Management of the hearing impaired infant

With the advent of new testing methods for screening and confirmation of hearing loss in the newborn and setting up neonatal screening programs across the country, significant number of children with hearing loss are being diagnosed very early. Although still considered as one of the best behavioural tests in the competent hands, distraction testing is becoming superseded by more refined and controlled techniques such as visual reinforcement audiometry which is capable of determining a more complete audiometric profile of an infant from about the age of 6 months. A combination of these methods has allowed audiologists to bring down the average age of diagnosis of permanent congenital hearing impairment (PCHI) from over 2 years to well below 12 months. At the same time, increasingly complex and sophisticated hearing instruments are being developed to address traditional problems and also to deliver better amplified speech. Habilitating a neonate with a hearing loss is often challenging and requires a significant amount of resources, expertise and experience. Determining the infant's amplification needs could be difficult, as often the audiometric information is not complete. Further, selecting a suitable hearing instrument for an infant from a vast range is not easy and measuring the outcome after fitting hearing aids, especially in a few months old infant, can be extremely hard. With professionals becoming more confident in implanting younger children and realizing the benefits of early implantation, especially for speech & language development, there is a growing demand for referring infants as early as possible to the implant teams. Providing amplification is only the beginning of the process of habilitation. A multidisciplinary team approach is extremely important in this process and inclusion of the parents in the multidisciplinary team managing the infant often leads to a much improved outcome. There is growing evidence that early diagnosis and habilitation of PCHI leads to better speech and language development and more children being educated in the mainstream setting.