Ambulatory Pediatrics

• Hearing loss is defined by the pure tone threshold:
• Normal hearing has a threshold of 0-20 dB
• Mild hearing loss from 20-40 dB
• Moderate hearing loss from 40-60 dB
• Severe hearing loss from 60-80 dB
• Profound hearing loss greater than 80 dB

• 4% are fully retractable at birth
• 50% are fully retractable at 1 year
• 80% by 2 years
• 96% by school age
• 100% by 17 years

• Manual retraction does not expedite retraction
• No special care is needed

2-4 months. In the NICHD study (1988), the median age for SIDS deaths was 11 weeks (~3 months), the peak incidence was between 2 and 4 months, and 90 percent occurred before 6 months of age.

• 80% of labial adhesions resolve spontaneously within 1 year of diagnosis, and nearly all resolve by puberty.
• Therefore, treatment can be reserved for patients who are symptomatic or have extensive adhesions or for patients whose parents are very concerned about physical appearance.
• The most frequently recommended treatment is topical estrogen (estradiol or conjugated estrogen applied once or twice daily for 4-6 weeks).
• The success rate is reported to be 46% to 100%
• Rare adverse reactions include breast enlargement or tenderness, labial engorgement, and vulvar hyperpigmentation.
• Myers et al studied topical betamethasone as an alternative to estrogen with the hopes of eliminating these adverse effects. They found that 1 to 3 courses (4-6 weeks each) of twice daily topical 0.05% betamethasone successfully treated labial adhesions 68% of the time. There were no adverse events related to this treatment
• Myers JB, Sorensen CM, Wisner BO, Furness PD, Passamaneck M, Koyle MA. Betamethasone cream for the treatment of pre-pubertal labial adhesions. J Pediatr Adolesc Gynecol. 2006;19(6):407-411

• The average age at the time of diagnosis is 2 years in unilateral cases and 1 year in bilateral cases.
• Leukocoria and strabismus are the most common presenting findings.