Biomedical subjects

Judith E Cho Lieu

Publications and source records attributed to Judith E Cho Lieu.

6 recordsLinked to original sources

PubMed2006

Initial audiologic assessment of infants referred from well baby, special care, and neonatal intensive care unit nurseries.

PURPOSE: The purpose of the study was to evaluate the effectiveness of a 2-hr initial audiologic assessment appointment for infants referred from area universal newborn hearing screening (UNHS) programs to a clinical audiology department in an urban hospital. METHOD: A prospective auditory brainstem response (ABR)-based protocol, including clicks, frequency-specific tone bursts, and bone-conducted stimuli, was administered by 10 audiologists to 375 infants. Depending on the ABR findings, additional test options included distortion product otoacoustic emissions (DPOAEs), high-frequency tympanometry, and/or otologic examination. RESULTS: In 88% of the 2-hr test sessions, at least 4 ABR threshold estimates were obtained (i.e., bilateral clicks and either a 500- or 1000-Hz tone burst and a 4000-Hz frequency tone burst for the better ear). The incidence of hearing loss was significantly different across nursery levels: 18% for Level I (well baby), 29% for Level II (special care), and 52% for Level III (neonatal intensive care unit). Hearing loss type was defined at the initial assessment for 35 of the 51 infants with bilateral hearing loss based on bone-conduction ABR, latency measures, DPOAEs, high-frequency tympanometry, and/or otologic examination. CONCLUSIONS: Our findings indicate that a 2-hr test appointment is appropriate for all nursery levels to diagnose severity and type of hearing loss in the majority of infants referred from UNHS. Examination by an otolaryngologist within 24-48 hr further defines the hearing loss and facilitates treatment plans.

Acoustic Impedance Tests↗

PubMed2006

Prediction of auditory brainstem reflex screening referrals in high-risk infants.

OBJECTIVES/HYPOTHESIS: The objectives of this study were to 1) quantify the relative importance of established risk factors for congenital hearing loss (HL), 2) identify other risk factors for congenital HL, and 3) create a prognostic system that can predict the chance of an infant having HL. METHODS: The authors conducted a retrospective cohort study with validation of a prognostic system. The authors used a medical record review on 1,863 infants admitted to level II and level III nurseries who underwent auditory brainstem reflex (ABR) hearing screening from 1998 to 1999 (derivation cohort). The primary outcome was hearing screening referral (i.e., hearing screening failure) classified as mild to moderate, moderate to severe, and severe to profound loss. To validate the prognostic system, a medical record review of a separate cohort of 437 infants admitted to a level III nursery who underwent ABR hearing screening in 2002 (validation cohort) was performed. RESULTS: In the derivation cohort, 1,513 infants (81%) passed the ABR screen at 30 dB, 77 (4%) had a unilateral referral, 243 (13%) had a bilateral referral, and 30 (1.6%) did not have a complete screening. In multivariable analysis, the following risk factors were clinically and statistically significant: craniofacial abnormalities, cytomegalovirus infection, bronchopulmonary dysplasia (BPD), maternal ethanol use, syndromes, hydrocephalus, and hyperbilirubinemia. CONCLUSIONS: Our results reaffirm the importance of several established risk factors for congenital HL, but suggest that BPD is an important predictor in high-risk populations. Whether these risk factors are causal or merely associated in congenital HL remains to be determined.

Cohort Studies↗

PubMed2004

Speech-language and educational consequences of unilateral hearing loss in children.

