The result of determination of some risk factors of hearing loss, deafness in neonates and infants Background: Newborns born prematurely or with high risk for hearing loss are 10 times more likely to develop hearing loss than well babies. Also, 1 out of 50 newborns hospitalized in the neonatal intensive care unit are at risk of hearing loss. The risk factors of hearing loss and deafness in children was first developed and tracked by Joint Committee on Infant Hearing in 1972, and has been further refined and updated since then. The last update was made in 2007 and used worldwide. The risk factors of hearing loss for children vary by age. Materials and methods: A case-control study was performed to identify some risk factors for the development of hearing loss and deafness in neonates and infants. The research case group included all the cases in which the diagnosis of congenital hearing loss or deafness was confirmed by the auditory brainstem response test (ABR) in the 3 stages of the study or the stage of diagnosis confirmation, while the control group included infants whose diagnosis was not confirmed and normal hearing was confirmed by the auditory brainstem response test (ABR). The study groups were selected in 1:1 ratio. Results: The perinatal disorders (OR 7.67; 95% CI; 3.61-16.34; p=<0.0001), genetic predisposition (OR 8.45; 95% CI; 1.04-68.46; p=0.045), PCOS (OR 2.85; 95% CI; 1.27-6.41; p=0.011), premature birth (OR 3.90; 95% CI; 1.27-6.41; p=<0.0001), hearing of children with congenital malformations (OR 16.55; 95% CI; 2.15-127.01; p=0.007) reduction and deafness are statistically significant. Conclusion: The perinatal disorders (OR 5.31), genetic factors (OR 10.01), congenital malformations (OR 2.65), ear disorders (OR 8.94), and premature birth (OR 2.57) are statistically significant factors in the development of hearing loss and deafness in neonates and infants.

The result of a study of prevalence, type and degrees Of hearing impairment in newborns and infants Introduction: Significant bilateral hearing loss is the most common congenital disorder of the newborn, occurring 2-3 times per 1000 live infants. In December 2012, for the first time in Mongolia, neonatal hearing screening was introduced at the National Center for Maternal and Child Health. We aimed at investigated the outcomes of neonatal hearing screening and diagnostics of type and degree of hearing loss in neonates and infants. Materials and methods: During the study period, 2019-2020, a total of 70,614 infants born in Urguu, Khuree, Amgalan maternity hospitals, Baganuur district health center, Intermed hospital, and the National Center for Maternal and Child Health were included in the prospective cohort study. The study was performed in three phases, following the clinical guidelines for neonatal hearing screening. Results from the well-baby newborn hearing screening program and diagnostic follow-up of referred children from 2019 to 2021 were included in calculating prevalence rates. Hearing loss was classified according to the degree and type. Results: A total of 94.1% of 70,614 children eligible for screening were included. A prevalence rate of bilateral hearing loss 2.23 per 1000 children was found. A prevalence rate of bilateral severe and profound hearing loss 1 per 1000 children was found. The mild sensorineural hearing loss 28 (26.0%) was most common in children, followed by moderate 19 (17,6%), severe 21 (19.4%), profound 19 (17.6%) and deaf 21 (19.4%). Conclusions: The coverage of hearing screening in maternity hospitals in Ulaanbaatar is relatively good (94.1%), but there is a repeat screening (62.1%) and follow-up and diagnostic tests (49.9%). shows that the system needs to be improved. Because of the well-by hearing screening program, reported results approximate prevalence rates of permanent hearing loss by severity.

BACKGROUND. Over 5% of the world’s population or 466 million people have disabling hearing loss (432 million adults and 34 million children). Profound sensorineural hearing loss and deafness can be treated successfully with a cochlear implant. A cochlear implant (CI) stimulates the auditory nerve, bypassing the defective cochlea, and provides auditory information to the developing brain, thus improving oral language. Children, who receive an early diagnosis of deafness and proper speech rehabilitation, and undergo early cochlear implantation, are able to develop auditory and linguistic skills at par with their hearing peers. METHOD. 6 deaf patients who underwent unilateral Cochlear Implantation at the NCMCH from January 2017 to June 2018 were included in the study. Participants were divided into 3 groups on the basis of age at which participants underwent implantation. RESULTS. Pre-op average MAIS was 1,6/40, Category of Auditory Performance (CAP) - 0,77 and SIR - 0,7/5 in all implanted age groups. Score increased over time to attain average score MAIS -29.6/40, CAP- 3.3/7 SIR-2.7/5 in all implanted groups at one year after implantation. CONCLUSION. There is a need for more research on patient age and gender composition, and outcomes of cochlear implantation and hearing devices in this study population. A robust set of study measures would provide statistical significance. Parent-child relationships affect hearing and speech therapy results, so there’s a need to improve parents’ knowledge regarding these therapies.

