! might be of lower’ priority. Sir Joh Wilson,in his discus. sion of deafness jn‘ metric service was developing countries 4 not available from previous health teams and was not announced to the community until the end of the children’s noted that the unmet 4 needs of third-world countries are not so 4 much technologic as 4 ZR" lmsbewegaepeek ee ~~ Fars + In thefirst five years oflife, critical language learning may be affected by even mild hearing loss. It has also been sug- gested that among school-age children, MICRO SOUND PRODUCTS 140 University Avenue, Suite 127 Palo Alto, CA 94301 (415) 322-0417 Circle 132 on Reader Service Card. 24 THE HEARING JOURNAL/AUGUST 1989 Dever GJ, Stewart JL, David A: Prevalence of otitis media in selected populations on Pohnpei: A preliminary study. Int | Ped Otorhinol 2. Dungy CI, Morgan B, Adams WH: Pediatrics in the Marshallislands. Clin Ped 1984, pp. 29-32. 3. 4. 6. ple factors that might offer increased pro- 7. public health goals should include recog- 8. Although it is difficult to identify sim- tection for these children, important nition of the importance of draining and JU I B48 1985, 10:143-152. Lessard E, Conrad RA: Exposure to fallout: The Rongelap and Utirik experience. Heai:n Physics 1984, 46:511]-527. Conard RA, et al.: Review of Medical Findings in a Marshallese Population Twenty-six years After Accidental Exposure to Radioactive Fallout. Upton, NY, Brookhaven National Laboratory, 1980. 5. Kessner DM, Snow CK,Singer J: Assessmentof shallese children pose a challengefor the health resources of their government. “ 188 Clear, Vivid Photographs of the External & Middle Ear Bardbound Book With Annotations. For more information write or call... PD Ear Disease fluctuating hearing loss, which often results from otitis media with effusion,® might result in delayed educational achievement. Other investigators have promoted a more cautious view toward the link between otitis, hearing loss, and language!/ cognitive impairment.’ Certainly, the otologic problemsidentified for the Mar- 1. medical care in children. Contrasts in Health Status. Washington, DC Institute of Medicine, National Acad. of Sciences, 1974; 3:200. Casselbrant ML, Brostoff LM, Cantekin EI, et al.: Otitis media with effusion in preschool children. Laryngoscope 1985, 95:428-436. Paradise JL: Otitis media during early life: How hazardous to development? Pediatrics 1981; 8:869-873. Wilson J: Deafness in developing countries. Arch Otolaryngol 1985, 11:2-9. VOL. 42 NO. 8 ee 5 A * t from more intensive Fs impaired persons J services. Further, it has been suggested 3 that programs sup ¥ porting the general health needs for all audiologic problems pazjent demonstrate a hearing screening Marshallese children would offer hopefor between the two 4 q group of Marshallese children. improvement of the groups of children — issues raised by this preliminary study. those with a family history of exposure to the Bravo nuclear explosion, and those in the “nonexposed” control group. BeThis work was supported by Contract DE- a cause those children did not have direct “4 AC02-76CHG0016 with the U.S. Department of exposure to the 1954fallout, we believed Energy. Accordingly, the U.S. Government retains that the social disruption and dietary a nonexclusive, royalty-free licence to publish or changes resuting from American aid proreproduce the published form of this contribution, or to allow others to do so, for U.S. Government grams were more likely to be possible purposes. contributors to altered risk. In fact, we found that the prevalence of hearing loss was high overall, but was not signifia E cantly different for either group. x REFERENCES ag CONCLUSIONS By Dr. Michael Hawke M.D. @ § % who might benefit wad Clinical Pocket Guide To § 3 oo have been madetothe Marshallese Health Ministry for estab. lishing audiologic resources and arisk registry for hearing- a local hospital on the Island of Majuro. However, data gathered on the children tested in that general program were ex-cluded from our study. As we noted, one issue of interest to the health team was the possiblity of a £4 difference in risk for 4 pediatric nurse practitioner and her re public at large at the eS madeavailable to the ee al screening was A of practical delivery 4 of otologic services.* Recommendations 4 At that time a gener- oo they are insufficient 3 awareness and lack § screening program. H i. ian la), and an infant's position during feeding. Among Marshall Island children, such other factors as crowded housing, suboptimal nutrition, limited access to health care, and limited knowledge of treatments for ear problems interact to increase their vulnerability for hearing loss. The high prevalence of ear problems in this study might have been attributable in part to the way in which the chil- selection bias toward the inclusion of youngsters with active health problems. However, the audio- painful ears, and the availability of antj.4 biotic treatment. Successful treatmentof 4 middle-ear effusion is difficult withour# surgical intervention, and on balance ® be infections, type of milk breast of formu- dren were chosen. Participation in the annual pediatric health screening is voluntary, which probably resulted in a latehieainmermmmgeis einengen shaeemmge loss, as compared to a sample of children in the United States among whom the prevalence of hearing loss was 15.3%to 23.8% .> Likewise, 45% of the 131 Marshallese children had abnormal middleear function, as compared to an occurrence of 20% to 30% abnormal ears among children in North America during warm weather months, as reported by Casselbrantet al.° It is also significant that in our study the distribution of abnormalities was relatively unchanged across all the ages tested through adolescence, while most North American research shows a decline in occurrence of middle-ear abnormalities after the age of 6 to 7 years.® Therisk of children having or developing hearing/ear problemsis influenced by many factors, including ethnic or genetic predisposition, exposure to respiratory