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dacryocystitis Inflammation of the lacrimal sac at the corner of the eye, caused by obstruction of the duct that causes tearing and discharge from the eye.


In the acute phase, the sac becomes inflamed and painful. The disorder almost always occurs only on one side and is usually seen in infants.


Systemic treatment of antibiotics will usually cure the problem.

deafness and hearing disorders Federal government projections have estimated that there are about 50,000 deaf and 325,000 hard-of-hearing children in the school-age population. Estimates suggest that one person in every 1,000 is born deaf, or is deafened before age three, and that one in 500 is hard of hearing or develops hearing problems by age 19. These figures vary, because it is especially hard to estimate the incidence of deafness among children since the condition so often goes unrecognized or misdiagnosed in the very young.

More than 90 percent of deaf children and 20 percent of hard-of-hearing children receive special education services, and in general, deaf children receive more intensive and comprehensive services than do children with a milder hearing loss.

The lack of early detection of hearing problems in children is a major public health problem. The average age at which moderate to severe hearing problems are detected in children is two to three years of age, but these problems can and should be identified and treated much sooner. If undetected and untreated, hearing loss in children leads to delayed speech and language development and can contribute to emotional, social, and academic problems later. Ideally, doctors should identify infants with hearing loss before three months of age, so that intervention can begin by six months.

Parents are usually the first to suspect a hearing loss. Any child should have a hearing test who experiences any of the following conditions:

• a history of frequent ear infections

• children at risk for hearing problems, such as those with abnormalities of the skull or face; prematurity; intrauterine infection; meningitis; genetic conditions relating to deafness; family history of hearing loss

• a child who does not follow directions

• speech or language delay (such as no babbling in a six-month-old, no words by 18 months, or no word combinations by age two)

• behavioral problems

• any child whose parent is concerned about hearing

If a parent or doctor suspects a hearing problem, the child's primary care provider may choose to conduct a hearing screening for a preschooler, but infants and young toddlers will need a referral for special tests. A pediatrician should conduct ongoing exams when a child has middle ear fluid, until it has cleared. If the fluid is present for several months without clearing, consultation with an otolaryngologist should be considered.

If a parent has any doubt about slower-than-normal sound and speech/language development, these concerns should be discussed with the child's doctor and hearing tests should be seriously considered.

There are several ways to test hearing in children, including behavioral testing, brainstem

138 DEET

evoked response testing, otoacoustic emissions, and central auditory processing testing.

Behavioral Testing

A behavioral test is a better measure of hearing and usually should be used first in most children, even older infants. In sound field audiometry, the child is placed in a soundproof booth and exposed to sound (even an infant of one or two months will startle after a loud noise). An infant who does not show a startle reaction may have a hearing problem. However, relying on startling alone may not identify infants with smaller but still significant losses.

In a type of test called visual response audiome-try, older infants will turn their head toward noise that gets their attention. Eventually they can learn that a stuffed animal will light up when there is noise, and they will look for the animal when they hear the noise. If they do not look, they did not hear it.

Conditioned play audiometry is a type of test that teaches toddlers up to age three or four to put a toy in a box when they hear the noise. Failure to put a toy in the box is an indication that they did not hear the noise.

In an air conduction audiometry test, children with a developmental age of four or above wear earphones and raise their hands when they hear a sound.

Older children can respond to a bone vibration, which helps to determine whether a hearing problem is in the middle ear or inner ear, in cases where both ears do not hear equally well. This is called bone conduction audiometry.

Brainstem Evoked Response Testing (BER, ABR, BSER)

This testing method is not a direct measure of hearing but a measure of nerve activity. It is used with children who cannot respond in the soundproof booth because in this type of test, no responses are required from the child. As the child sleeps (with or without sedation), earphones and electrodes record activity from the hearing nerve. The test, which measures high-pitched sounds better than low-pitched sounds, is often used by hospitals to test newborns.

Otoacoustic Emissions

This is a very new method of rapid testing that can be used for screening in the newborn nursery and also with a child who cannot respond to behavioral testing. It is based on the fact that the ear not only hears noise but also makes noises. By measuring the very faint noises made by the ear, the test estimates how well the ear hears. An ear that does not hear will not make the expected noises. These noises are much too faint to be heard by human ears, but there are machines that can measure the sounds.

Central Auditory Processing Testing

A child must be able to speak in full sentences and have reasonably advanced language to take the central auditory processing test, so they must be at least age five. The test assesses the ability to process the sounds children hear. Some children hear very well but have trouble deciding what to do with the sound once they hear it. These children are typically intelligent but have trouble following directions in school, especially in noisy environments. They may have had many ear infections when they were younger and developed difficulty dealing with sound as a method of communication.

DEET (N1 N-diethyl-m-toluamide) The most effective of all bug repellants, this product may be safely used on children—but not on infants. DEET should be kept out of the eyes. New preparations combine sunscreen with DEET in one cream.

Every year about a third of the U.S. population is expected to use DEET in a variety of liquids, lotions, sprays, and impregnated materials (such as wrist bands). DEET is available in formulations registered for direct application to human skin containing from 4 percent to 100 percent DEET. Except for a few veterinary uses, DEET is registered for use by consumers and should not be used on food. Consumers who use a repellent with DEET on children should use it only when outdoors and wash the child's skin after coming indoors. Children should be sure not to breathe in or swallow DEET or get it into the eyes. It should never be applied to wounds or broken skin.

DEET is designed for direct application to human skin to repel insects rather than kill them.

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