BACKGROUND. Hearing loss is likely to be the most common congenital abnormality in newborns, with a reported prevalence of 1 to 2 per 1000 live births. It is vitally important to diagnose infant hearing loss or deafness at its early stages. Early detection and intervention is critical to prevent the adverse consequences of a delayed diagnosis on speech, language and cognitive development. Universal screening of hearing loss has been introduced in practice with distortion product of otoacoustic emission (DPOAE). The automated auditory brainstem response (AABR) screener is a dedicated hearing screening device which provides information not only about the outer and middle ear and cochlea but also about the auditory pathway up to the brainstem. METHODS. The study was descriptive and based on a retrospective analysis of the two year period databases (2014-2016) from the newborn hearing screening program. We have started the hearing screening from December 2012. Between 2014 to 2017 we have been screened total of 11218 newborns. We tested automated audiotory brainstem response of the newborns in their 1- 3 days of birth, using Maico MB11 Beraphone machine (German) according to the Joint Committee on Hearing Screening guidence. We assessed the test result of “pass” as “normal hearing, “refer” as to rescreen and tested again after 1 month. Infants referred again were gone to a specialist for further audio logic analysis (behavioral tests, auditory brainstem response, otoacoustic emissions and auditory steady state response). RESULTS. Our study was the first in Mongolia. Total of 10290 newborns passed bilaterally out of 11218 and 1323 referred in the first screening. For the rescreen test, 1088 out of 1134 infants resulted with “pass” and 46 infants with “refer”. For those infants, we did ABR test in their 3 and 6 months, and result of 9 children (18 ears) have bilateral profound hearing loss, 2 children (2 ears) have bilateral mixed profound hearing loss and 13 (26 ears) have bilateral profound conductive hearing loss. Coverage rate was 34,7%. First refer rate was 11,7%. Follow rate was 39,7%. We conducted the cochlear implantation surgery for 2 children out of 11. Currently, we are preparing other infants with bilateral profound hearing loss of 0-3 years old for the follow up CI surgery. CONCLUSION. In Mongolia, the data of infant hearing difficulties and prevalence of deafness is lacking. Although newborn hearing screening program has been approved in 2014 and brought opportunities to conduct universal neonatal hearing screening program. But at the moment, its only available at NCMCH which located in Ulaanbaatar city. 11 cases have a bilateral profound hearing loss out of 11218 newborns. Our study result shows similiar pattern (1.1 - 1.3 ear deafness in every 1000 birth. Lenarz et all.2008). Automated audiotory brainstem response was efficient in early identification of newborn hearing loss with high sensitivity and specification rates. Small population in the remote locations, high birth percentage, short period in the hospital after birth, lack of technology and human resources, and other factors result in higher level of referral rate newborn hearing screening and lower level of follow up and confirmation rate referals in Mongolia.

Introduction: In gallstone diseases, common bile duct stones and thickened bile could cause hepatitis or other difficulties. Therefore intraoperative cholangiography is helpful in many operations besides detecting and diagnosing the gallstones in common bile duct. Materials and Methods: Out of 266 patients who had undergone Laparoscopic Cholecystectomy surgery in GrandMed Hospital, 14 patients were found to have jaundice and cholestasis after undergoing laboratory and radiology tests. Results: These 14 patients have all undergone IOC. 7 out of 14 patients were found to have positive cholangiogram and the other 7 - negative. Biliary tract tumor and anatomic anomalies were not identified among these patients. Conclusion: Making analysis using only laboratory data is not adequate for directly detecting choledocholithiasis. IOC not only shows bile tract obstruction and determines cholestasis causes, but it also identifies the anatomy biliary tract, which is a procedure that facilitates dissection. Therefore IOCcan prevent the most serious complication of laparoscopic cholecystectomy - common bile duct injury. The sensitivity of IOC ensures the gathering of important information on time, so suggest to use it for every suspicious case.

Introduction: In gallstone diseases,common bile duct stones and thickened bilecould cause hepatitis or other difficulties.Therefore intraoperative cholangiography ishelpful in many operations besides detectingand diagnosing the gallstones in commonbile duct.Materials and Methods: Out of 266patients who had undergone LaparoscopicCholecystectomy surgery in GrandMedHospital, 14 patients were found to havejaundice and cholestasis after undergoinglaboratory and radiology tests.Results: These 14 patients have allundergone IOC. 7 out of 14 patients werefound to have positive cholangiogram andthe other 7 - negative. Biliary tract tumorand anatomic anomalies were not identifiedamong these patients.Conclusion: Making analysis usingonly laboratory data is not adequate fordirectly detecting choledocholithiasis. IOCnot only shows bile tract obstruction anddetermines cholestasis causes, but it alsoidentifies the anatomy biliary tract, whichis a procedure that facilitates dissection.Therefore IOCcan prevent the most seriouscomplication of laparoscopic cholecystectomy- common bile duct injury. The sensitivityof IOC ensures the gathering of importantinformation on time, so suggest to use it forevery suspicious case.

