1. WHO schema for disablements Aetiology - eg. Meningitis Pathology - Hair cell damage Impairment - Hearing loss Disability - Speech and Language disorder Handicap- Inability to lead a normal life

2. Early identification of Impairment Reduces Disability Prevents Handicap Early intervention i.e development of normal speech and language i.e able to lead a normal communal life

3. Aim -A Team that is led by a consultant paediatrician in Audiological medicine to deliver to the children aged 0-16 (?19yrs soon) a service that concerns itself with disorders of Peripheral hearing – sensori-neural hearing loss, conductive hearing loss etc. Pure Neural Hearing loss - Auditory Neuropathy Increased hearing sensitivity - Hyperacuisis Tinnitus Vestibular System - screen and refer to GOSH if further assessment is indicated. Auditory processing – not commissioned yet! Non organic or functional hearing loss

4. It also concerns itself with Diagnosis of Normal Hearing in children with special needs - This can be a challenge needing special skills Diagnosis and management hearing impairment in children who have other special needs - 40% of children with SNHL have other problems

5. Early Identification Need to do active case finding Promote awareness –Parents –Professionals Screening at different ages

6. Neonatal - electrophysiological tests (OAE and AABR) –universal - training of screening staff 5 years - performance test –universal – training of school nurses and continued updating

8. Therefore referrals are received from the Newborn screening teams at birth school screening service at 5 years of age from professionals- Acute Paediatricians Community paediatricians, General practitioners, ENT surgeon, School Health/Child Health personnel.

9. After diagnosis of Permanent hearing loss Anatomical diagnosis Aetiological diagnosis Multi-disciplinary management programme

10. Otitis Media with Effusion also known as “glue ear” “secretory otitis media” “serous otitis media” New NICE guidance available February 2008

11. Nice Guidance - 3 care pathways 1) Children with suspected OME 2) Children with Down’s Syndrome 3) Children with Cleft palate

12. “OTITIS MEDIA WITH EFFUSION” Assessment of disability, Monitoring Assessment for referral for surgery - work closely with ENT Conservative Management advice on management in classroom Hearing aids fitting

13. Do not offer the following for the Rx of OME Antibiotics Antihistamines Decongestants Steroids Homeopathy Cranial osteopathy Acupuncture Dietary Modification Massage

15. Human Communication is action. It is culture. It is the fabric of all society It is the history of man. Its absence negates man’s existence

16. commissioning policy Parental re referrals ?? Guidance for referrals – discuss document