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Children with one or more risk factors should receive monitoring of hearing, speech and language development and periodic hearing screening.

  • Parent/caregiver concern regarding hearing, speech, language or developmental delay
  • Recurrent or persistent otitis media with effusion for at least 3 months
  • Family history of hereditary childhood sensorineural hearing loss
  • In utero infection: cytomegalovirus, rubella, syphilis, herpes, and toxoplasmosis
  • Craniofacial abnormalities incl. morphological abnormalities of the pinna and ear canal
  • High Risk Neonatal Indicators:
    • Birthweight < 1500 g.
    • Hyperbilirubinemia at a serum level requiring exchange transfusion
    • History of persistent pulmonary hypertension of the newborn associated with mechanical ventilation
    • Apgar scores of 0-4 at 1 minute or 0-6 at 5 minutes
    • Mechanical ventilation lasting 5 days or longer
    • Use of extracorporeal membrane oxygenation
    • Ototoxic medications used in multiple courses or used with loop diuretics
  • Physical findings associated with a syndrome known to include sensorineural or conductive hearing loss or Eustachian tube dysfunction
  • Neurodegenerative disorders, such as Hunter’s syndrome, or demyelinating disorders, such as Friedreich’s ataxia and Charcot-Marie-Tooth syndrome
  • Head trauma associated with loss of consciousness or skull fracture
  • Postnatal infections associated with sensorineural hearing loss, including bacterial meningitis. mumps, or measles

Physical Findings of the Head and Neck associated wtih Hearing Impairment

  • Heterochromia of the irises
  • Malformation of the auricle or ear canal
  • Abnormalities of the eardrum
  • Dimpling or skin tags around the auricle
  • Cleft lip and/or palate
  • Asymmetry of facial structures
  • Microcephaly
  • Abnormal pigmentation of the skin, hair or eyes, e.g. Waardenburg’s syndrome
  • Recurrent or persistent otitis media


  1. Universal Newborn Hearing Screening, Diagnosis and Intervention: Guidelines for Pediatric Medical Home Providers. AAP. Jan 2003.
  2. Hearing assessment in infants and children: Recommendations beyond neonatal screening. Cunningham M, Cox EO et al. Pediatrics. 111(2):436-440, 2003.
  3. Principles and Guidelines for early hearing detection and intervention programs. 2000 Position Statement. Joint Committee of Infant Hearing. American Academy of Audiology. 9:9-29.
  4. Protocal for Diagnostic Audiologic Assessment:Follow-Up for Newborn Screening. Washington State Department of Health