Younger patients and those who have received higher radiation doses are more likely to experience sclerotic side effects and eustachian tube dysfunction. They are also at greater risk for developing sensorineural hearing loss. Patients should have audiograms or brainstem auditory evoked response (BAER) tests performed yearly, or as clinically indicated. Speech and language evaluations should be performed at the end of treatment and as needed for clinical concerns. Those children with hearing loss will require routine speech and language therapies. Special educational interventions may be required as well, including alternative learning methods, individualized education plans (IEP) and preferential seating in the classroom. Table 7.2 lists various amplification and assisted living devices currently available. The use of a hearing aid can help amplify any residual hearing. Personal

Table 7.2. Amplification and assisted listening devices for children with hearing loss devices, such as FM trainers, can aid in reducing the signal-to-noise ratio in various listening situations, e.g., in the classroom, where, at times, there may be significant background noise.

For those suffering with chronic otitis, ENT referral is indicated. Treatment usually includes antibiotic therapy, myringotomy and/or the placement of pressure-equalizing tubes. Chronic cerumen and obstruction of the ear canal will require routine cleaning and the use of agents to soften the cerumen. Some patients may require treatment for otitis externa with the use of topical otic drops. These patients should avoid submersion in water without protective earplugs.

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