Inspect the external ear. An imaginary line from the inner and outer canthus of the eye toward the vertex should be at or below the level of the superior attachment of the ear. Low-set ears are often associated with congenital kidney defects or chromosomal disorders. Frequently, the ears are misshapen as a result of intrauterine positioning. Such misshaping usually resolves within 1 to 2 days after birth. In rare instances, one ear is malformed and reduced in size.
*As prophylaxis against gonorrheal conjunctivitis, also known as ophthalmia neonatorum.
This condition, microtia, is often associated with a condition called hemifacial microsomia or Goldenhar's syndrome. It is frequently associated with other anomalies on the ipsilateral side of the face.
Are any skin tags present? A skin tag or cleft in front of the tragus often represents a remnant of the first branchial cleft and may be an isolated anomaly or part of a more widespread group of malformations, such as Treacher Collins syndrome or the aforementioned hemifacial microsomia.
Hearing in newborns may be tested by using the primitive acoustic blink reflex. Blinking in response to snapping of the fingers or a loud noise indicates that the newborn can hear. This is a crude test with low sensitivity. A negative response should be further tested with a specific pure-tone screening device. Most states now mandate neonatal hearing screening before discharge from the birth hospital. The parents of a child who passes the screen can be told with confidence that their child has normal hearing at birth. (Some congenital causes of deafness may cause progressive hearing loss over the first 2 years of life.) Only a fraction of children who fail the screen do in fact have hearing deficits.
The external canal should be inspected. Hold the otoscope (as indicated in Chapter 11, The Ear and Nose) by bracing it against the newborn's head. Insert the otoscope by pulling the pinna gently downward. The external canal is usually filled with vernix caseosa, and so the tympanic membrane may not be seen. If the tympanic membrane can be seen, usually only the most superior portion is visualized. The tympanic membrane may appear to be bulging, with amniotic fluid behind it. This is a normal condition. Rotation of the tympanic membrane to the adult position occurs within 6 to 12 weeks.
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