Chapter 52. Hearing Screening

Indications

• • Conductive hearing loss results from an obstruction of the air conduction pathway in the outer or middle ear.

  • Sensorineural hearing loss results from a defect in the cochlea or auditory nerve.

  • Both forms of hearing loss may be congenital or acquired.

  • The American Academy of Pediatrics recommends universal newborn hearing screening (UNHS) for all infants for the following reasons:

  • • Hearing loss in infants is not readily detectable by routine clinical observation.

    • Screening programs based on the presence of risk factors or family history will miss up to 50% of children with hearing loss because these children lack identifiable risk factors.

    • Infants identified before age 6 months demonstrate better language development than those identified later.

  • Screening should be completed during the hospital birth admission; before discharge from the neonatal intensive care unit; or for alternative birth locations, such as home births before 1 month of age.

  • When UNHS is not available, infants with the following risk factors should be screened before 1 month of age:

  • • Stay in neonatal intensive care unit of 48 hours or more.

    • Stigmata or other findings associated with syndrome known to include hearing loss.

    • Family history of permanent childhood hearing loss.

    • Craniofacial anomalies, including abnormalities of the pinna and ear canal.

    • In utero infections associated with hearing loss, including cytomegalovirus (CMV), herpes, toxoplasmosis, or rubella.

  • Children with the following risk factors for progressive or delayed-onset hearing loss should be tested every 6 months until at least 3 years of age, even if they passed the newborn screening:

  • • 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 bacterial meningitis.

    • In utero infections, such as CMV, herpes, toxoplasmosis, rubella, and syphilis.

    • 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 disease.

    • Head trauma.

    • Recurrent or persistent otitis media with effusion for at least 3 months.

  • The American Academy of Pediatrics recommends that all children receive hearing screening at their annual well-child visits:

  • • Age-appropriate objective testing at ages 4, 5, 6, 8, 10, 12, 15, and 18 years of age.

    • Subjective evaluation by history at all other annual well-child visits.

  • In addition to otoacoustic emissions, auditory brainstem response, and conventional pure tone audiometry, audiologists may use behavioral assessments.

Contraindications

Relative

• • Wax in the ear canal may interfere with otoacoustic emissions.