Introduction: Various modalities oftechniques from standard discectomy,microdiscectomy, percutaneous discectomy,and transforaminal endoscopic discectomyhave been in use for lumbar intervertebraldisc prolapse1. The access to spine is keptto a minimum without stripping paraspinalmuscles minimizing muscle damage bytransforaminal endoscopic approach2.Currently in the population of the Mongoliabeen increased of the spinal nerve rootcompression, which are resulting in lumbardisc pathological changes. In other developedcountries has been successfully introducingthe spine endoscopic surgery use for thatpathological changes. In regard to our countryhad not yet implemented for until now asthese high technological surgeries3. Spinesurgery department team of the GrandMedhospital had successfully introduced that thespine endoscopic surgery.Materials and Methods: We performedtransforaminal endoscopic lumbardiscectomy surgeries on patients age of 24,38, 78 on July/23/2016 All patients withsingle nerve root compression due to Lumbardisc herniations, including sequestrated ormigrated and selected central disc at L4-5. All patients had preoperative MRI andpostoperative MRI to check the adequacy ofdecompression. All patients were operatedby 18-mm ports of the S-Gun endoscopicequipments. Procedure had done under localanesthesia. Postoperatively, all patients weremobilized as soon as the pain subsided anddischarged within 24-48 h post-surgery.Patients were followed up at 2, 6 weeks.Results: The mean follow up was 2-6weeks. The average surgical time was 70min (range 25-210 min). Average blood losswas 20-30 ml. Postoperative MRI showedcomplete decompression. All of patients hadgood-to-excellent results and straight raisingleg test (Lasegue) were 90/90 respectively.All patient is preoperatively visual analogyscale was 8±1 and then became to 1±1.Conclusion: Microendoscopic discectomyis minimally invasive procedure fordiscectomy with results of this procedure areacceptable safe and effective. However, forthis technique has required to do accuracyand experienced surgeon.

Hearing loss is likely to be the most common congenital abnormality in newborns, with a reported prevalence of 3 per 1000 live births. It is vitally important to diagnose infant hearing loss or deafness at its early stages. The automated auditory brainstem response (AABR) screener is a dedicated hearing screening device which provides information not only about the outer and middle ear and cochlea but also about the auditory pathway up to the brainstem. The data presented were collected in the well-baby nursery. Overall, data from 5857 neonates screened from December 2012 to July 2015 were analyzed in this study. During 1-3 days after birth, they were analyzed with automated auditory brainstem response (AABR). Neonates referred the screening were scheduled for repeated diagnostic evaluation within a month. And newborns referred again were sent to a specialist for further audiology analysis. Out of the 5857 babies screened, 5050 passed bilaterally and 807 referred. The number of infants referred for 2nd stage, post-discharge re-screening was 319. Of this group, 287 passed bilaterally and 32 failed the re-screening in one or both ears. Diagnostic testing was performed on all of the 32 infants who were referred. The resulting referral rate was 13.7% for first stage and 1,4% for second stage. The follow-up rate was 37%. The confirm rate was 0,13%. Profound bilateral sensor neural hearing loss was identified in 3 infants. Profound bilateral mixed hearing loss was identified in 1 infant. Automated auditory brainstem response (AABR) was efficient in the early identification of newborn and infant hearing loss with high sensitivity and specificity rates. Due to the results of the study, 3 out of 5857 infants were diagnosed with a profound hearing loss and it’s approximately close to the results of other studies and statistics.

Hearing loss is likely to be the most common congenital abnormality in newborns, with a reported prevalence of 3 per 1000 live births. It is vitally important to diagnose infant hearing loss or deafness at its early stages. The automated auditory brainstem response (AABR) screener is a dedicated hearing screening device which provides information not only about the outer and middle ear and cochlea but also about the auditory pathway up to the brainstem.The data presented were collected in the well-baby nursery. Overall, data from 5857 neonates screened from December 2012 to July 2015 were analyzed in this study. During 1-3 days after birth, they were analyzed with automated auditory brainstem response (AABR). Neonates referred the screening were scheduled for repeated diagnostic evaluation within a month. And newborns referredagain were sent to a specialist for further audiology analysis.Out of the 5857 babies screened, 5050 passed bilaterally and 807 referred. The number of infantsreferred for 2nd stage, post-discharge re-screening was 319. Of this group, 287 passed bilaterally and 32 failed the re-screening in one or both ears. Diagnostic testing was performed on all of the 32 infants who were referred. The resulting referral rate was 13.7% for first stage and 1,4% for second stage. The follow-up rate was 37%. The confirm rate was 0,13%. Profound bilateral sensor neural hearing loss was identified in 3 infants. Profound bilateral mixed hearing loss was identified in 1 infant.Automated auditory brainstem response (AABR) was efficient in the early identification of newborn and infant hearing loss with high sensitivity and specificity rates. Due to the results of the study, 3 out of 5857 infants were diagnosed with a profound hearing loss and it’s approximately close to the results of other studies and statistics.