BACKGROUND: In the past, unilateral hearing loss (UHL) in children was thought to have little consequence because speech and language presumably developed appropriately with one normal-hearing ear. Some studies from the 1980s and 1990s have suggested that a significantly increased proportion of children with UHL may have educational and/or behavioral problems, compared with their normal-hearing peers. Limited data exist about the effect of UHL on acquisition of speech and language skills. OBJECTIVE: To review the current literature about the impact UHL has on the development of speech and language and educational achievement. DATA SOURCE: MEDLINE search between 1966 and June 1, 2003, using the medical subject heading "hearing loss," combined with the textword "unilateral." STUDY SELECTION: Studies were limited to those written in English, reporting speech-language and/or educational results in children. DATA EXTRACTION: Articles were read with attention to study design, population, recruitment of subjects, and outcomes measured. DATA SYNTHESIS: Problems in school included a 22% to 35% rate of repeating at least one grade, and 12% to 41% receiving additional educational assistance. Speech and language delays have been reported in some but not all studies. CONCLUSIONS: School-age children with UHL appear to have increased rates of grade failures, need for additional educational assistance, and perceived behavioral issues in the classroom. Speech and language delays may occur in some children with UHL, but it is unclear if children "catch up" as they grow older. Research into this area is necessary to clarify these issues and to determine whether interventions may prevent potential problems.

Child↗

PubMed2003

Methodologic assessment of studies on endoscopic sinus surgery.

BACKGROUND: Functional endoscopic sinus surgery (ESS) has become the procedure of choice for surgical treatment of chronic rhinosinusitis. Does the published literature support the claims of greater efficacy than medical treatment alone or older sinus procedures? OBJECTIVE: To analyze the methodology of the published literature regarding the efficacy of ESS. DATA SOURCES: MEDLINE search for primary studies published in 1987 through 2001, written in the English language, reporting results on more than 100 patients, using the MeSH (medical subject headings) terms sinusitis [subheadings surgery or therapy] and endoscopy. STUDY SELECTION: Of 512 studies initially identified, 29 studies met the inclusion and exclusion criteria for further assessment of methodologic criteria. An additional 6 studies were found when the reference lists of reviews or included studies were searched. DATA EXTRACTION: Articles were evaluated for 4 core (inclusion/exclusion criteria, control group, intervention, and clear outcome measure) methodologic criteria essential to the determination of efficacy of ESS. Eight additional methodologic criteria were also used to rate the articles. DATA SYNTHESIS: Three studies met all 4 core methodologic criteria. Only 4 of 35 studies used a control group to evaluate efficacy of ESS to treat chronic sinusitis. Mean number of criteria met was 7.2, with a range of 2 to 11. CONCLUSIONS: Absence of a control group is the most important reason that studies are unable to scientifically assess the comparative efficacy of ESS to medical therapy or other sinus procedures. The methodologic criteria described here can be used to evaluate studies of interventions for other disorders.

Comorbidity↗

PubMed2003

Prognostic staging system and therapeutic effectiveness for recurrent or chronic sinusitis in children.

OBJECTIVE: We sought to assess the clinical status of pediatric sinusitis patients after a minimum of 2 years follow-up and to evaluate relative treatment effectiveness. Study design We conducted a medical record review of 308 patients, with a 2-year follow-up questionnaire. RESULTS: Overall, 55% of children were "much improved." A 4-stage prognostic system was developed and used to compare results in 133 patients who had not responded to medical treatment and who had positive sinus computed tomography scans. Endoscopic sinus surgery (ESS) had no apparent advantages in stages I and IV, but in stages II and III, rates of "much improved" for ESS versus medical therapy were 79% versus 54% and 68% versus 42%, respectively. CONCLUSION: These results suggest that ESS may be particularly effective for patients from intermediate prognostic stages. SIGNIFICANCE: This type of prognostic staging and evaluation of treatment effectiveness is necessary and important in chronic sinusitis, where randomized trials are unlikely to be performed.

Child, Preschool↗

PubMedDate not supplied

Development of staging and stratification systems.

Physicians communicate with each other on a daily basis using staging and stratification systems, whether they recognize this or not. At a minimum, they help convey a wealth of information in communicating about patients and their disease; more sophisticated staging systems help physicians recommend therapy and prevention strategies for patients, or predict functional and survival prognoses in concordance with the current scientific evidence. The goal of this article is to discuss the purpose and rationale of staging or stratification systems, and to introduce the clinical and statistical development and evaluation of these systems. The practicing physician should be aware of basic methodologic principles in the development of staging systems that help ensure their quality and applicability, so that staging systems can help improve patient care.

Cohort Studies↗