• Parental or caregiver concern regarding hearing, speech, language,
or developmental delay.
• Family history of permanent childhood hearing loss.
• Stigmata or other findings associated with a syndrome known to
include hearing loss or eustachian tube dysfunction.
• Postnatal infections associated with hearing loss, including
• In utero infections, such as CMV, herpes, toxoplasmosis, rubella,
• Neonatal indicators including hyperbilirubinemia requiring exchange
transfusion, persistent pulmonary hypertension of the newborn associated
with mechanical ventilation, and conditions requiring extracorporeal
membrane oxygenation (ECMO).
• Syndromes associated with progressive hearing loss, such as neurofibromatosis,
osteopetrosis, and Usher syndrome.
• Neurodegenerative disorders, such as Hunter syndrome, or sensorimotor
neuropathies, such as Friedreich ataxia and Charcot-Marie-Tooth
• Head trauma.
• Recurrent or persistent otitis media with effusion for at least