Diagnosis

ABSTRACT

The goal of early identification of hearing loss in children should include the timely and accurate diagnosis of permanent unilateral hearing loss (UHL) of any degree and mild bilateral hearing loss (MBHL), which are common conditions of childhood. UHL and MBHL can result in developmentally significant conditions that can affect speech, language, learning, and social-emotional development. This article will review current assessment strategies that contribute to the goal of early and accurate diagnosis of UHL and MBHL. An overview of the components of the test battery includes electrophysiologic, otoacoustic, and behavioral methods while using ear-specific and frequency-specific strategies. Issues are discussed that may challenge audiologists during the identification process. The article concludes that though there are many unanswered questions in need of further research, current assessment strategies generally are effective and time and cost efficient in the identification of UHL and MBHL.

KEYWORDS

Mild hearing loss - unilateral hearing loss - pediatric audiology - childhood hearing loss

REFERENCES

• 1 Cone-Wesson B, Vohr B R, Sininger Y S et al.. Identification of neonatal hearing impairment: infants with hearing loss.  Ear Hear. 2000;  21 488-507
• 2 Johnson J L, White K R, Widen J E et al.. A multicenter evaluation of how many infants with permanent hearing loss pass a two-stage otoacoustic emissions/automated auditory brainstem response newborn hearing screening protocol.  Pediatrics. 2005;  116 663-672
• 3a American National Standards Institute .Specifications for Audiometers. (ANSI S3.6-1996). New York, NY; American National Standards Institute 1996
• 3b White K R. The current status of EHDI programs in the United States.  Ment Retard Dev Disabil Res Rev. 2003;  9 79-88
• 4 Joint Committee on Infant Hearing . Year 2007 position statement: principles and guidelines for early hearing detection and intervention programs.  Pediatrics. 2007;  120 898-921
• 5 Oyler R F, Matkin N D. National survey of educational preparation in pediatric audiology.  ASHA. 1987;  29 27-33
• 6 Oyler R F, Gross S R. Survey of educational preparation in pediatric audiology: a decade later.  Commun Disord Q. 2000;  21 195-209
• 7 American Speech-Language-Hearing Association .Guidelines for the audiologic assessment of children from birth to 5 years of age. Available at: http://www.asha.org/docs/html/GL2004-00002.html Accessed December 17, 2007
• 8 The Pediatric Working Group .Amplification for Infants and Children with Hearing Loss. Nashville, TN; Vanderbilt Bill Wilkerson Press 1996
• 9 Weber B A. Validation of observer judgments in behavioral observation audiometry.  J Speech Hear Disord. 1969;  34 350-354
• 10 Wilson W R, Thomson G. Behavioral audiometry. In: Jerger J Pediatric Audiology. San Diego, CA; College-Hill Press 1984: 1-44
• 11 Bernstein R S, Gravel J S. A method for determining hearing sensistivity in infants: the interweaving staircase procedure (ISP).  J Am Acad Audiol. 1990;  1 138-145
• 12 Widen J E, Folsom R C, Cone-Wesson B et al.. Identification of neonatal hearing impairment: hearing status at 8-12 months corrected age using a visual reinforcement audiometry protocol.  Ear Hear. 2000;  21 471-481
• 13 Widen J E, Kenner S K. Diagnostic testing for hearing loss in infants and young infants.  Ment Retard Dev Disabil Res Rev. 2003;  9 220-224
• 14 Northern J, Downs M P. Hearing in Children. Behavioral Hearing Testing. Philadelphia, PA; Lippincott Williams & Wilkins 2002: 159-208
• 15 Moog J S, Geers A E. Early speech perception test for profoundly hearing-impaired children. St. Louis, MO; Central Institute for the Deaf 1990
• 16 Elliott L, Katz D. Development of a new children's test of speech discrimination. St Louis, MO; Audiotec 1980
• 17 Ross M, Lerman J A. A picture identification test for hearing-impaired children.  J Speech Hear Res. 1970;  13 44-53
• 18 Eisenberg L S, Martinez A S, Boothroyd A. Assessing auditory capabilities in young children.  Int J Pediatr Otorhinolaryngol. 2007;  71 1339-1350
• 19 Welsh L W, Welsh J J, Rosen L F et al.. Functional impairments due to unilateral deafness.  Ann Otol Rhinol Laryngol. 2004;  113 987-993
• 20 Boothroyd A. Auditory perception of speech contrasts by subjects with sensorineural hearing loss.  J Speech Hear Res. 1984;  27 134-144
