ROLE OF ENT IN PERINATAL PERIODDr Sheelu Srinivas

Consultant ENT Surgeon

Fortis Hospitals

Bannerghetta Road

Newborn Hearing Screening Programme

OTOLARYNGOLOGIC MANIFESTATIONS OF PREGNANCY

OTOLARYNGOLOGIC MANIFESTATIONS OF PREGNANCY

Metabolic and physiologic changes during pregnancy

– Hearing & Balance

– – Bell's palsy

– – Nasal symptoms

– – Oral manifestations

– – Aero digestive tract

– – Thyroid

– – Dermatologic manifestations

Rhinitis During Pregnancy:

Other underlying conditions– Allergic rhinitis– Rhinitis medicamentosa– Bacterial rhinosinusitis– Vasomotor rhinitis– Nasal polyps– Deviated septum

RHINITIS RX

• AVOID TOPICAL DECONGESTANTS & SPRAY

• SALINE NASAL SPRAY

• Environmental control

• Antihistamines: chlorpheniramine (cat. B)

• Loratidine and cetirizine (cat. B)• Only after 1st trimester

• Intranasal corticosteroids

Gastro esophageal Reflux

• Reflux • 50-75% of gravid women• Heartburn, sore throat, hoarseness• Third trimester– Increased abdominal pressure– Decreased gastric emptying– Increased intestinal transit time?– Decreased LES pressure

Gastro esophageal Reflux

• Antireflux precautions, frequent small meals

• Antacids, Sucralfate

– • H2 Blockers:– Cimetidine. Ranitidine - OK

– • Proton pump inhibitors - after 1st trimester–

Why newborn hearing screening?• Two to four newborns, out of

every 1,000, have hearing deficiency

• among the high-risk babies, the number of hearing-impaired is 5 to 14 per cent.

• High-riskers include those

birth weight was

less than 1.5 kg;

jaundice,

meningitis or birth asphyxia;

ventilation after birth;

family history of hearing loss

It is estimated to be 30 times more common than other congenital defects, such as sickle cell anemia, cystic fibrosis, hypothyroidism, etc.

• Deafness is one of the commonest congenital disabilities in the world.

Do we need a test?

• Initially, babies who are born with hearing loss do not look or behave any differently from babies who are hearing.

• However, undetected and untreated hearing loss has serious consequences on the acquisition of language skills as well as cognition and emotional and social development.

• The first 6 months of a baby’s life are very crucial for the development of speech and language.

When?

• The hearing screen is usually done before you leave the maternity unit.

What does it involve?

• A soft tip ear piece is placed in outer part of babies ear.

• It sends clicking sounds down the ear

• When an ear receives sound –cochlea responds with echo

• Screening equipment picks up this response

Results

• Given immediately

• Either Pass/Refer

• Even though child passes if he is a high risker further assessment done

• Up to 3 years ,every 6 months

What if no response ?

• Second test in a week

• Causes- baby unsettled, background noises, ear fluid

Second test

• Similar to first

• ABR/BERA

Do tests hurt?

• No

• Soft tips/soft head phones

• Keep child comfortable

• Feed before test

• Carry things to make comfortable

Is this universally available

Not in India

In most of the States in the U.S./UK/Europe, for instance, the neo-natal hearing testing is compulsory by law and the protocol is called `1-3-6' (meaning, all babies should have their hearing screened by the first month; diagnosed by the third month and be receiving hearing aids by six months.)

Is the test compulsory?

• Definitely for high risk baby

• who may have passed the hearing screening should, nonetheless, receive audiologic monitoring every 6 months until age 3 years

THANK YOU