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      Congenital hypothyroidism as a risk factor for hearing and parents’ knowledge about its impact on hearing

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          Abstract

          Aim

          To evaluate the hearing of children with congenital hypothyroidism (CH) and to analyze the knowledge that parents’ have on the possible auditory impacts of the disease.

          Methods

          A total of 263 parents/guardians were interviewed about aspects of CH and hearing. Audiological evaluation was performed on 80 participants, divided into two groups: with CH (n= 50) and without CH (n=30). Clinical and laboratory CH data were obtained from medical records, pure tone auditory thresholds and acoustic reflexes were analyzed. The auditory data was compared between groups. Student’s t-test and Chi-square were used for statistical analysis at a significance level of 5% (p ≤0.05).

          Results

          The majority (78%), of the parents were unaware that CH when not treated early is a potential risk to hearing. There was no correlation between socioeconomic class and level of information about CH and hearing (p>0,05; p=0.026). There was a statistically significant difference between the auditory tone thresholds of the groups and between the levels of intensity necessary for the triggering of the acoustic reflex. The group with CH presented the worst results (p≤0.05) and absence of acoustic reflex in a normal tympanometric condition.

          Conclusions

          Children with CH are more likely to develop damage to the auditory system involving retrocochlear structures when compared to healthy children, and that the disease may have been a risk factor for functional deficits without deteriorating hearing sensitivity. The possible impacts of CH on hearing, when not treated early, should be more publicized among the parents/guardians of this population.

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          Most cited references38

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          Year 2019 position statement: principles and guidelines for early hearing detection and intervention programs

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            Update of newborn screening and therapy for congenital hypothyroidism.

            Unrecognized congenital hypothyroidism leads to mental retardation. Newborn screening and thyroid therapy started within 2 weeks of age can normalize cognitive development. The primary thyroid-stimulating hormone screening has become standard in many parts of the world. However, newborn thyroid screening is not yet universal in some countries. Initial dosage of 10 to 15 microg/kg levothyroxine is recommended. The goals of thyroid hormone therapy should be to maintain frequent evaluations of total thyroxine or free thyroxine in the upper half of the reference range during the first 3 years of life and to normalize the serum thyroid-stimulating hormone concentration to ensure optimal thyroid hormone dosage and compliance. Improvements in screening and therapy have led to improved developmental outcomes in adults with congenital hypothyroidism who are now in their 20s and 30s. Thyroid hormone regimens used today are more aggressive in targeting early correction of thyroid-stimulating hormone than were those used 20 or even 10 years ago. Thus, newborn infants with congenital hypothyroidism today may have an even better intellectual and neurologic prognosis. Efforts are ongoing to establish the optimal therapy that leads to maximum potential for normal development for infants with congenital hypothyroidism. Remaining controversy centers on infants whose abnormality in neonatal thyroid function is transient or mild and on optimal care of very low birth weight or preterm infants. Of note, thyroid-stimulating hormone is not elevated in central hypothyroidism. An algorithm is proposed for diagnosis and management. Physicians must not relinquish their clinical judgment and experience in the face of normal newborn thyroid test results. Hypothyroidism can be acquired after the newborn screening. When clinical symptoms and signs suggest hypothyroidism, regardless of newborn screening results, serum free thyroxine and thyroid-stimulating hormone determinations should be performed.
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              European Society for Paediatric Endocrinology Consensus Guidelines on Screening, Diagnosis, and Management of Congenital Hypothyroidism

              Objective: The aim was to formulate practice guidelines for the diagnosis and management of congenital hypothyroidism (CH). Evidence: A systematic literature search was conducted to identify key articles relating to the screening, diagnosis, and management of CH. The evidence-based guidelines were developed with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system, describing both the strength of recommendations and the quality of evidence. In the absence of sufficient evidence, conclusions were based on expert opinion. Consensus Process: Thirty-two participants drawn from the European Society for Paediatric Endocrinology and five other major scientific societies in the field of pediatric endocrinology were allocated to working groups with assigned topics and specific questions. Each group searched the literature, evaluated the evidence, and developed a draft document. These papers were debated and finalized by each group before presentation to the full assembly for further discussion and agreement. Recommendations: The recommendations include: worldwide neonatal screening, approaches to assess the cause (including genotyping) and the severity of the disorder, the immediate initiation of appropriate L-T4 supplementation and frequent monitoring to ensure dose adjustments to keep thyroid hormone levels in the target ranges, a trial of treatment in patients suspected of transient CH, regular assessments of developmental and neurosensory functions, consulting health professionals as appropriate, and education about CH. The harmonization of diagnosis, management, and routine health surveillance would not only optimize patient outcomes, but should also facilitate epidemiological studies of the disorder. Individuals with CH require monitoring throughout their lives, particularly during early childhood and pregnancy.
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                Author and article information

                Contributors
                Journal
                J Otol
                J Otol
                Journal of Otology
                Chinese PLA General Hospital
                1672-2930
                2524-1753
                11 September 2020
                April 2021
                11 September 2020
                : 16
                : 2
                : 71-79
                Affiliations
                [a ]Postgraduate Program in Interactive Processes of Organs and Systems, Institute of Health Science – Federal University of Bahia, Avenue Rector Miguel Calmon, Valley of Canela, 40110100, Salvador, Bahia, Brazil
                [b ]Department of Speech Therapy, Institute of Health Science – Federal University of Sergipe, Av. Marechal Rondon, 49100-000, São Cristóvão, Sergipe, Brazil
                [c ]Department of Speech Therapy, Institute of Health Science – Federal University of Bahia, Avenue Rector Miguel Calmon, Valley of Canela, 40110100, Salvador, Bahia, Brazil
                [d ]Department of Bioregulation, Health & Sciences Institute – Federal University of Bahia, Avenue Rector Miguel Calmon, Valley of Canela, 40110100, Salvador, Bahia, Brazil
                [e ]Medical School, Institute of Health Science– Federal University of Bahia, Avenue Rector Miguel Calmon, Valley of Canela, 40110100, Salvador, Bahia, Brazil
                Author notes
                []Corresponding author. , Address: Av. Reitor Miguel Calmon s/n - Vale do Canela, CEP 40.110-100, Salvador, Bahia, Brazil. Number: helidaboliveira@ 123456gmail.com
                Article
                S1672-2930(20)30086-6
                10.1016/j.joto.2020.09.003
                7985011
                aebc85cb-ac0f-43b8-9dd8-60032b97c82b
                © 2020 PLA General Hospital Department of Otolaryngology Head and Neck Surgery. Production and hosting by Elsevier (Singapore) Pte Ltd.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 1 July 2020
                : 22 August 2020
                : 2 September 2020
                Categories
                Research Article

                auditory perception,hearing,congenital hypothyroidism,risk factors,survey and questionnaire

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