OPTIMAL SURVEILLANCE AND HEARING SCREENING PROGRAMPrimary care physicians and the medical home often offer the first opportunity for an infant who failed newborn hearing screening in the hospital to obtain a repeat hearing screening test within the first month of life. These guidelines are intended to create a gold standard of care regarding this rescreening.
The Joint Committee on Infant Hearing (2007) recommends an inclusive strategy of surveillance of all children within the medical home based on the pediatric periodicity schedule. This protocol will permit the detection of children with either missed neonatal or delayed-onset hearing loss irrespective of the presence or absence of a high-risk indicator. These guidelines will also help physicians in creating this surveillance system within their practice setting.
The JCIH recognizes that an optimal surveillance and screening program within the medical home would include the following:
- At each visit, on the AAP periodicity schedule, infants should be monitored for auditory skills, middle-ear status, and developmental mile-stones (surveillance). A validated global screening tool should be administered to all infants at 9, 18, and 24 to 30 months or, if there is physician or parental concern about hearing or language, sooner.
- A careful assessment of middle-ear status (using pneumatic otoscopy and/or tympanometry) should be completed at all well-child visits, and children with persistent middle-ear effusion that last for 3 months or longer should be referred for otologic evaluation.
- If a child does not pass the speech-language portion of the global screening or if there is physician or caregiver concern about hearing or spoken-language development, the child should be referred immediately for further hearing evaluation by an audiologist and for a speech and language evaluation by a speech-language pathologist.
- Once hearing loss is diagnosed in a child, siblings are at increased risk of having hearing loss and should be referred for audiological evaluation.
- Children with risk indicators that are highly associated with delayed-onset hearing loss, such as family history of deafness, having received ECMO, or having CMV infection, should have diagnostic assessment by an audiologist at least annually. All infants with a lower risk indicator for hearing loss (such as NICU stay for over 5 days) should be referred for a diagnostic audiological assessment at least once by 24 to 30 months of age.