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Hearing Loss in Newborns with Cleft Lip and/or Palate
Enrica E K Tan1, Karen Y M Hee, Annie Yeoh
1Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore.
Insights
Newborns with cleft deformities have a significantly higher risk of hearing loss. Early identification through hearing screens is crucial, as failure of the initial screen accurately predicts the need for further evaluation.
Area of Science:
- Pediatric audiology
- Craniofacial anomalies
- Newborn hearing screening
Background:
- Infants with cleft deformities present a higher risk for hearing impairment.
- Routine hearing screening protocols may not fully capture the incidence of hearing loss in this population.
Purpose of the Study:
- To review hearing screen outcomes in newborns with cleft deformities.
- To assess the predictive value of initial hearing screens for otolaryngology referral.
- To evaluate the role of high-risk hearing screens in identifying hearing loss.
Main Methods:
- Retrospective audit of 123 newborns with cleft deformities.
- Analysis of universal newborn hearing screen (UNHS) and high-risk hearing screen data.
- Review of audiology records, including age at diagnosis, hearing loss type/severity, and interventions.
Main Results:
- 25.2% of newborns failed the initial automated auditory brainstem response (AABR).
- 67.5% of all infants required otolaryngology referral; 90.3% of those failing the initial AABR did.
- The incidence of hearing loss was 24.4%, predominantly conductive, significantly higher than the general hospital rate.
Conclusions:
- Newborns with cleft deformities have an elevated risk of hearing loss, often conductive.
- Initial AABR failure is a strong predictor of otolaryngology referral, potentially negating the need for a second AABR.
- High-risk hearing screens are vital for detecting hearing loss that may develop or be missed early on.
Introduction:
This study aims to review the results of hearing screens in newborns with cleft deformities.
Materials And Methods:
A retrospective audit of 123 newborns with cleft deformities, born between 1 April 2002 and 1 December 2008, was conducted. Data on the results of universal newborn hearing screens (UNHS) and high-risk hearing screens, age at diagnosis, severity/type of hearing loss and mode of intervention were obtained from a prospectively maintained hearing database.
Results:
Thirty-one of 123 newborns (25.2%) failed the first automated auditory brainstem response (AABR). Seventy percent of infants (56 out of 80) who passed the UNHS failed the high-risk hearing screens which was conducted at 3 to 6 months of age. Otolaryngology referral rate was 67.5% (83/123); 90.3% of 31 newborns who failed the first AABR eventually required otolaryngology referrals. Incidence of hearing loss was 24.4% (30/123; 25 conductive, 2 mixed and 3 sensorineural), significantly higher than the hospital incidence of 0.3% (OR: 124.9, 95% CI, 81.1 to 192.4, P <0.01). In terms of severity, 8 were mild, 15 moderate, 5 severe, 2 profound. Eighteen out of 30 infants (60%) were detected from the high-risk hearing screens after passing the first AABR.
Conclusion:
These newborns had a higher risk of failing the UNHS and high-risk hearing screen. There was a higher incidence of hearing loss which was mainly conductive. Failure of the first AABR was an accurate predictor of an eventual otolaryngology referral, suggesting that a second AABR may be unnecessary. High-risk hearing screens helped to identify hearing loss which might have been missed out early on in life or which might have evolved later in infancy.
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