Pediatric Audiology: A Review

Ryan B. Gregg, AuD* 2. Lori S. Wiorek, MA† 3. Joan C. Arvedson, PhD‡ 1. *Senior Pediatric Audiologist 2. †Pediatric Audiologist 3. ‡Program Coordinator, Feeding and Swallowing Services, Children’s Hospital of Wisconsin; Professor, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI After completing this article, readers should be able to: 1. Know at what age a child’s hearing can be tested accurately. 2. Recognize when a child should be referred for audiologic testing. 3. Discuss the importance of early diagnosis and management of children who have hearing loss. 4. Describe the key steps to early diagnosis of childhood hearing loss. The prevalence of congenital deafness in the United States is estimated to be approximately 1:1,000 or 0.1%. Approximately 3:1,000 well babies have hearing loss of varying degrees. Approximately 6:1,000 combined well and at-risk babies have some degree of hearing loss (HL). Prior to the onset of Universal Newborn Hearing Screening (UNHS), there was an inverse relationship between degree of HL and average age of identification. In other words, mild HLs were identified much later than were severe HLs. Prior to UNHS, many children who had bilateral profound HL were not identified until 18 to 24 months of age. In some instances, children who had mild HL were not identified until 4 years of age or older. The single best predictor of school success is a child’s speech and language skills. HL has a significant negative impact on a child’s speech and language development. If a child is unable to hear sounds across the speech spectrum (250 through 4 kHz) at an appropriate level, it is unlikely that the child will be able to produce those speech sounds correctly. Furthermore, most speech and language learning takes place from birth to about 3 years of age. Even a borderline-to-mild HL that is not detected can affect a child during that critical period. The longer the time spent with a HL and the more time within the critical period that the child goes without appropriate management, the poorer the long-term prognosis becomes with regard to speech and language …