Visual and hearing disturbances in infancy and childhood

Chapter 3 Visual and hearing disturbances in infancy and childhood



Case 3.1



1. What is the likely diagnosis?

Acute suppurative otitis media (AOM).


2. Is a history of a recent URTI of any significance?

Yes, it often precedes the ear infection. The likely mechanism is as follows.


Infection in the upper respiratory tract causes inflammation and fluid accumulation near the opening of the auditory tube. This causes some degree of obstruction to the tube. Normally, air moves from the nasopharynx, through the auditory tube to the middle ear, where it is subsequently absorbed. If the air in the middle ear is not replaced (due to blockage), it causes a negative pressure, pulling fluid from the surrounding tissues into the middle ear and the tube, resulting in a collection of serous fluid. This creates a breeding ground for bacteria, and an acute infection results.


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

These include:[1]


a the characteristic anatomy of the auditory tube in children

b age: most common in the under 3-year old age group.

c infants who have their first episode of acute otitis media prior to the age of 6 months, are more predisposed to further infection

d history of seasonal allergies

e enlarged adenoids

f sex: it is more common in males

g abnormalities of the face or skull (eg: cleft palate)

h genetic predisposition

i the presence of gastroesophageal reflux

j higher frequency of upper respiratory tract infections, which may possibly account for the greater frequency of AOM in children who attend day care centres regularly

k exposure to cigarette smoking in the child’s environment

l bottle fed babies have a higher risk, especially when fed while they are lying supine (may be related to feeding position, in addition to the lack of maternal antibodies which would normally be present in breast fed infants)

m use of pacifiers (’dummy’s’)

n presence of Helicobacter pylori in the region may possibly have a role.

4. What are some of the possible complications if this disorder is untreated, or poorly managed?
• Fluid remaining in middle ear, causing Serous otitis media (‘glue ear’).

• Rupture of the tympanic membrane, which may heal or scar.

• Cholesteatoma formation and possible destruction of the ossicles.

• Extension of the infection into surrounding tissue (eg: labyrinthitis, meningitis, mastoiditis, brain abscess etc.).


Case 3.2



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

Trachoma, caused by Chlamydia trachomatis.


2. What should be done to diagnose this condition?

The presence of a follicular conjunctivitis in a community where trachoma is endemic, should suggest the diagnosis. A sample of secretions can be sent to a laboratory for identification of the microbial agent.


3. Why is it so common in these communities?

It spreads easily between individuals when personal and community hygiene is poor. Hot and dusty climate predisposes to the condition. Flies, in addition to unwashed hands and fomites contaminated with secretions spread the disease between individuals. Overcrowded living spaces are also a problem.


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

Trachoma is the leading cause of blindness worldwide. Although it commences as a follicular conjunctivitis, after repeated episodes there is significant scarring of the conjunctiva, distortion of the upper tarsal plate, inturning of the eyelid and consequently irritation and damage to the cornea. This causes scarring and opacification of the cornea, and eventually blindness. The time period over which these develop may be long, and require repeated episodes of infection. Corneal scarring and opacification usually occurs in older individuals, whereas the young child generally presents with the mucopurulent stage of the disease.


The World Health Organization (WHO) has a classification system for staging the progression of the disease.


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

The prevention of trachoma is described by the WHO and their partners as the SAFE protocol: Surgery, Antibiotics, Facial cleanliness, and Environmental improvement.[2]


6. Briefly describe the epidemiology of this disorder.

Refer to ‘Further Reading’ at the end of the chapter.


7. What is the aetiology of the tiny follicles?

The follicles are inflammatory in nature, comprising germinal centres composed of lymphocytes and monocytes.



Case 3.3



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

It is a characteristic sign of retinoblastoma, a tumour which is seen in infancy or early childhood. The sign is known as leukocora.


2. What questions do you want to ask your friend regarding this child?
• Did you notice any bulging of the child’s eye or a squint?

• Had the child complained of any visual problems?

• Had any of the child’s siblings had a serious eye problem?

• Was there a family history of retinoblastoma?

3. What is the physiological basis of the ‘red-eye’ effect often seen with flash photography?

It is a reflection of the retinal blood vessels.


4. What is the pathological basis of the ‘white eye’ effect in this disorder?

The tumour is usually pale in colour, and blocks the reflection from the blood vessels.


5. Would this white eye be seen without the aid of a flash? What other signs may be present?

Yes. Strabismus and/or proptosis may be present.

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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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