Screening for delayed-onset hearing loss in preschool children who previously passed the newborn hearing screening

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Abstract

Objective

The goal of this study was to investigate the prevalence of delayed-onset hearing loss in preschool children who previously passed newborn hearing screening in Shanghai, China.

Methods

Between October 2009 and September 2010, 21,427 preschool children were enrolled from five areas of Shanghai, who had passed newborn hearing screening. Children were screened for delayed-onset hearing loss with pediatric audiometers. Children with positive results in initial and re-screening tests were assessed audiologically and for risk indicators according to the Year 2007 Statement of the American Joint Committee on Infant Hearing (JCIH).

Results

During the study period, 445 children (2.08%) were referred for audiologic assessment; 16 (0.75/1000, 95% CI 0.38–1.12) had permanent delayed-onset hearing loss. Of these, five (0.23/1000) had bilateral moderate hearing loss; seven (0.33/1000) had mild bilateral hearing loss; and four (0.19/1000) had unilateral moderate or mild hearing loss. JCIH risk indicators were established for six children (6/16, 37.5%), including parental concern regarding speech and language developmental delay, neonatal intensive care unit with assisted ventilation or hyperbilirubinemia, recurrent otitis media with effusion, craniofacial malformation, and family history (n = 1 for each). The remaining ten (62.5%) had no related risk factors.

Conclusions

A significant proportion of preschool children have undiagnosed delayed-onset hearing loss. Hearing screening in preschool is recommended for an early detection.

Section snippets

Background

Universal newborn hearing screening (UNHS) has been successfully implemented in many countries [1] and has contributed to a significant reduction in the average age of confirmation of hearing loss (declining from 24–30 months to 2–3 months) [2]. Early detection of hearing disability in children is associated with better outcomes in communication development [3], [4], [5], [6], [7]. However, not every hearing impairment can be detected at birth, as deafness can be acquired, delayed in onset or

Study design

The present study was a cross-sectional, representative cluster-sample survey of 3–6-year-old children living in the city of Shanghai. A sample of 22,361 (94% response of 23,788) nursery school children from five residential areas spread throughout the city [Changshou (Putuo District); Zhongyuan (Yangpu District); Yanghang (Baoshan District); Tangqiao (Pudong New District); and Liangcheng (Hongkou District)] was targeted for screening. The study did not include Down Syndrome and other children

Results

Of the 22,316 children, 912 children had moved to Shanghai from other provinces and had not undergone UNHS at birth, 19 children already had a hearing loss diagnosis through the UNHS program, and three children had been diagnosed with hearing loss before our study. These children were consequently excluded, resulting in 21,427 children deemed eligible for our study (11,103 boys, 10,324 girls). The mean age was 4.89 ± 1.11 years. All agreed to undergo PA screening.

Of these, 445 children (2.08%)

Discussion

Our current analysis is based on the “delayed-onset hearing loss” concept of hearing loss occurring after birth. It is defined simply by onset time and includes late-onset, progressive, and acquired hearing loss. A target child's hearing is deemed normal in the perinatal period, but deteriorates thereafter.

In the present analysis, the percentages of children with bilateral moderate delayed-onset hearing loss was 0.23/1000; with bilateral mild delayed-onset hearing 0.33/1000; and for unilateral

Conclusion

In our study, the detection rate of delayed-onset hearing loss was 0.75/1000 in 3–6-year-olds who had previously passed the newborn hearing screening. This rate suggests that preschool hearing screening should be recommended for early detection of delayed-onset hearing loss. Audiological assessment restricted to children with risk factors would have missed the larger part of delayed-onset hearing loss in this population. It would be better to extend the time range of hearing screening to the

Acknowledgements

We thank Ms. Xiaoxin X.U., MD, for the advice on the use of statistical data in this manuscript, and thank all the children and their parents for participating in the study. This study received funding from the Science and Technology Commission of the Shanghai Municipality (08411954500, 08XD1402900), the Ministry of Education (20090073110084), and the School of Medicine of Shanghai Jiaotong University (BXJ0918).

The Collaborative Study Group consisted of: Yuli MA, MD (Putuo District Women and

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