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Moderate consumption of HLSO preserves CL and mitochondrial function in the failing heart and may be a useful adjuvant therapy for this condition.

Image-guided bone tumor biopsies can be successfully used to acquire cellular and molecular material for analyses in patients with osteoblastic prostate cancer metastases. Diagnostic yields are significantly increased in lesions with areas of radiolucency, density ≤ 475 HU, ill-defined margins, and interval growth and in patients with alkaline phosphatase > 110 U/L.

Objectives After completing this article, readers should be able to: 1. Determine the difference between conductive and sensorineural hearing loss. 2. Discuss the congenital and acquired causes of hearing loss. 3. Delineate the most appropriate times for screening, diagnosis, and interventions for hearing loss. 4. List the risk factors for hearing loss in all children. 5. Recognize the need for identification of hearing loss and prompt intervention in all children. Case Studies Case 1 During his routine health supervision visit, a healthy 2-year-old boy is noted to have an isolated speech delay. There is no family history of hearing problems. On questioning about the child's newborn hearing screen, the mother says, "They said something about repeating it, but we were pretty busy, so we never got around to it. Since no one mentioned it again, I didn't think it was important." The child is referred to audiology and diagnosed with moderate bilateral sensorineural hearing loss. A hearing aid and intensive speech therapy are recommended. Case 2 A 4-year-old girl presents for evaluation of behavioral problems. Her parents are worried about attention-deficit disorder. They report that she frequently ignores their requests, does not seem to pay attention, and has trouble following instructions. In addition, she has not outgrown her temper tantrums like other children with whom she plays. She can understand preschool activities when the whole class is doing them, but she has the most difficulty with directions given to her individually. She has had frequent medical visits for acute otitis media. Physical examination reveals tympanic membranes that are retracted, with some scarring bilaterally. In-office tympanometry and audiometry suggest a moderate conductive hearing loss. Due to concerns that her behavioral problems are related to her hearing loss, she is referred to an otolaryngologist for consideration of tympanostomy tube placement.

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