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Dandruff (pityriasis capitis) is mainly a physiological process, the result of normal desquamation of scale from the scalp. It is most prevalent in adolescence and worst around the age of 20.

++ Treatment (if necessary)

Shampoos: zinc pyrithione (e.g. Dan-Gard, Head and Shoulders) or selenium sulfide (e.g. Selsun)


Method: massage into scalp, leave for 5 mins, rinse thoroughly twice wkly

Persistent dandruff

Persistent dandruff with severe flaking and itching indicates seborrhoeic dermatitis or psoriasis in which the scalp skin feels lumpy.

++ Treatment

Shampoos: coal tar + salicylic acid compound (Sebitar) shampoo or Ionil T plus shampoo


Method: as above, followed by Sebi Rinse or ketoconazole (Nizoral) shampoo


If persistent, esp. itching, and Nizoral shampoo ineffective, use a corticosteroid (e.g. betamethasone scalp lotion).


Deafness and hearing loss


Deafness is defined as impairment of hearing, regardless of its severity. It is a major community health problem requiring a high index of suspicion for diagnosis, esp. in children. Deafness may be conductive, sensorineural (SND) or a combination of both (mixed).


  • Deafness occurs at all ages but more common in the elderly—50% >80 yrs could be helped by a hearing aid.

  • The threshold of normal hearing is from 0 to 20 dB, about the loudness of a soft whisper.

  • Degrees of hearing impairment:

    • mild = loss of 20–40 dB (soft spoken voice is 20 dB)

    • moderate = loss of 40–60 dB (normal spoken voice is 40 dB)

    • severe = loss of 70–90 dB (loud spoken voice)

    • profound = loss of over 90 dB (shout)

  • People who have worked in high noise levels (>85 dB) are more than twice as likely to be deaf.

  • There is a related incidence of tinnitus with deafness.


Red flags that warrant referral

  • asymmetric sensorineural hearing loss

  • cranial nerve defects

  • ear canal or middle ear mass

  • deep ear pain

  • discharging ear

Figure D1

Prevalence of hearing problems with increasing age

Graphic Jump Location
Deafness in children

Deafness in childhood is relatively common and often goes unrecognised. A mother who believes that her child may be deaf is rarely wrong in this suspicion.

++ Screening

The aim of screening should be to recognise every deaf child by the age of 8–10 mths—before the vital time for learning speech is wasted.


Optimal screening times:


  • 8–9 mths (or earlier)

  • school entry


No child is too young for audiological assessment. Informal office tests are inadequate to exclude hearing loss.

++ Features


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