ࡱ> GIF)` &bjbj *8{{   8B<~,v("0 moooooo$dh nmm `za3 m0:!:!:!<L6,<<<<<< ff Clinical Management Information Template Form Type of document Please tick the relevant box: Clinical Policy (must do)  FORMCHECKBOX  Clinical Guideline (should do) X Clinical Protocol (must do)  FORMCHECKBOX  Title of document Aetiological investigation of a child with hearing loss Specialty Paediatrics/ENT/Audiology 1. Indications 1.1 Background The national Newborn Hearing Screening Programme aims to identify babies with congenital hearing loss as early as possible to facilitate investigation and treatment and provide the best outcome for patients and families. The local programme in Salisbury seeks to follow nationally recommended pathways to meet the above aims via locally agreed guidelines. These take into account local staffing and facilities. 1.2 Aim/purpose Investigation aims to try and answer the question "Why is my child deaf?" , identify and treat any medical conditions, assist the family in making decisions about the most appropriate communication mode, inform genetic counselling and epidemiological research. 1.3 Patient/client group All children identified through the screening process with bilateral permanent hearing loss and thresholds over 40 dBHL in the better ear averaged across 500, 1000, 2000 and 4000Hz. 1.4 Exceptions/ contraindications Babies whose parents do not give consent for investigation after appropriate counselling. 1.5 Options 2. Clinical Management 2.1 Staff & equipment Investigations and assessment should be performed by a consultant ENT surgeon with interest in childhood hearing loss and a paediatrician with ability to identify any associated congenital abnormalities. This assessment does not have to occur simultaneously but communication should occur in a timely manner to discuss investigations performed and results obtained, ensuring a multidisciplinary approach in the care of the child. Paediatric audiologists should also be kept updated with results of aetiological assessment. 2.2 Method/procedure Babies should be investigated in line with best practice guidelines produced by the British Association of Audiological Physicians / British Association of Paediatricians in Audiology . These are divided into level 1 investigations (considered for every child) and level 2 investigations (as indicated from history and clinical findings) see appendix 1. A check list can be printed and filed in notes listing which investigations have been requested and act as a prompt to check all results have been reviewed see appendix 2. The national 㴫ýP database (eSP) has the facility to record the aetiological investigations performed and outcomes. Written parental consent must be obtained to enter this information (appendix 3). 2.3 Potential complications / Risk Management MRI of internal auditory meati is not routinely performed at SDH. If this test is indicated, consideration should be made to referring the child to University Hospital Southampton 㴫ý Trust. MRI scans will be performed routinely if the child is referred to the Cochlear Implant Team at UHS. 2.4 After care Results should be discussed at 㴫ýP aetiology MDT meetings (ENT, paediatrics, audiology) as they become available and shared with families and other relevant professionals (e.g. GP, teacher of the deaf) as indicated, in a timely manner. Onward