Evidence-based overview of ophthalmic disorders in deaf children: a literature update

Periodic health evaluation in Para athletes: a position statement based on expert consensus

Para athletes present a broad range of sports-related injuries and illnesses, frequently encountering barriers when accessing healthcare services. The periodic health evaluation (PHE) is a valuable tool for continuously monitoring athletes' health, screening for health conditions, assisting in the surveillance of health problems by establishing baseline information and identifying barriers to athlete's performance. This position statement aims to guide sports healthcare providers in the PHE for Para athletes across key impairment categories: intellectual, musculoskeletal, neurological and vision. A panel of 15 international experts, including epidemiologists, physiotherapists, optometrists and physicians with expertise in Para athlete health, convened via videoconferences to discuss the position statement's purpose, methods and themes. They formed working groups to address clinical, cardiorespiratory, neuromusculoskeletal, nutritional status, mental and sleep health, concussion and female Para athlete health assessment considerations. The PHE's effectiveness lies in its comprehensive approach. Health history review can provide insights into factors impacting Para athlete health, inform physical assessments and help healthcare providers understand each athlete's needs. During the PHE, considerations should encompass the specific requirements of the sport modality and the impairment itself. These evaluations can help mitigate the common tendency of Para athletes to under-report health issues. They also enable early interventions tailored to the athlete's health history. Moreover, the PHE serves as an opportunity to educate Para athletes on preventive strategies that can be integrated into their training routines, enhancing their performance and overall health. This position statement can potentially enhance clinical translation into practice and improve the healthcare quality for Para athletes.

The association between amblyopia and the risks of hearing loss: A propensity matched analysis

INTRODUCTION

Amblyopia occurs due to an imbalance in the visual input between the eyes. This can induce structural changes in the central nervous system and, if left untreated, eventually lead to permanent blindness in the affected eye. As these changes may also impact the auditory system, which closely interacts with the visual system, this study aimed to investigate the risk of hearing loss in patients with amblyopia.

MATERIALS AND METHODS

This study was a retrospective review of the electronic medical records contained in a United States national database of medical records. Patients younger than 18 years old with and without amblyopia were matched and compared to evaluate the relative risk (RR) of having a hearing loss. Stratified analyses were further performed to explore whether the disease laterality and the amblyopia subtype influenced the risks.

RESULTS

Compared to the controls, patients with amblyopia had a higher overall risk of having hearing loss (RR: 1.09, CI: 1.03-1.14), specifically sensorineural hearing loss (SNHL) (RR: 1.24, CI: 1.08-1.42). The stratified analysis further revealed that SNHL was associated with refractive amblyopia (RR: 1.84, CI: 1.50-2.26), but not strabismic amblyopia (RR: 1.23, CI: 1.10-1.38). The laterality of amblyopia did not influence the risk of hearing loss.

CONCLUSIONS

Children with amblyopia have a higher rate of SNHL than children without amblyopia. As vision and hearing are essential in the proper cognitive development, language acquisition, and social and emotional well-being of children, patients with amblyopia may benefit from more frequent audiologic screening.

Characteristics associated with blindness or visual impairment within the adolescent demographic: a national cohort analysis

BACKGROUND

Psychosocial metrics associated with self-reported blindness or visual impairment for adolescents in the National Survey of Drug Use and Health (NSDUH) have not been fully characterized. This retrospective cohort analysis of the latest NSDUH aimed to determine novel characteristics associated with self-reported visual loss among adolescents in the United States.

METHODS

Data from the NSDUH2020, a publicly available, federally validated database, were analyzed. Self-reported severe visual impairment or blindness was defined as being truly blind or having serious difficulty seeing even when wearing corrective lenses (s-rSVI). Inclusion criteria were all cases of s-rSVI in adolescents aged 12-17 years. NSDUH weights were used to accommodate complex survey design, nonresponse rates, and population variance. Weighted percentages, asymptotic two-sided Rao-Scott χ2 analyses, and multivariable logistic regression were performed. Statistical significance was considered reached at P < 0.05.

RESULTS

A total of 5,667 adolescents aged 12-17 years were surveyed, and s-rSVI occurred in 236 cases (weighted percentage, 3.48%). Within our final multivariable risk model, characteristics associated with increased odds of s-rSVI were female sex, Asian and Latino race/ethnicity (relative to non-Hispanic White), and self-reported serious difficulty hearing and concentrating (all P < 0.05).

CONCLUSIONS

This national retrospective cohort analysis highlights risk factors associated with s-rSVI for adolescents within the 2020 NSDUH. Clinicians and policymakers should consider at-risk demographics for s-rSVI during development and enhancement of screening programs, population health initiatives, and healthcare policy issues.

Trends in the prevalence of common ocular conditions and comparison of ophthalmic outpatient utilisation related to these conditions in children with and without various types of disabilities: analysis of nationwide population-based data from Taiwan, 2014-2019

OBJECTIVE

The study objectives were to investigate trends in the prevalence of common ocular conditions among children with and without disabilities; to compare the prevalence of these conditions in children with various disabilities; and to compare ophthalmic outpatient utilisation related to these ocular conditions in children with and without disabilities.

DESIGN

Repeated cross-sectional nationwide population-based study.

SETTING

Nationwide analysis in Taiwan based on National Health Insurance (NHI) claims data and the National Disability Registry, from 2014 to 2019.

PARTICIPANTS

All children (aged under 18 years) with a disability in any given year between 2014 and 2019 were included in our analysis. All children with a disability (experimental group) were matched 1:1 with a child of the same age without a disability (control group). Data regarding the children's disability type and status and ocular conditions were obtained from the National Disability Registry and NHI database of Taiwan.

