Visual and hearing disturbances in infancy and childhood

Chapter 3 Visual and hearing disturbances in infancy and childhood



Case 3.1


One of your regular patients and her 18-month-old son James present to your practice. She states that he has been irritable and fussy over the last 24 hours and woke up several times during the night. She states that her son was crying and yelling when he was put to bed last night, and wouldn’t settle. Eventually James fell sleep but continued to wake up throughout the night, crying and tugging on his left ear and at the back of his head on that side.


He had a cold about 1 week ago, but has otherwise been well. He has had the normal immunisations for his age. He has a fever of 38.9°C. Otoscopic examination is shown in Figure 3.1.


image

Figure 3.1


(Source: Mir, MA. Atlas of Clinical Diagnosis [2nd edn]. Edinburgh: Saunders; 2003: 128, Fig 5.29)




Questions



1. What is the likely diagnosis?

2. Is a history of a recent upper respiratory tract infection (URTI) of any significance?

3. What other factors predispose a child to this disorder?

4. What are some of the possible complications if this disorder is untreated, or poorly managed?


Case 3.2


While on a field trip to a remote Aboriginal community in the Northern part of Australia, as part of your clinical training, you observe that one of the children you are examining has swollen eyelids, red eyes, plus the presence of numerous tiny follicles lining erythematous eyelids. On questioning the child’s mother, you determine that about 10 days ago her daughter developed red eyes, which she rubbed incessantly. She stated that her eyes ‘stung’ and that the light hurt her eyes. The follicles developed a few days later. She wasn’t concerned about it, as ‘lots of folk around here have the same problem’. One of her eyes is shown in Figure 3.2.


image

Figure 3.2


(Source: Mir, MA. Atlas of Clinical Diagnosis [2nd edn]. Edinburgh: Saunders; 2003: 95, Fig 3.31)




Questions



1. What is your differential diagnosis? What is the likely causative agent?

2. What should be done to diagnose this condition?

3. Why is it so common in these communities?

4. What are the possible consequences if this disorder is untreated?

5. What are some of the basic preventative measures which can limit the spread of this infection?

6. Briefly describe the epidemiology of this disorder.

7. What is the aetiology of the tiny follicles?


Case 3.3


A friend is showing you some photos taken recently on a vacation. In one of the photographs, taken at night with a flash, you observe something quite unusual. Although most subjects in the photo demonstrated the typical ‘red-eye’ appearance that is so common when using a flash, a young child in the photo has one eye that appears white, rather than red. You are immediately concerned.




Questions



1. Why are you so concerned? What could this appearance mean?

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Dec 26, 2016 | Posted by in MANUAL THERAPIST | Comments Off on Visual and hearing disturbances in infancy and childhood

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