Incidence and consequences of hearing loss
As with any childhood-related medical issue, it is important for providers to be aware of the incidence of hearing impairment in childhood so the problem can be put into perspective and given an appropriate priority for screening during well visits.
According to data from the Centers for Disease Control and Prevention (CDC) from 2017, approximately 98% of newborns in the United States are screened for congenital hearing loss.3 The data indicate that 1.7 of every 1000 babies in the United States is born with hearing loss, and 25% of babies do not undergo follow-up testing (ie, are lost to follow-up). Neonatal intensive care unit (NICU) patients are at higher risk for neurosensory hearing loss with an incidence of 16.7/1000 infants and an auditory neuropathy incidence of 5.6/1000 infants.4,5
According to some estimates, the incidence of childhood hearing loss increases to 6 of 1000 children in the United States by age 6 years.2 The National Health and Nutrition Examination Surveys indicate that hearing loss greater than 25 dB affects 3% to 5% of American adolescents!6
The sooner a hearing impairment is identified in an infant or child, the sooner the child can receive hearing aids or, when appropriate, a cochlear implant as well as educational support should the family decide to adopt these options. Without detection of hearing impairment, even a moderate impairment, the child may perform poorly in school, develop a poor self-image, and consequently fail to achieve their potential. Numerous studies have shown that the sooner a hearing-impaired child receives hearing augmentation, the sooner they develop vocal communicative and linguistic skills.7,8
When to be concerned
Primary care providers should be suspicious that a child may have a significant hearing loss if a child has a speech or developmental delay or if parents are concerned about a possible hearing loss. Other aspects of the history that should prompt consideration of an audiology referral include a family history of childhood hearing loss, neonatal intensive care of 5 days or longer, in utero infections, craniofacial anomalies, and other risk factors listed in Table 2.
1. Joint Committee on Infant Hearing. Year 2019 position statement: principles and guidelines for early hearing detection and intervention programs. JEHDI. 2019;4(2):1-44.
2. Todd NW. The etiologies of childhood hearing impairment. In: NCHAM E-Book: A Resource Guide for Early Hearing Detection and Intervention. National Center for Hearing Assessment and Management; 2015; ch 6. Accessed April 8, 2020. http://www.infanthearing.org/ehdi-ebook/2015_ebook/6-Chapter6Etiologies2015.pdf
3. Centers for Disease Control and Prevention. 2017 Annual Data Early Hearing Detection and Intervention (EHDI) Program. Last reviewed December 5, 2019. Accessed April 8, 2020. https://www.cdc.gov/ncbddd/hearingloss/ehdi-data2017.html
4. Xoinis K, Weirather Y, Mavoori H, Shaha SH, Iwamoto LM. Extremely low birth weight infants are at high risk for auditory neuropathy. J Perinatol. 2007;27(11):718-723.
5. Korver AM, van Zanten GA, Meuwese-Jongejeugd A, van Straaten HL, Oudesluys-Murphy AM. Auditory neuropathy in a low-risk population: a review of the literature. Int J Pediatr Otorhinolaryngol. 2012;76(12):1708-1711.
6. Barret TS, White KR. Trends in hearing loss among adolescents. Pediatrics. 2017;140(6):e20170619.
7. Robinshaw HM. Early intervention for hearing impairment: differences in the timing of communicative and linguistic development. Br J Audiol. 1995;29(6):315-334.
8. Apuzzo ML, Yoshinaga-Itano C. Early identification of infants with significant hearing loss and the Minnesota Child Development Inventory. Semin Hear. 1995;16:124-139.
9. Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017.
10. Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131:e964-e999.
11. Sabo DL. Assessment of the young pediatric patient. In: The NCHAM E-Book: A Resource Guide for Early Hearing Detection and Intervention. National Center for Hearing Assessment and Management; 2015:ch 5. Accessed April 8, 2020. https://www.infanthearing.org/ehdi-ebook/2015_ebook/5-Chapter5Assessment2015.pdf