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Identifying congenital hearing impairment. Personal experience based on selective hearing screening
1Department of Medical-Surgical Specialization, Otolaryngology and Cervico-Facial Surgery Division, University of Perugia, Italy.
Insights
Early detection of congenital hearing impairment is crucial for infant development. This study found that while high-risk infants had slightly delayed diagnoses, a significant portion of diagnosed infants had no risk factors, highlighting the need for improved screening methods.
Area of Science:
- Pediatrics
- Audiology
- Preventive Medicine
Background:
- Congenital hearing impairment (hypoacusis) is the most common congenital disease.
- Early detection is vital for language and cognitive development through interventions like hearing aids and rehabilitation.
- Current screening methods include selective screening for high-risk infants and in-hospital screening for newborns without risk factors.
Purpose of the Study:
- To critically review the timing of hypoacusis diagnosis at an audiology laboratory.
- To evaluate the effectiveness of selective and in-hospital hearing screening methods for infants.
- To identify challenges and propose improvements for congenital hearing loss screening.
Main Methods:
- Retrospective analysis of approximately 10 years of audiology screening data.
- Screening of children with and without congenital risk indicators for hearing loss.
- Comparison of diagnosis timing between high-risk and no-risk groups, and with international guidelines.
Main Results:
- High-risk infants diagnosed with hypoacusis were slightly older than international guidelines suggest.
- Approximately half of identified hypoacusic infants lacked congenital risk indicators, experiencing delayed diagnosis.
- Infants without risk factors diagnosed via in-hospital screening received early detection.
Conclusions:
- Selective screening alone results in delayed diagnosis for a significant proportion of infants with congenital hearing loss.
- In-hospital screening for infants without risk factors enables early detection.
- A combined approach of compulsory selective screening and in-hospital screening for all newborns is recommended to approach universal hearing screening.
Abstract:
If all degrees of permanent uni- or bilateral hypoacusis are taken into consideration, hearing impairment is the most common congenital disease. Early detection of permanent infantile hearing impairment has become extremely important in preventive medicine, since steps can be taken with hearing aids and rehabilitation to ensure better development of language and higher cognitive functions. Aim of this study is to provide a critical review of the time of diagnosis of hypoacusis at our audiology laboratory, where two methods were used to screen hearing of children with/without risk indicators. Results of approximately 10 years' work were re-examined during which time outpatient screening was conducted on children referred by colleagues in neonatology and paediatrics. All were carriers of congenital risk indicators associated with sensorineural and/or conductive hearing loss, based on the Joint Committee on Infant Hearing findings, or were suspected of being hypoacusic even if they had no known congenital risk factors. Hearing screening was conducted in hospital on newborns with no risk factors, within the first few days of birth. Results of the present study showed that when selective hearing screening was performed, the mean age of high-risk patients diagnosed with hypoacusis was slightly higher than that in international guidelines. Moreover, these patients represent approximately half the hypoacusic population identified in the study period. The other half of congenital hypoacusic subjects identified had no risk indicators and there was a significant delay in diagnosis due to later manifestation of symptoms indicating hypoacusis, and thus, in turn, delayed referral for hearing tests. In contrast, subjects without risk indicators who underwent in-hospital hearing screening and proved to be hypoacusic, were diagnosed early. In our experience, however, universal screening has considerable disadvantages, such as difficulty in covering the entire population, difficulty in follow-up after discharge from hospital, and last, but by no means least, significant organisational and professional commitments, making it impossible to perform in all hospitals. In order to ensure effective hearing screening for congenital hearing loss and, thus permit prompt identification of hypoacusic children, use of hearing aids and rehabilitation screening should incorporate two aspects. First, selection should be compulsory, thereby reducing waiting time between collecting case histories and performing outpatient tests; second, hospital screening of children without risk factors should be performed whenever possible. Integrating these two aspects would make it possible to approach the "utopia" of universal hearing screening.
