!
Fm. 1. Example of laceration. (See Table I.)
938 HEARING SCREENING
ries. But the best indication of the problem’s scope may be found in public health statistics’ which recorded over 30,000 children injured by glass in 1967 alone.
Ordinary glass breaks into sharp pieces
which may cut or stab. On the other hand, tem-pered glass is four times stronger than ordinary glass and breaks safely into rounded pieces.
Tempered glass storm doors are now offered by
at least several manufacturers.
Plastic materials are also safe. Cast acrylic sheets are inexpensive and can be purchased in a size that will exactly replace unsafe glass panes. There is economy in replacing only the
glass and not the whole storm door.
Other safety measures appear less suitable. Metal guards offer only incomplete protection and are unsightly. Decals do prevent distracted
adults from strolling through an otherwise in-visible sliding patio door or full length
win-(low. Storm door accidents, however, mainly
involve children at play, who back into, are
chased into, or are thrust against a quite
visi-Fic. 2. Another example of laceration. (See Table I.)
ble, but closed storm door. Decals are not likely to prevent accidents that occur during the heat of play.
SUMMARY
Six children in this pediatric practice have suffered accidental glass door injury during the last 18 months. Five of these accidents
in-volved the familiar aluminum frame storm doors and four accidents occurred at play. The experience in this practice and throughout the country indicates a significant increase in the number of such injuries. The problem is thus defined as a distinct hazard of childhood.
It is necessary to alert both pediatrician and parent to the danger of storm and other glass
doors and to the possibility of replacing easily broken glass, in whole or part, with a safety
material. In addition, there is a distinct need for legislation that will eventually eliminate
un-safe glass in doors.
SHELDON N. FEINBERG, M.D., F.A.A.P.
98 Broadwa,
Flillsdale, New Jersey 07642
REFERENCES
1. U.S. Department of Health, Education and Welfare: Safety glass needed in doors and
panels. Public Health Rep., 82:720, 1967. 2. Sachatello, C., and Sawyers, J.: The invisible
glass door: Another hazard of modern living.
J. Tenn. Med. Ass., 61:395, 1968.
3. Szczypinski, A. F., and Fuerst, E. J.: Accidental
severance of the major vessels and nerves of the axilla with report of two patients success-fully treated. J. Trauma, 4:175, 1964.
4. Keddy, J. A.: Accidents in childhood: A report
on 17,141 accidents. Canad. Med. Ass.
J.,
91:675, 1964.
5. White, J. J., Talbert, J. L., and Haller, J. A., Jr.: Peripheral arterial injuries in infants and chil-dren. Ann. Surg., 167:757, 1968.
Modified
Hearing
Screening
Method
The subject of this communication is a modi-fled technique for hearing screening in young
children that is quick, easy to use, and appears
to be effective. In the original method
EXPERIENCE AND REASON-BRIEFLY RECORDED 939
Fic. 1. Illustration of a hearing screening method.
child usually responds by turning his head to-ward the sound. This technique is most suitable for the 9-month to 18-month age group when the patient is too old for newborn screening
techniques and too young for conventional au-diometry and when deafness may not yet be
suspected from failure of normal language de-velopment.
The development of a hearing screening method for this age group followed our discov-ery that three children with permanent deafness
in our practice had not been diagnosed until age 2 and that, in each, the parent’s report of speech development recorded at earlier well-baby visits had been misleading.
Our modification consists of replacing the
adult behind the child with an inexpensive
ste-reo tape recorder.#{176} Various noise makers
in-cluding a cricket, bell, pitch pipe, and human
voice, were recorded alternately on the right and left channels of the tape recorder. Play-back volume is adjusted so that the reproduced sounds are not as loud as the original noise makers to minimize spurious responses as well as playback distortion. The sequence of sounds presented is random to maintain the child’s in-terest and minimize adaption to the stimuli.
