Testing Hearing in Infants and Children

• Indications: universal screening of neonates may be employed in the future, otherwise, should screen for high risk factors (TORCH infections or bacterial meningitis, family history, presence of other head and neck abnormalities, birth weight <1500 g, neonatal hyperbilirubinemia, Apgar score <4 at 1 minute or <6 at 5 minutes (asphyxia), prolonged stay at the neonatal intensive care unit or

ECMO)

• objective measures such as ABR, immittance testing, and otoacoustic emissions are the mainstay of testing

• Behavior Observation Audiometry: narrow band of tones (warble tones) are introduced via a speaker and the examiner observes for a response (eye widening, startle, head turn, etc) to provide a means for grossly estimating an infants' auditory thresholds

• by 3 years old may consider conventional testing

Ancillary Tests (may be considered for select cases)

• CT of Temporal Bones: may be considered to evaluate for inner ear disorders, cholesteatoma, and osteodysplasias

• Complete Blood Count: may suggest leukemic process, labyrinthitis, active inflammation

• Treponemal Studies: Lyme titers and VDRL/FTA-ABS (luetic labyrinthitis)

• Perchlorate Test and Thyroid Function Tests: indicated if suspect Pendred syndrome

• Lipid Profile: evaluate for hyperlipedemia (associated with hearing loss)

• Immune Function Tests: may suggest an autoimmune disorder (Cogan's)

• Electrocardiogram: screen for Jervell and Lange-Nielsen syndrome, Rifsum syndrome (retinitis pigmentosa, hypertrophic peripheral neuropathy, SNHL)

• Urine Analysis, Blood Urea Nitrogen, Serum Creatinine: screen for Alpert's and Branchio-oto-renal syndromes

• TORCH Studies: IgM assay which investigates common intrauterine infections (Toxoplasmosis, Other [syphilis], Rubella, Cytomegalovirus, Herpes simplex

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