FLUCTUATING AND OR PROGRESSIVE SENSORINEURAL HEARING-LOSS IN CHILDREN/

Sensorineural hearing loss (SNHL) which is sudden in onset, fluctuatin g, and/or progressive complicates medical management, hearing aid sele ction, and individualized educational planning for a hearing-impaired child. In spite of multidisciplinary evaluation and intervention, a gr adual decrease in auditory acuity may continue unabated in a significa nt number of cases. Intercurrent middle ear disease and inconsistent a udiologic technique can account for threshold variation in some cases. The study population consisted of 229 children (132 boys; 97 girls) a ged 1 to 19.9 years at first audiogram which revealed at least a mild degree of sensorineural hearing loss in one or both ears (35 unilatera l), and who demonstrated threshold variation of 10 dB or more in at le ast one ear at one or more of the standard audiometric test frequencie s (250, 500, 1000, 2000, 4000, and 8000 Hz) and were without concurren t middle ear disease (mean length of follow-up, 4.9 years; mean number of audiograms, 10.3). Of 365 ears demonstrating threshold variation o f 10 dB or more, 22 (6%) had purely progressive losses without intercu rrent upward fluctuation, 208 (57%) had fluctuating thresholds with gr adually progressive losses, and 135 (37%) had intermittent threshold f luctuation without permanent deterioration. The probability of contral ateral threshold fluctuation if one ear fluctuated was 0.91, while the probability of contralateral progressive SNHL if one ear progressed w as 0.67. Demographic data, presumptive etiology, degree of initial SNH L, audiometric configuration, and symmetry of threshold variation were considered as potential predictors of the likelihood of threshold flu ctuation and/or progression.