Children are tested in a multipurpose room
with the door closed to reduce noise and other
distractions. The tape recording is about 20 seconds long with an initial silent period of 6
seconds. The entire test requires only a few
940
DE
LANGE SYNDROMEminutes, including the time spent explaining the procedure to the mother.
The mother sits with the child on her lap, as shown in Figure 1, with right and left speakers behind them. The nurse switches on the tape recorder and observes the child’s reactions as the taped sounds come alternately from right and left speakers. Reacting to at least one sound on each side is considered normal. The child reacts by showing attention to the sound
and usually turns his head toward the appro-priate loudspeaker. The nurse records the re-sponse as “passed,” “failed,” or “doubtful” for each ear.
Testing is done before the child is undressed
and weighed so that he is less likely to be upset or crying. The mothers and children have coop-erated readily and seem to enjoy the test. The
only change necessary in the original procedure followed the nurse’s discovery that the
chil-dren’s responses were more clear cut if she avoided attracting their attention.
We began using this method for screening children about 1 year ago, at one well-baby
visit between 9 and 15 months of age, and
have tested 175 children. No congenital deaf-ness has been detected so far, but two children
who failed to respond on one side were found on examination to have otitis media in that ear.
Our purpose is to find patients in need of
au-diologic referral. Mild losses in hearing acuity cannot be determined with any reliability by this method. The most important point is to set the sound output of the tape recorder low enough to ensure that a truly deaf child does
not give a falsely positive response. Ideally sound output should be calibrated. For the first year’s screening, sound output was adjusted by
ear to be definitely less intense than the
origi-nal sound, yet loud enough to be definitely
per-ceptible. A variety of sounds were selected
within the range of human speech, from the complex sound of voice itself to the pitch pipe which is essentially a pure tone. Sound repro-duction much beyond the speech range is lim-ited by the recording and reproduction process, particularly at low end since small speakers can reproduce little sound below 300 hertz.
The ideal testing situation requires precise
sound calibration in a really sound proof room. However, for those with less than ideal facili-ties and lacking access to the services of an acoustic engineer, this screening test seems
su-perior to other techniques currently available to the practicing pediatrician. Advantages of
this method include standardization of testing procedure, simplicity of administration, patient cooperation, and minimal utilization of nurse
time.
J
AMES G. Cus, M.D.EVELYN R. CALLAS, M.D.
The Permanente Medical Group
4 G Street
San Rafael, California
REFERENCES
1. Hardy,
J.
B., Dougherty, A., and Hardy, W. C.: Hearing responses and audiologic screening in infants. J. Pediat., 55:382, 1959.2. Ewing, I. R., and Ewing, A. W. G. : The ascer-tainment of deafness in infancy and early childhood.
J.
Laryng. Otol., 59:309, 1944.Can the de Lange Syndrome
Always
Be Diagnosed
at
Birth?The comment “ . . . The children are
diag-nosable at birth. This resemblance to one an-other is as striking to us as the resemblance of mongols to each other”1 holds true for most,
but not all cases of the de Lange syndrome.2’3
This paper will describe a patient who at the
age of 9 months had features suggestive of
Turner’s syndrome, and at the age of 21
months had the typical appearance of the de Lange syndrome.23
CASE REPORT
The patient, a Caucasian female, was the third
child of unrelated parents who were 28 and 30 years old respectively when she was born January 29, 1968. The two siblings, a boy of 6 and a girl of 43 years, were healthy and normal in appearance.
The patient’s birth followed a 40-week gestation period complicated only by a moderate degree of first trimester morning sickness. The mother’s weight gain was 9.6 kg. The labor and delivery were unremarkable but the infant was noted to be flaccid, markedly cyanosed, and weighed 3.7 kg.
Investigation at a local hospital revealed
tetral-ogy of Fallot. Because of increasing cyanosis with
metabolic acidoses, she was transferred at 5 days of age to The Montreal Children’s Hospital for an emergency palliative shunt. At operation the as-cending aorta was anastomosed to a very small right pulmonary artery
