Hearing impairment in children: Evaluation
- Richard JH Smith, MD
Richard JH Smith, MD
- Professor of Otolaryngology
- University of Iowa
- Adrian Gooi, MD, FRCS(C)
Adrian Gooi, MD, FRCS(C)
- Assistant Professor
- University of Manitoba
Hearing loss in children can be a silent handicap. Children with hearing loss frequently appear to be normal. Hearing loss that is undetected and untreated can result in speech, language, and cognitive delays. Early identification and effective treatment of hearing loss improve language, communication, and cognitive skills [1-4].
The evaluation of hearing impairment in children is reviewed here. The etiology and treatment of hearing loss in children are discussed separately (table 1). Newborn hearing screening is also covered in detail separately. (See "Hearing impairment in children: Etiology" and "Hearing impairment in children: Treatment" and "Screening the newborn for hearing loss".)
Children with hearing loss should have a complete history, physical examination, and formal audiologic testing to determine the type and etiology of hearing loss and the optimal treatment plan [5,6]. Infants with hearing loss should be evaluated by an otolaryngologist who is knowledgeable in pediatric hearing loss and should have at least one examination to assess visual acuity by an ophthalmologist who is experienced in evaluating infants . In a series of 226 children with sensorineural hearing loss (SNHL), the prevalence of ophthalmologic abnormalities was 22 percent (compared with approximately 14 percent in the general population) [7,8]. Refractive errors (myopia, hyperopia, astigmatism) were more frequent than nonrefractive conditions (eg, strabismus, amblyopia, nystagmus, optic atrophy, retinitis pigmentosa).
Important questions in the history include:
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- PHYSICAL EXAMINATION
- General examination
- Ear examination
- Office hearing tests
- OFFICE AUDIOLOGY SCREENING
- FORMAL AUDIOLOGY
- Pure tone audiometry
- Speech audiometry
- Behavioral testing
- Impedance testing
- - Tympanometry
- Brainstem response
- Otoacoustic emissions
- Stapedial reflex
- LABORATORY TESTING
- Initial tests
- Ancillary evaluation
- Genetic testing
- RADIOLOGIC TESTING
- Computed tomography
- Magnetic resonance imaging
- SUMMARY AND RECOMMENDATIONS