PubMed Health⌕ Search

Biomedical subjects

H Fortnum

Publications and source records attributed to H Fortnum.

10 recordsLinked to original sources
PubMed1999

Variations in genetic assessment and recurrence risks quoted for childhood deafness: a survey of clinical geneticists.

We report here the results of a questionnaire survey of consultant clinical geneticists in the United Kingdom to which we had an 81% response rate. In this questionnaire we asked about: (1) the nature of services currently offered to families with hearing impaired children, (2) what recurrence risks they quoted in isolated non-syndromic cases, and (3) what they might suggest for improving the range of genetic services available at present. We noted great variation both in these services and in the recurrence risks quoted in isolated cases. Based on the results of the questionnaire, we have proposed a protocol for the investigation of permanent childhood hearing impairment, which we believe to be both comprehensive and practical in an outpatient clinic setting. It is only by improving existing clinical and social understanding and knowledge of childhood hearing impairment that it will become possible to use recent molecular advances to develop comprehensive and consistent services for these families.

Child↗
PubMed1997

Epidemiology of permanent childhood hearing impairment in Trent Region, 1985-1993.

This retrospective study of permanent childhood hearing impairment (PCHI) > or = 40 dB HL in children born between 1985 and 1993 and resident in Trent Health Region, achieved an ascertainment of 92.9% of that expected from previous studies and 100% for the subset of children born between 1985 and 1990. The prevalence rate of all permanent hearing impairment > or = 40 dB HL for the birth cohort 1985-90 is 133 (95% confidence interval, (ci) 122-145) per 100,000 live births (1 in 750). Sixteen per cent of PCHI were postnatally acquired, late-onset or progressive impairments. Excluding these, the prevalence rate for congenital impairments is 112 (ci 101-123) per 100,000 (1 in 900). The rate for profound impairments > or = 95 dB HL is 24 (ci 20-30) per 100,000 live births (1 in 4150). Prevalence was increased sixfold for children with a history of neonatal intensive care and 14-fold for children with a family history, compared with children with no risk factors. A more than two-fold increase in prevalence was seen in Asian children. For the congenitally-impaired children born between 1985 and 1990, 29% had a stay in neonatal intensive care > or = 48 hours, 30% had a family history of permanent childhood hearing impairment, and 12% had a cranio-facial abnormality (CFA). Over 59% were potentially detectable by a targeted neonatal screening programme using these three high-risk factors. For 1985-1993, the overall yield of the targeted neonatal screening programmes available in three of the 11 health districts was 15% but increased over time. The overall yield from the Health Visitor distraction test was 30% but lower in districts with neonatal screening programmes. Only 59% of children had a stated aetiology, classified by time of onset into genetic, including syndromes and CFA (41%), pre- or peri-natal (10%), post-natally acquired (6%), and uncertain onset (2%). Just under 40% of the children were said to have another clinical or developmental problem, about half of whom had at least two additional problems. The median age at referral, confirmation of the impairment, prescription of the hearing aid and fitting of the hearing aid were, respectively, 10.4 months, 18.1 months, 24.4 months and 26.3 months. A more severe impairment was associated with earlier age. Small improvements in the median age of hearing aid prescription and fitting were seen over time. Twenty-five per cent of children were referred for genetic counselling, the proportion increasing systematically with the severity of the impairment. Based on evidence of the yield from hearing screens we suggest a wider implementation of neonatal screening and further consideration of the role of the health visitor distraction test in the identification of children with PCHI. To facilitate further assessment of services for hearing-impaired children we suggest implementation of a co-ordinated shared list of children with permanent hearing impairment on a region-wide basis to provide adequate numbers for comparison over time, and the routine collection of a minimum set of data for each child.

Age Distribution↗
PubMed1995

Children who could benefit from a cochlear implant: a European estimate of projected numbers, cost and relevant characteristics.

The incidence of profound hearing impairment by the age of 5, derived from a number of retrospective studies in the UK (population about 58 million; birth rate 14/1000), is estimated to be about 300 per annual birth cohort in the 1990s. This estimate includes 80 children who might be expected to acquire deafness in those first 5 years. Projected to Europe as a whole (population 511 million; birth rate 12/1000) this would mean a population who should be considered as potential cochlear implant patients of some 2268 children, given a variety of assumptions. At a take-up rate of 25% for both congenital and acquired cases of profound hearing impairment this would imply a European-wide expenditure of the order of 17 pounds m/p.a. on hardware and associated rehabilitation programmes. The need for such programmes is explored, in the context of strategies of early identification of hearing impairments.