referrals, if indicated, to genetics or other subspecialty consultants are the responsibility of the local team. Babies who meet the criteria for referral to the Cochlear Implant team should be referred by the ENT consultant assessing the child in a timely manner. See appendix 4 which should be completed to refer the baby for assessment by the Southampton team. Up to date referral criteria for the service can be obtained via: http://ais.southampton.ac.uk/professionals-area/guidelines-for-referral-of-patients/ 3. Patient Information Parents should be given a copy of the NDCS (National Deaf Childrens Society) information leaflet Why does my child have a hearing loss? if they are not already in receipt of this publication. Further information for families is also available through other NDCS publications such as Understanding your childs hearing tests and can be accessed via the charitys website www.ndcs.org.uk. 4. Audit 4.1 Audit Indicators Investigations offered and performed as per guideline, with results communicated to family/GP via letter. 4.2 Audit design Case note review 4.3 User Involvement 5. Evidence Base 5.1 Sources of information Guidelines for aetiological investigation of infants with congenital hearing loss identified through newborn hearing screening Authors : BAAP/BAPA and 㴫ýP Clinical Group January 2009 5.2 Summary of evidence, review and recommendations 6. Appendices Appendix 1 Level 1 and 2 aetiological investigations Appendix 2 Aetiology checklist Appendix 3 Consent Form for storing aetiology investigation data on e-Screener Plus Appendix 4 Referral for assessment by cochlear implant team     Salisbury Health Care 㴫ý Trust Integrated Clinical Information Database Project  DATE \@ "MM/dd/yy" 10/15/15  PAGE 2 Status: Ref: Source: ./@^yz% & ( 1 K L N ^ _ n J K   2 @ L e f g h 蠛{s{sjsh@*h@*^Jh@*CJ^Jh@*h@*CJ^J h@*CJh@*h@*CJ h=6CJ hX6hX6fHq  hX5h@jthX5CJU h@5CJjhX5CJUjhX5CJU hX5CJ hX5CJ hXCJhX)./@^& ' ( L M N _ n  ! dd[$\$gd@*,$d%d&d'd-DM NOPQ%h z     ! 9 : G p  % M l m n z | ûÊ~xql]h@*h@*OJQJmH sH  hX6 h@*5CJ hXCJ h]CJ hK#CJh=6h=6CJ hK#5hXCJ^Jhe~CJ^JhK#CJ^JhShSCJ^JhShS5 hX5 hX5CJh@*h@*^J h@*^Jh-fh@*CJ^JmH sH h@*CJ^Jh@*h@*CJ^J!! :  m n z { | /0 dd[$\$gd@* 7$8$H$gdK# 9r ,$d%d&d'd-DM NOPQ dd[$\$gdK#gdS $%3DLP !Wb ƺծծztzdWJh@CJOJQJ\^Jh]CJOJQJ\^JhK#hK#CJOJQJ\^J hK#CJhK#hK#CJhX5CJOJQJmH sH hX5OJQJmH sH h@*hXOJQJmH sH h@*OJQJmH sH h]OJQJmH sH h@*h-fOJQJmH sH h-fh@*OJQJh@*h@*OJQJmH sH h]h@*5OJQJmH sH  '(67CDNOPQXYghyz./3[˾˾uni hX5 hX5CJh)Rh@*CJ^JhPCJ^Jh)Rh)RCJ^Jh|JCJ^JhK#CJ^Jh)RCJ^Jh@*CJ^Jh>bh@*CJ^Jh@*CJOJQJ\^JhK#CJOJQJ\^Jh]CJOJQJ\^Jh^CJOJQJ\^JhvcCJOJQJ\^J&k+,=NOdefg,$d%d&d'd-DM NOPQ 7$8$H$gd)R/OKLjkde[vwx½xsjjjdjs hCCJh@h@CJ hX6hHh<CJ^JhHhHCJ^J hHhHhHCJ^Jh<CJ^JhCJ^Jh@CJ^Jh)RCJ^J hX5 hX5CJh)RhXCJ h-fCJ h@CJ hCJ h)RCJh-fh)RCJmH sH h)Rh)RCJ'*+,=MOdfgy&KLM?@A񾮾᧠xsohH hH5hH5CJOJQJhHCJOJQJh[njh[nU hH5CJ hP5CJ h^5CJhK#h@CJOJQJ\^Jh@CJOJQJ\^J hX6 hXCJ hXCJ hX5 hX5CJh@hXCJ h@CJh@h@CJ(gyLMA &dP,$d%d&d'd-DM NOPQ #$%& $dN   #$%& hH5CJh[nhHhH0JCJmHnHuhH0JCJjhH0JCJUhHCJmHnHu hHCJjhHCJU(/ =!n"n#n$n%77 tDeCheck1tDeCheck3H@H Normal CJOJQJ_HmH nHsH tH:@: Heading 1$@&568@8 Heading 2$@&5F@F Heading 4$@&5CJmH sH uDA@D Default Paragraph FontVi@V  Table Normal :V 44 la (k@(No List L@L Header  9r CJOJQJmH sH u4>@4 Title$a$5CJ0J@0 Subtitle54 @"4 Footer  !.)@1. 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