Hearing

Risk Indicators for Hearing Loss

Children with one or more risk factors should receive monitoring of hearing, speech and language development and periodic hearing screening.

• Parent/caregiver concern regarding hearing, speech, language or developmental delay
• Recurrent or persistent otitis media with effusion for at least 3 months
• Family history of hereditary childhood sensorineural hearing loss
• In utero infection: cytomegalovirus, rubella, syphilis, herpes, and toxoplasmosis
• Craniofacial abnormalities incl. morphological abnormalities of the pinna and ear canal
• High Risk Neonatal Indicators:
  • Birthweight < 1500 g.
  • Hyperbilirubinemia at a serum level requiring exchange transfusion
  • History of persistent pulmonary hypertension of the newborn associated with mechanical ventilation
  • Apgar scores of 0-4 at 1 minute or 0-6 at 5 minutes
  • Mechanical ventilation lasting 5 days or longer
  • Use of extracorporeal membrane oxygenation
  • Ototoxic medications used in multiple courses or used with loop diuretics
• Physical findings associated with a syndrome known to include sensorineural or conductive hearing loss or Eustachian tube dysfunction
• Neurodegenerative disorders, such as Hunter's syndrome, or demyelinating disorders, such as Friedreich's ataxia and Charcot-Marie-Tooth syndrome
• Head trauma associated with loss of consciousness or skull fracture
• Postnatal infections associated with sensorineural hearing loss, including bacterial meningitis. mumps, or measles

Physical Findings of the Head and Neck associated wtih Hearing Impairment

• Heterochromia of the irises
• Malformation of the auricle or ear canal
• Abnormalities of the eardrum
• Dimpling or skin tags around the auricle
• Cleft lip and/or palate
• Asymmetry of facial structures
• Microcephaly
• Abnormal pigmentation of the skin, hair or eyes, e.g. Waardenburg's syndrome
• Recurrent or persistent otitis media
  

References

1. Universal Newborn Hearing Screening, Diagnosis and Intervention: Guidelines for Pediatric Medical Home Providers. AAP. Jan 2003.
2. Hearing assessment in infants and children: Recommendations beyond neonatal screening. Cunningham M, Cox EO et al. Pediatrics. 111(2):436-440, 2003.
3. Principles and Guidelines for early hearing detection and intervention programs. 2000 Position Statement. Joint Committee of Infant Hearing. American Academy of Audiology. 9:9-29.
4. Protocal for Diagnostic Audiologic Assessment:Follow-Up for Newborn Screening. Washington State Department of Health