Exploring reasons for late identification of children with early-onset hearing loss
Elizabeth M Fitzpatrick1, Johnny Cesconetto Dos Santos2, Viviane Grandpierre1
1Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8L1, Canada; Child Hearing Lab, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Ontario K1H 8M5, Canada.
Insights
Despite universal newborn hearing screening (UNHS), 16.5% of infants with hearing loss experienced delays in confirmation. Infants with developmental issues or middle ear dysfunction were most at risk for delayed diagnosis and intervention.
Area of Science:
- Pediatric Audiology
- Public Health
- Developmental Pediatrics
Background:
- Early identification of childhood hearing loss is crucial for optimal language development.
- Universal Newborn Hearing Screening (UNHS) programs aim to detect hearing loss early, but delays in confirmation persist.
- Understanding reasons for delayed diagnosis is key to improving intervention timeliness.
Purpose of the Study:
- To determine the proportion of children with delayed confirmation of congenital and early-onset hearing loss within a Canadian UNHS program.
- To identify the contributing factors to these delays in diagnosis.
Main Methods:
- Population-level data collected prospectively for children identified through UNHS.
- Defined delay as >3 months between initial audiologic assessment and confirmation of hearing loss.
- Conducted detailed chart reviews to ascertain reasons for delayed confirmation.
Main Results:
- Of 182 infants with hearing loss, 30 (16.5%) experienced diagnostic delays exceeding 3 months.
- Median age for first assessment was 3.7 months and confirmation was 13.8 months for delayed cases.
- Common factors included developmental/medical issues (73.3%), middle ear dysfunction (50%), and family follow-up concerns (30%).
Conclusions:
- Significant delays in hearing loss confirmation and intervention occur despite UNHS.
- Infants with developmental/medical issues and middle ear disorders face a higher risk of prolonged diagnostic timelines.
- Addressing these barriers is essential to ensure timely intervention for pediatric hearing loss.
Introduction:
Several studies have shown that early identification of childhood hearing loss leads to better language outcomes. However, delays in the confirmation of hearing loss persist even in the presence of well-established universal newborn hearing screening programs (UNHS). The objective of this population-based study was to document the proportion of children who experienced delayed confirmation of congenital and early onset hearing loss in a UNHS program in one region of Canada. The study also sought to determine the reasons for delayed confirmation of hearing loss in children.
Methods:
Population level data related to age of first assessment, age of identification and clinical characteristics were collected prospectively for all children identified through the UNHS program. We documented the number of children who experienced delay (defined as more than 3 months) from initial audiologic assessment to confirmation of hearing loss. A detailed chart review was subsequently performed to examine the reasons for delay to confirmation.
Results:
Of 418 children identified from 2003 to 2013, 182 (43.5%) presented with congenital or early onset hearing loss, of whom 30 (16.5%) experienced more than 3 months delay from initial audiologic assessment to confirmation of their hearing disorder. The median age of first assessment and confirmation of hearing loss for these 30 children was 3.7 months (IQR: 2.0, 7.6) and 13.8 months (IQR: 9.7, 26.1) respectively. Close examination of the factors related to delay to confirmation revealed that for the overwhelming majority of children, a constellation of factors contributed to late diagnosis. Several children (n = 22; 73.3%) presented with developmental/medical issues, 15 of whom also had middle ear dysfunction at assessment, and 9 of whom had documented family follow-up concerns. For the remaining eight children, additional reasons included ongoing middle ear dysfunction for five children, complicated by family follow-up concerns (n = 3) and mild hearing loss (n = 1) and the remaining three children had isolated reasons related to family follow-up (n = 1) or mild hearing loss (n = 2).
Conclusion:
Despite the progress made in the early detection of pediatric hearing loss since UNHS, a substantial number of children referred for early assessment can experience late confirmation and intervention. In particular, infants with developmental and/or medical issues including middle ear disorders are at particular risk for longer time to confirmation of hearing loss.
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