Hearing Screening

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Abstract
1. Jennifer Sokol, FRACP* 2. Martyn Hyde, PhD† 1. *Fellow in Neonatal Intensive Care, Division of Pediatrics, Department of Neonatology, Hospital for Sick Children, University of Toronto; Consultant Neonatologist, Princess Margaret Hospital for Children, Perth, Western Australia 2. †Professor, Otolaryngology/Public Health Sciences, Hearing and Balance Unit, Mt. Sinai Hospital, University of Toronto, Ontario, Canada After completing this article, readers should be able to: 1. Describe the prevalence and burden of hearing impairment. 2. Delineate the “gold” and “proxy” gold standards for measuring hearing impairment. 3. Describe the screening tests currently used to detect newborn hearing impairment. 4. Identify the advantages and disadvantages of universal newborn hearing screening. 5. Describe appropriate hearing screening methods after infancy. A number of authors suggest that the critical period for development of the auditory system and speech commences in the first 6 months of life and continues through 2 years of age. Specific linguistic experience in the first 6 months of life, before meaningful speech begins, affects infants’ perception of speech sounds and their capacity to learn. Moderate-to-severe hearing impairment in the first year of life is believed to compromise speech and language acquisition as well as cognitive and social development. Mild or unilateral hearing deficits also are considered to affect language development and behavior of children. Early intervention (following detection of hearing impairment in those younger than 3 months of age) reduces the age for access to effective medical and habilitative intervention for many infants. Intervention for those younger than 6 months of age also is believed by many to improve speech and language development and cognitive outcomes, diminishing the need for special education and improving quality of life. The evidence for these effects currently is limited in quantity and quality; most studies are retrospective and have significant limitations. The prevalence of moderate through profound hearing impairment‡ in newborns, including both sensorineural (SNHL) and conductive hearing loss (CHL), is in the range of 1 to 3/1,000. Previously published reports are believed to reflect an underestimate of the true prevalence. If infants who have mild SNHL are included, the prevalence would at least double. Furthermore, the prevalence of hearing impairment is increased substantially …