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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:
• birthweight < 1500 g
• APGAR (5 minute) 0-6
• perinatal TORCHES infection – toxoplasmosis, rubella, cytomegalovirus, herpes, syphilis (CMV is especially important)
• postnatal infections associated with hearing impairment, including bacterial meningitis, viral encephalitis or labyrinthitis
• hyperbilirubinemia at serum levels indicating exchange
• Ototoxic medication dosage risk (e.g., double dose error – standard courses of aminoglycoside antibiotics with normal trough levels are no longer considered a significant risk indicator)
• any condition requiring ECMO (extracorporeal membrane oxygenation)
• mechanical ventilation > 5 days
• PPHN (persistent pulmonary hypertension) associated with mechanical ventilation
• indicators of syndromes associated with hearing loss (e.g. Down, Goldenhar, CHARGE)
• craniofacial anomalies (including dysmorphic pinna/canal, ear tags)
• significant head trauma associated with loss of consciousness or skull fracture
• family history of childhood permanent hearing impairment
All newborns with risk indicators for hearing impairment should be screened before discharge from the hospital (if admitted to a special care nursery), 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 three years old.
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:
• postnatal infections associated with hearing impairment, including bacterial meningitis, viral encephalitis or labyrinthitis
• stigmata or other findings associated with a syndrome known to include a sensorineural and/or conductive hearing loss (e.g. neurofibromatosis, osteopetrosis, Usher's syndrome)
• neurodegenerative disorders, such as Hunter syndrome, or sensory motor neuropathies such as Friedreich's ataxia and Charcot-Marie-Tooth syndrome
• significant head trauma associated with loss of consciousness or skull fracture that required neurological consultation
• family history of childhood permanent hearing impairment
(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.
