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Late diagnosis of congenital sensorineural hearing impairment: why are detection methods failing?
C Robertson1, S Aldridge, F Jarman
1Centre for Community Child Health and Ambulatory Paediatrics, Royal Children's Hospital, Parkville, Victoria, Australia.
Insights
Infant hearing screening fails to detect congenital sensorineural hearing impairment (SNHI) early. Many children with risk factors are missed, leading to delayed diagnosis and intervention, impacting long-term outcomes.
Area of Science:
- Audiology
- Pediatrics
- Public Health
Background:
- Congenital sensorineural hearing impairment (SNHI) requires early detection for optimal development.
- Universal infant screening programs aim for timely diagnosis.
- Delays in diagnosis and intervention negatively affect speech, language, and cognitive outcomes.
Purpose of the Study:
- To analyze the diagnostic pathways for children with congenital SNHI.
- To identify factors contributing to delayed diagnosis in Victoria, Australia.
- To evaluate the effectiveness of existing infant hearing screening protocols.
Main Methods:
- Retrospective study of 197 children diagnosed with SNHI between 1989-1991.
- Analysis of parent questionnaires (n=143) regarding risk factors and referral history.
- Review of screening test results and time intervals to diagnosis, aid fitting, and intervention.
Main Results:
- Median age at diagnosis was 18.0 months, significantly later than recommended screening age.
- 49% of children had known risk factors, but only 20% were referred pre-screening.
- Screening coverage was incomplete (63% eligible received it), with variable test efficacy.
- Parental and professional denial contributed to delays in 17% and 10% of cases, respectively.
Conclusions:
- Current infant hearing screening methods are insufficient for early SNHI detection.
- Inadequate screening coverage, test limitations, and denial contribute to diagnostic delays.
- Improved screening strategies and professional awareness are crucial for timely intervention in SNHI.
Abstract:
This study was designed to look in detail at the paths to diagnosis for a group of 197 children with congenital sensorineural hearing impairment (SNHI), who were diagnosed between 1989 and 1991 in the state of Victoria, Australia. Despite the existence of universal infant screening at 7-9 months by distraction test or questionnaire, the median age at diagnosis for the study group was 18.0 months, with median age at aid fitting of 20.8 months, and median age at commencement of specialised intervention programmes of 22.3 months. Parent questionnaires completed for 143 (73%) of these children showed that 49% had known risk factors for hearing loss yet only 20% of them had been referred for audiological assessment before the 7-9 month screen. Only 63% of those eligible for the 7-9 month screen had received it. Of those children who were screened by distraction test 46% passed as did 57% of those screened by questionnaire. Twenty four parents (17%) described how they had initially 'denied' their own observations of their infants' abnormal hearing behaviour. When concerns were raised with professionals, 10% of parents were falsely reassured without audiological assessment. Detection methods are failing through a combination of poor screen test efficacy, incomplete population coverage, and parental and professional denial.