Evaluating Hearing Loss in Infants – A Crucial UKMLA/PLAB exam Scenario
Understanding Early Hearing Loss Management for PLAB/UKMLA Exams
In this article, we explore a question from the August 2024 PLAB 1 exam that focuses on the early detection and management of congenital hearing loss. This scenario is vital for medical students preparing for licensing exams like the UKMLA and PLAB, as it tests knowledge of paediatric diagnostic pathways and the importance of timely intervention in developmental disorders.
PLAB 1 Exam Case Scenario: A 3-month-old infant fails the initial hearing screening test. The parents are concerned because there is a family history of congenital hearing loss. The infant appears to respond to loud sounds but does not react consistently.
What is the most appropriate next investigation?
- A) Otoacoustic emissions (OAE) test
- B) Tympanometry
- C) Brainstem evoked response audiometry (BERA)
- D) Pure-tone audiometry
- E) Audiogram
Answer with an explanation is provided below.
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Explanation for the above PLAB / UKMLA exam question
Correct Answer: C) Brainstem evoked response audiometry (BERA)
Explanation and Clinical Reasoning
Why BERA is the Best Next Step
Gold Standard for Infant Hearing Assessment:
Brainstem Evoked Response Audiometry (BERA) is the most reliable and objective test for evaluating hearing in infants.
It measures the electrical activity in the auditory nerve and brainstem in response to sound stimuli, identifying the severity and location of hearing loss.
Non-Behavioral Test:
BERA does not rely on behavioural responses, making it ideal for infants who cannot actively respond to sound.
Family History Consideration:
The family history of congenital hearing loss increases the likelihood of sensorineural hearing loss, which BERA is well-suited to detect.
Why Other Options Are Less Appropriate
A) Otoacoustic Emissions (OAE) Test:
The OAE test is useful for initial hearing screenings and assesses cochlear function. However, it is not sufficient as a follow-up after a failed screening because it cannot detect neural or brainstem-related hearing loss.
B) Tympanometry:
Tympanometry evaluates middle ear function, such as the presence of fluid or eardrum mobility, but it does not directly measure hearing ability or assess the auditory nerve or brainstem.
D) Pure-Tone Audiometry:
Pure-tone audiometry requires a behavioural response from the patient, which is not feasible for infants. This test is more appropriate for older children and adults.
E) Audiogram:
An audiogram is a visual representation of hearing test results, typically from tests like pure-tone audiometry. Since audiometry is unsuitable for infants, an audiogram is not appropriate in this scenario.
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