visit. Three out of five ears that were passed showed normal ABR, but two ears had an abnormal ABR. The V-wave threshold of ABR was improved by more than 20 dB in four ears during the first 5-9 months. The children who are detected by the screening should be followed up and their parents should be given psychological support.
We experienced six cases whose audiometry has been improved during their growth. They included 2 Down's syndrome infants,2 cleft palate infants and 2 patients without any complication. We believe that there is a high incidence of hearing loss in infants with various accompanying complications, such as Down's syndrome and cleft palate. Attention should be paid to hearing loss infants with complications. Possible causes of alteration of hearing impairment may include healing of exudative otitis media, elimination of mesenchymal tissue in the middle ear, and completion of myelinization around auditory nerve axon.
Thirty mild and moderately hearing impaired children (under 70 dBHL) were evaluated and 4difficult cases are reported. The first case preferred the expensive all in-the-ear canal type (ITE) hearing aids compared to the behind-the-ear type. However, he was able to wear ITE hearing aids on both side assisted by some degree of personal contribution, and as a result, he exhibited good language development. The second case was able to change over to a hearing aid after remaking another small type of ITE, but this was tolerated for only a short time, and the development of language was not good. The third case exhibited a Trough-Shaped Curve of hearing loss, and generally did not use any ITE hearing aid. The fourth case who had refused to wear a hearing aid, was finally persuaded to wear an ITE from 14 years of age, and subsequently reported that he would have gained more confidence in communication if he had worn a hearing aid at a younger age. Early wearing of a hearing aid is important for mild and moderate hearing impaired children. Guidance for their parents and communication training of the patients are highly important measures.
Although the complication of hearing loss rarely occurs in pediatric patients with mumps infection, the prognosis of mumps deafness is poor. Early treatment for hearing loss after mumps is difficult in children aged 5 years or younger because the diagnosis is not readily established. We encountered 3 early cases of mumps deafness, which occurred at almost the same time. Steroid therapy was performed in both patients with slight improvement of the hearing disturbance in one patient, but his hearing loss progressed after one year.
We report two infants of inapparent congenital cytomegalovirus (CMV) infection accompanied by sensorineural hearing loss. In both patients, this impairment was bilateral and of significant magnitude. Patient 1. A female infant was born at 35 weeks of gestation and weighed 1516 g at birth. She was in good condition. On admission, the serum IgM level was 31 mg/dl in the laboratory examination. Virological studies revealed significantly elevated anti-CMV IgM antibody titers and CMV was isolated from the urine. Maternal serological investigation revealed positivity for anti-CMV IgM antibody. Patient 2. A male infant was born at 36 weeks of gestation and weighed 1800 g at birth. He was in good condition. Hepatosplenomegaly was noticed at 35 days after birth and anti-CMV IgM antibody was detected in the serum. CMV was isolated from the urine at 50 days after birth. Maternal serological investigation revealed negative anti-CMV IgM antibody. However, the serum of the mother was seropositive to anti-CMV IgG antibody at 32 weeks of gestation. Recently, it was reported that the maternal seropositive rate of C MV antibody had decreased significantly in Japan, which may be responsible for the high incidence of congenital cytomegalovirus infection. Therefore, we should establish a diagnostic procedure for congenital CMV infection to enable the discovery of congenital sensorineural hearing loss.