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Tri-Regional Infant Hearing Program Screening for Risk for Hearing Loss |
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Congenital and neonatal risk factors for permanent hearing loss may include:
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birthweight less than 1200 grams
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five-minute APGAR score less than or equal to 3
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Congenital Diaphragmatic Hernia (CDH)
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Persistent Pulmonary Hypertension of the Newborn (PPHN)
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Hypoxic-Ischemic Encephalopathy (HIE), Sarnat II or III – brain injury due to decreased blood flow/oxygen
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Intra-ventricular Hemorrhage (IVH), Grade III or IV – bleeding into the ventricles of the brain
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Peri-ventricular Leukomalacia (PVL) – abnormality of the white mater surrounding the ventricles in the brain
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Extra-Corporeal Membrane Oxygenation (ECMO), inhaled Nitrous Oxide (iNO) or High-Frequency Oscillatory (HFO) or Jet (HFJ) ventilation
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Hyperbilirubinemia greater than or equal to 400 μΜ or exchange levels
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craniofacial anomaly (i.e. a very small, malformed or absent ear or ear canal, cleft lip and/or palate)
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syndromes associated with hearing loss (i.e. Down, Goldenhar, CHARGE)
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ototoxic medication dosage risk (i.e. double dose error)
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proven perinatal TORCHES infection such as toxoplasmosis, rubella, herpes, syphilis or cytomegalovirus (CMV)
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proven meningitis (bacterial or viral)
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family history of a permanent childhood hearing loss – baby’s sibling, parent, grandparent, aunt or uncle has a permanent hearing loss that was present during childhood (less than 18 years old)
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other high risk indicator specified by baby's treating physician
All newborns with risk indicators for hearing impairment should be screened before discharge from the hospital, using AABR instrumentation. Babies with any of the above indicators are at risk for progressive early childhood hearing loss and will be monitored by the Infant Hearing Program until they are 30 months corrected.
A refer result at any point indicates the baby should have a comprehensive hearing assessment. Because these babies have risk indicators, they will go directly to an audiology assessment with only one AABR refer result.
NEONATAL RISK FACTORS
Babies who were successfully screened at birth (0 to 4 months of age) may be referred to the Infant Hearing Program up to the age of 24 months if they exhibit an acquired, late-onset or progressive risk factor for permanent hearing loss. Hearing screening and assessment services will be provided for these infants as soon as possible upon referral.
Referral must be based on evidence of a valid risk indicator for permanent hearing loss. The indicators include, but should not be limited to:
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parent/caregiver concern about hearing/speech/language
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postnatal infections associated with sensorineural hearing loss (i.e. meningitis, viral encephalitis, labyrinthitis)
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syndromes associated with progressive hearing loss (i.e. neurofibromatosis, osteopetrosis, Stickler, Usher)
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neurodegenerative disorders (i.e. Hunter syndrome) and sensory motor neuropathies (i.e. Friedreich’s ataxia, Charcot-Marie-Tooth syndrome)
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head trauma sufficient to cause unconsciousness or skull fracture
(from Well-baby (DPOAE) Screening - Protocol and Training Manual – MCYS -2002
The “LittlEARS Auditory Questionnaire” is a parent questionnaire that evaluates all types of auditory behaviour which are observable as a reaction to acoustic stimuli. The Auditory Questionnaire is the first module of the LittlEARS battery, which is designed to assess the preverbal auditory development in very young children.
The “LittlEARS Auditory Questionnaire” is intended to follow the auditory development of children from newborn hearing screening to 24 months of age or hearing impaired children with cochlear implants or hearing aids with a hearing age (time after first fitting of the devices) of 0-24 months.
The questionnaire was standardized on 218 normal hearing children aged 0-24 months and is currently being evaluated on children with cochlear implants. Expected values and minimal values are given for individual comparison.
The questionnaire consists of 35 questions, which can be completed by parents.
Completion instructions are provided on the questionnaire. It takes about 10 minutes for the parent to complete the questionnaire.
