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An Enhanced Audiologic Protocol for Early Identification of Conductive Hearing Loss in Patients with Cleft Palate
Elizabeth West Ellis1,2,3, Miriam R Smetak1, Alexandra Alving-Trinh4
1Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Insights
Conductive hearing loss (CHL) is common in infants with cleft palate (CP), even after passing newborn hearing screening. An enhanced audiologic protocol allows for earlier identification of CHL in these high-risk infants.
Area of Science:
- Pediatric Audiology
- Craniofacial Anomalies
- Hearing Health
Background:
- Infants with cleft palate (CP) have a higher risk of developing conductive hearing loss (CHL).
- Newborn hearing screening (NBHS) may not detect all cases of CHL in this population.
- Early identification and intervention for CHL are crucial for speech and language development.
Purpose of the Study:
- To determine the prevalence and onset of CHL in pediatric patients with CP before palatoplasty.
- To evaluate the effectiveness of an enhanced audiologic protocol for early CHL detection.
- To characterize the age of CHL identification in infants with CP.
Main Methods:
- Retrospective cohort study at a tertiary care center.
- Compared a standard audiologic protocol (testing at 9 months) with an enhanced protocol (earlier testing).
- Included pediatric patients with CP who had pre-operative audiologic workup.
Main Results:
- The enhanced protocol identified CHL in 48% of infants by 3 months and 20% by 6 months of age.
- The enhanced protocol significantly reduced the number of patients not undergoing post-NBHS testing (44.9% to 4.2%).
- No significant difference in NBHS pass rates or subsequent hearing loss was observed between standard and enhanced protocols initially.
Conclusions:
- Conductive hearing loss (CHL) is prevalent in infants with cleft palate (CP) even with normal newborn hearing screening (NBHS).
- An enhanced, earlier, and more frequent audiologic testing protocol is recommended for infants with CP.
- Early detection of CHL in infants with CP is critical for timely intervention.
Objective:
To characterize the onset and prevalence of conductive hearing loss (CHL) in pediatric patients with cleft palate (CP) prior to palatoplasty with an enhanced audiologic protocol.
Design:
Retrospective cohort study.
Setting:
Multidisciplinary cleft and craniofacial clinic at a tertiary care center.
Patients:
Patients with CP who received audiologic workup pre-operatively. Patients with bilateral permanent hearing loss, expiration prior to palatoplasty, or no pre-operative data were excluded.
Interventions:
Patients with CP born February 2019 to November 2019 who passed newborn hearing screening (NBHS) received audiologic testing at 9 months of age (standard protocol). Patients born December 2019 to September 2020 underwent testing prior to 9 months of age (enhanced protocol).
Main Outcome Measures:
Age of identification of CHL in patients after implementation of the enhanced audiologic protocol.
Results:
The number of patients who passed their NBHS in the standard protocol (n = 14, 54%) and the enhanced protocol (n = 25, 66%) did not differ. Infants who passed their NBHS, but demonstrated hearing loss on subsequent audiologic testing did not differ between enhanced (n = 25, 66%) and standard cohort (n = 14, 54%). Of patients who passed NBHS in the enhanced protocol, 48% (n = 12) had CHL identified by 3 months, and 20% (n = 5) by 6 months of age. With the enhanced protocol, patients who did not undergo additional testing post NBHS significantly dropped from 44.9% (n = 22) to 4.2% (n = 2) (P < .0001).
Conclusion:
Even with passed NBHS, CHL is still present for infants with CP pre-operatively. Earlier and more frequent testing for this population is recommended.
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