Child↗
PubMed1993

Reliability of notification data for childhood bacterial meningitis.

This study reports the notification rates over ten years (1980-1989) for 232 children with documented bacterial meningitis in Nottingham District Health Authority. The average notification rate was approximately 50 per cent of known cases. It was higher for meningococcal infections (57/84, 68 per cent) than for any other type (45/148, 30 per cent), and lower in neonates (1/29, 3 per cent) than in any other age group (101/203, 50 per cent). The results show that the notification rates required to be adjusted during the decade of the study (1980-1989). The achievement of better notification rates may now be more feasible since implementation of the recommendations of the Committee of Inquiry into the Future Development of the Public Health Function for the control of communicable diseases. This paper provides a baseline upon which to measure the impact of such changes.

Adolescent↗
PubMed1993

The feasibility of evoked otoacoustic emissions as an in-patient hearing check after meningitis.

The desirability of finding children with hearing impairment after bacterial meningitis as soon as possible prompted us to examine the feasibility of using evoked otoacoustic emissions (EOAE) as an in-patient check of hearing status in children recovering from bacterial meningitis. Sixty-six episodes of bacterial meningitis were studied. Traces could be recorded for only 54.7% of ears. All children subsequently found to have sensorineural hearing impairment who were tested with EOAE, failed the screening test. The low coverage of the screening test and the predicted low specificity due to the high incidence of conductive hearing impairments, lead us to conclude that, with the technology currently available, the measurement of EOAE after bacterial meningitis is not a practical method for a pre-discharge check of hearing. Every effort must still be made to ensure all children are referred for an appropriate auditory assessment.

Adolescent↗
PubMed1993

Hearing impairment in children after bacterial meningitis: incidence and resource implications.

A retrospective review over ten years of childhood cases of bacterial meningitis treated in two hospitals in Nottingham revealed 301 cases: 88.4% of these children survived. The audiological and clinical hospital records of the survivors were examined to see if the children had been assessed for hearing impairment following the illness. Results indicate that 202/261 (77.4%) of the survivors remaining in the local area had had a formal hearing assessment. Fifteen of these children (7.4% of those assessed) suffered some degree of sensorineural or mixed hearing loss as a direct consequence of meningitis. The impairments ranged from mild unilateral to profound bilateral and the affected children were aged between 0 (i.e. infection at birth) to 15 years. The data indicate that bacterial meningitis of any type can result in sensorineural hearing impairment of any degree in a child of any age. A significantly increased risk of hearing impairment was found for children aged less than one month or over 5 years, for children with associated hydrocephalus, for children admitted between October and March, for those in hospital longer than 16 days and for those with a cerebro-spinal fluid glucose concentration of < or = 2.2 mmol/l. No differential increased risk was noted for different causative pathogens. Abnormal tympanograms indicative of conductive hearing impairment were measured at the first visit in 45% of children attending for hearing assessment. These conductive losses resolved in 75% of cases. These data suggest that an English health district, with a total population of 250,000, would need to provide annual resources for about 30-40 appointments for children after meningitis. Over a period of 5 years it might provide hearing aids for three children and a cochlear implant for one child. Bacterial meningitis is the single most important cause of acquired sensorineural hearing impairment in children and every attempt should be made to assess the child's hearing as soon after recovery as possible.

Acoustic Impedance Tests↗
PubMed1987

Patterns of exposure of schoolchildren to amplified music.

The amplified-music listening habits and the hearing status of 1443 comprehensive schoolchildren have been surveyed by questionnaire. In a stratified sample of them (n = 25), the levels at which they would listen to a personal cassette player (PCP) in various circumstances were measured. The main conclusion drawn was reassuring: that these children seem to be more conservative in their music-listening habits than young people are commonly given credit for. Nevertheless, music may sometimes make a small contribution to socioacusis and to the total noise dosage of those exposed to noise occupationally. Some recommendations are made for manufacturers of PCPs, and for some restrictions on the use of PCPs in occupational noise.

Adolescent↗