1 Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA.
2 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
Otolaryngol Head Neck Surg. 2018 Mar;158(3):553-558. doi: 10.1177/0194599817738975. Epub 2017 Nov 21.
Objective The purpose is to determine the prevalence of electrocardiogram (ECG) abnormalities, including borderline and prolonged QT, among screened children with sensorineural hearing loss (SNHL) and to analyze their subsequent medical workup. Study Design Institutional Review Board-approved case series with chart review. Setting Tertiary academic center. Subjects and Methods Cases from 1996 to 2014 involving pediatric patients (N = 1994) with SNHL were analyzed. Abnormal ECGs were categorized as borderline/prolonged QT or other. A board-certified pediatric cardiologist retrospectively determined the clinical significance of ECG changes. For follow-up analysis, children with heart disease, known syndromes, or inaccessible records were excluded. Results Among 772 children who had ECGs, 215 (27.8%) had abnormal results: 35 (4.5%) with QT abnormalities and 180 (23.3%) with other abnormalities. For children with QT abnormalities meeting inclusion criteria (n = 30), follow-up measures included cardiology referral (46.6%), repeat ECG by ear, nose, and throat (ENT) specialist (20%), clearance by ENT specialist with clinical correlation and/or comparison with old ECGs (20%), and pediatrician follow-up (6.7%). Documentation of further workup by ENT or referral was absent for 6.7%. For children with other ECG changes meeting inclusion criteria (n = 136), abnormalities were documented for 57 (41.9%); normal QT without other abnormality was documented for 18 (13.2%). The most common follow-up referrals were to pediatricians (16.9%) and cardiologists (10.3%). Among patients with clinically significant non-QT abnormalities mandating further evaluation (n = 122), 38 (31.1%) had documented follow-up in medical records. Conclusion There is a high prevalence of ECG abnormalities among children with congenital SNHL. If findings are confirmed by future studies, screening should be considered for congenital unilateral or bilateral SNHL, regardless of severity. We describe a standardized protocol for ECG screening/follow-up.
确定筛选出的感音神经性听力损失（SNHL）儿童中心电图（ECG）异常（包括边缘性和 QT 延长）的发生率，并分析其后续的医学检查。
经机构审查委员会批准的病例系列，结合图表回顾。
三级学术中心。
分析了 1996 年至 2014 年期间患有 SNHL 的儿科患者（N=1994）的病例。将异常 ECG 分为边缘性/延长性 QT 或其他。一位经委员会认证的儿科心脏病专家回顾性确定 ECG 变化的临床意义。对于后续分析，排除患有心脏病、已知综合征或记录不可用的儿童。
在 772 例行 ECG 的儿童中，215 例（27.8%）出现异常结果：35 例（4.5%）存在 QT 异常，180 例（23.3%）存在其他异常。对于符合纳入标准的 QT 异常儿童（n=30），后续措施包括心脏病学转诊（46.6%）、耳鼻喉科专家重复进行 ECG（20%）、耳鼻喉科专家通过临床相关性和/或与旧 ECG 进行比较来清除（20%）以及儿科医生随访（6.7%）。6.7%的儿童缺乏耳鼻喉科进一步检查或转诊的记录。对于符合纳入标准的其他 ECG 变化的儿童（n=136），有 57 例（41.9%）存在异常记录；18 例（13.2%）记录 QT 正常但无其他异常。最常见的后续转诊是儿科医生（16.9%）和心脏病专家（10.3%）。在需要进一步评估的具有临床意义的非 QT 异常患者中（n=122），38 例（31.1%）在病历中有记录随访。
先天性 SNHL 儿童的心电图异常发生率很高。如果未来的研究证实了这一点，那么无论严重程度如何，都应考虑对先天性单侧或双侧 SNHL 进行筛查。我们描述了一种心电图筛查/随访的标准化方案。
