Foster Care, Medical Evaluation — Hearing Screening — Clinical Pathway: Outpatient Specialty

Foster Care Clinical Pathway — Outpatient Specialty Care

Hearing Screening

Age Hearing Assessment
All Ages
  • Risk indicators:
    • Caregiver concern regarding hearing, speech or developmental delay
    • Family history of permanent childhood hearing loss
    • N/IICU > 5 days, or ECMO, assisted ventilation, exposure to ototoxic medications (gentamicin, tobramycin), exposure to loop diuretics (furosemide/Lasix), hyperbilirubinemia treated with exchange transfusion
    • In utero infections such as CMW, herpes, rubella, syphilis, toxoplasmosis
    • Craniofacial abnormalities, including abnormalities of the pinna, ear canal, ear tags, ear pits, and temporal bone abnormalities
    • Physical exam findings associated with a syndrome known to include sensorineural or conductive hearing loss, such as white forelock
    • Syndrome associated with hearing loss such as neurofibromatosis, osteopetrosis, Usher syndrome
    • Neurodegenerative disorders such as Hunter syndrome or sensory motor neuropathies such as Friedreich ataxia
    • Culture-positive postnatal infections associated with sensorineural hearing loss, including meningitis
    • Head trauma, especially basal skull/temporal bone fracture that requires hospitalization
    • Chemotherapy
    • Recurrent or persistent otitis media for at least 3 months
< 1 year
  • Assess for risk indicators
  • Make every attempt to verify newborn hearing screen
1-3 years
  • Assess for risk indicators
4-10 years
  • Assess for risk indicators
  • Audiometry
11+ years
  • Assess for risk indicators
  • Audiometry
  • Questionnaire to evaluate for hearing loss in adolescents, for example:
    • Do you have a problem hearing over the telephone?
    • Do you have trouble following the conversation when two or more people are talking simultaneously?
    • Do people complain that you turn the TV volume too high?
    • Do you have to strain to understand the conversation?
    • Do you have trouble hearing in a noisy background?
    • Do you find yourself asking people to repeat themselves?
    • Do many people you talk to seem to mumble or not speak clearly?
    • Do you misunderstand what others are saying and respond inappropriately?
    • Do you have trouble understanding the speech of women and children?
    • Do people get annoyed because you misunderstand what they say?

Consider referral to audiology if failed newborn screen, failed screening test/risk factor assessment, parental concern for hearing loss or unable to complete routine screening due to behavioral problems/developmental abnormalities.

For additional, information visit the CHOP Pathway for Hearing Screening at Well Child Visit

Reference

Hearing Assessment in Infants and Children: Recommendations Beyond Neonatal Screening