• 21 Jerger S. Current state of knowledge: perceptual processing by children with hearing impairment.  Ear Hear. 2007;  28 754-765
• 22 Stapells D R, Gravel J S, Martin B A. Thresholds for auditory brainstem responses to tones in notched noise from infants to young children normal hearing or sensorineural loss.  Ear Hear. 1995;  16 361-371
• 23 Galambos R, Makeig S, Talmachoff P J. A 40 Hz auditory potential recorded from the human scalp.  Proc Natl Acad Sci U S A. 1981;  78 2643-2647
• 24 Johnson T A, Brown C J. Threshold prediction using the auditory steady-state response and the tone burst auditory brain stem response: a within-subject comparison.  Ear Hear. 2005;  26 559-576
• 25 Rance G, Roper R, Symons L et al.. Hearing threshold estimation in infants using auditory steady-state responses.  J Am Acad Audiol. 2005;  16 291-300
• 26 Ahn J H, Lee H S, Kim Y J et al.. Comparing pure-tone audiometry and auditory steady state response for the measurement of hearing loss.  Otolaryngol Head Neck Surg. 2007;  136 966-971
• 27 Kemp D T. Otoacoustic emissions, their origin in cochlear function, and use.  Br Med Bull. 2002;  63 223-241
• 28 Norton S J. Applications of transient evoked otoacoustic emissions to pediatric populations.  Ear Hear. 1993;  14 64-73
• 29 Lonsbury-Martin B L, Whitehead M L, Martin G K. Clinical applications of otoacoustic emissions.  J Speech Hear Res. 1991;  34 964-981
• 30 Hall J W. Handbook of Otoacoustic Emissions. Clinical Application of Otoacoustic Emissions in Children. San Diego, CA; Singular 2000: 389-480
• 31 Gorga M P, Neely S T, Dorn P A. Distortion product otoacoustic emission test performance for a priori criteria and for multifrequency audiometric standards.  Ear Hear. 1999;  20 345-362
• 32 Norton S J, Gorga M P, Widen J E et al.. Identification of neonatal hearing impairment: evaluation of transient evoked otoacoustic emission, distortion product otoacoustic emission, and auditory brain stem response test performance.  Ear Hear. 2000;  21 508-528
• 33 Gorga M P, Neely S T, Bergman B et al.. A comparison of transient-evoked and distortion product otoacoustic emissions in normal-hearing and hearing-impaired subjects.  J Acoust Soc Am. 1993;  94 2639-2648
• 34 Fitzgerald T S, Prieve B A. Detection of hearing loss using 2f2-f1 and 2f1-f2 distortion-product otoacoustic emissions.  J Speech Hear Res. 2005;  48 1165-1186
• 35 Lonsbury-Martin B L, Martin G K. Otoacoustic emissions.  Curr Opin Otolaryngol Head Neck Surg. 2003;  11 361-366
• 36 Nozza R J, Bluestone C D, Kardatzke D et al.. Identification of middle ear effusion using aural acoustic admittance and otoscopy.  Ear Hear. 1994;  15 310-323
• 37 Stockard J E, Curran J S. Transient elevation of threshold of the neonatal auditory brainstem response.  Ear Hear. 1990;  11 21-28
• 38 Rosenfeld R M, Culpepper L, Doyle K J et al.. Clinical practice guidelines: otitis media with effusion.  Otolaryngol Head Neck Surg. 2004;  130(Suppl) 95-118
• 39 Bluestone C D, Beery Q C, Paradise J L. Audiometry and tympanometry in relation to middle ear effusion in children.  Laryngoscope. 1973;  83 594-604
• 40 Marchant C, McMilliam P, Shurin P et al.. Objective diagnosis of otitis media in early infancy by tympanometry and ipsilateral acoustic reflex thresholds.  J Pediatr. 1986;  109 590-595
• 41 Margolis R H, Bass-Ringdahl S, Hanks W D et al.. Tympanometry in newborn infants-1 kHz norms.  J Am Acad Audiol. 2003;  14 383-392
• 42 Nozza R J, Bluestone C D, Kardatzke D et al.. Towards the validation of aural acoustic immittance measures for diagnosis of middle ear effusion in children.  Ear Hear. 1992;  13 442-453
• 43 Roush J, Bryant K, Mundy M et al.. Developmental changes in static admittance and tympanometric width in infants and toddlers.  J Am Acad Audiol. 1995;  6 334-338
• 44 Metz O. Threshold of reflex contractions of muscles of middle ear and recruitment of loudness.  Arch Otolaryngol. 1952;  55 536-543
• 45 Jerger J, Burney P, Mauldin L et al.. Predicting hearing loss from the acoustic reflex.  J Speech Hear Disord. 1974;  39 11-22
• 46 Bennett M, Weatherby L. Newborn acoustic reflexes to noise and puretone signals.  J Speech Hear Res. 1982;  25 383-387
• 47 Gallaudet Research I .Regional and National Summary Report of Data from the 2004-2005 Annual Survey of Deaf and Hard of Hearing Children and Youth. Washington, DC; GRI, Gallaudet University 2005