Rosh Pediatrics Practice Exam

For a 4-month-old boy with suspected hearing loss, which management step is most appropriate?

1. Bilateral cochlear implants

2. Intratympanic injection of dexamethasone

3. Mastoidectomy with tympanoplasty

4. Myringotomy with tympanostomy tube insertion

The correct answer is: Bilateral cochlear implants

In the management of a 4-month-old boy with suspected hearing loss, the most appropriate step is to consider the age and developmental stage of the child. Cochlear implants are generally indicated for children with profound sensorineural hearing loss who do not benefit from hearing aids. However, this decision typically comes after a thorough evaluation including a definitive diagnosis of hearing loss and assessment of the child's response to amplification devices, as cochlear implantation is usually not performed until older than 12 months due to specific developmental considerations. Therefore, the best approach to manage suspected hearing loss in a very young child, especially considering the options presented, would involve ensuring appropriate drainage of any fluid (if present), alleviating any potential conductive hearing loss, and allowing for further assessment of the child's hearing ability. This is where myringotomy with tympanostomy tube insertion becomes relevant, as it can address middle ear fluid related to otitis media, thus facilitating improved hearing and developmental outcomes. In summary, while cochlear implants can be a future management step for children with confirmed significant hearing loss, myringotomy with tympanostomy tube insertion is the more immediate and appropriate intervention for a young child with suspected hearing loss in order to clarify the nature of the hearing impairment and promote better