OUTCOME MEASURES

(1) The prevalence of myopia, strabismus, astigmatism, amblyopia and hyperopia over time; (2) the prevalence of myopia, strabismus, astigmatism, amblyopia and hyperopia in children with various disabilities; and (3) the association between disability and the use of outpatient vision care. All outcome measures were assessed using data from 2014 to 2019.

RESULTS

Among children with disability, the prevalence of myopia increased from 15.97% in 2014 to 18.07% in 2019. The prevalence of strabismus (2.06-3.90%), astigmatism (8.25-9.24%), amblyopia (4.13-4.95%) and hyperopia (3.36-4.58%) also increased over the study period in children with disabilities. The prevalence of strabismus, astigmatism, amblyopia and hyperopia was significantly higher in children with disabilities than in those without disabilities in all years. For example, in 2019, the prevalence values for strabismus, astigmatism, amblyopia and hyperopia were 3.90%, 9.24%, 4.95% and 4.58%, respectively, among children with disabilities, and 0.67%, 5.84%, 1.33% and 1.70%, respectively, for those without disabilities. The prevalence of these conditions varied considerably across disability types. For example, in 2019, the prevalence of strabismus was highest in children with visual disabilities (10.66%; p<0.001); these children also exhibited a high prevalence of amblyopia (24.34%; p<0.001). The prevalence of myopia was high in children with autism (24.77%), but the prevalence of other ocular conditions was not elevated in this group. Regression results indicated that for myopia, children with disability had 0.48 fewer outpatient clinic visits than those without disability (p<0.001).

CONCLUSIONS

The prevalence of common ocular conditions and the corresponding vision care required vary across types of disabilities among children. Healthcare policies must account for children at high risk of various ocular conditions, including those with less common disabilities.

Evaluation of neonatal hearing screening results of newborns with premature retinopathy

OBJECTIVES

To reveal the risk situations of ROP patients in terms of hearing loss by examining the newborn hearing screening test results.

METHODS

Hearing screening test results of ROP patients and newborns with similar congenital risk factors(control group) treated in our hospital were retrospectively screened. Both groups were compared in terms of newborn hearing screening test results.

RESULTS

In the first screening test, the rate of ''refer'' result in the ROP group was significantly higher than the control group (p < 0.05). There was no significant difference between the two groups in terms of second hearing screening test results (p > 0.05). In the second screening test, 100% of stage 3 ROP patients failed from the right ear and 80% in the left ear, and this difference was statistically significant compared to the other two groups (p < 0.05).

CONCLUSION

Newborn hearing screenings of patients with advanced stage ROP patients should be followed up more sensitively, since stage 3 ROP patients had more failure results from the screening test in our study.

Prevalence and characteristics of hearing and vision loss in preschool children from low income South African communities: results of a screening program of 10,390 children

BACKGROUND

The majority of children with sensory impairments live in low- and middle-income countries. More studies of hearing and vision impairment prevalence are needed, in order to generate more accurate estimates of trends in sensory impairments. This study aimed to estimate the prevalence and describe the characteristics of hearing and vision loss among preschool children (4-7 years) in an underserved South African community following community-based mobile health (mHealth) supported hearing and vision services.

METHODS

A screening program of sensory impairments was undertaken of children attending preschools in the communities of Khayelitsha and Mitchell's Plain, Cape Town, from September 2017 until June 2019. Hearing and vision screening were done by trained community health workers using mHealth technology. Children who failed hearing and vision screening were seen for follow-up assessments at their preschools. Follow-up assessments were conducted using smartphones that host point-of-care validated and calibrated hearing and vision testing applications (hearTest app, hearX Group, South Africa and PeekAcuity app, Peek Vision, United Kingdom). Descriptive statistical analysis and logistic regression analysis were conducted after extracting data from a secure cloud-based server (mHealth Studio, hearX Group) to Microsoft Excel (2016).

RESULTS

A total of 10,390 children were screened at 298 preschools over 22 months. Of the children screened, 5.6 and 4.4% of children failed hearing and vision screening respectively. Community-based follow-up hearing tests were done at the preschools on 88.5% (514) of children of whom 240 children (54.2% female) presented with hearing loss. A preschool-based follow-up vision test was done on 400 children (88.1%). A total of 232 children (46.1% female) had a vision impairment, and a further 32 children passed the test but had obvious signs of ocular morbidity. Logistic regression analysis found that age was a significant predictor of vision loss (p < 0.05), but not for hearing loss (p = 0.06). Gender was not a significant predictor of hearing (p = 0.22) or vision loss (p = 0.20).

CONCLUSIONS

Hearing loss is prevalent in at least 22 per 1000 and vision loss in at least 23 per 1000 preschool children in an underserved South African community. Timely identification of sensory losses can be facilitated through community-based hearing and vision services supported by mHealth technology.

Changes in Vestibular Function Following Pediatric Cochlear Implantation: a Prospective Study

OBJECTIVES

Given the close interconnection between the auditory and vestibular end organs, the increasingly broad application of (bilateral) cochlear implantation (CI) in children raises concern about its impact on the vestibular function. Unfortunately, literature on this matter is inconclusive and subject to several limitations. Therefore, this study aimed to elucidate the impact of pediatric CI on the vestibular function in a large sample of children, representative for the current CI population.

DESIGN

Fifty hearing-impaired children followed in the Ghent University Hospital were included in this prospective study. Twenty-seven patients underwent unilateral CI, and 23 were bilaterally implanted (9 sequentially, 14 simultaneously), adding up to 73 implanted ears. Children's median age at first implantation was 29 (range 8 to 194) months. Vestibular assessment was scheduled on average 2.8 months (SD: 3.6) before and 4.6 (SD: 4.0) months after implantation and consisted of video Head Impulse Testing of the lateral semicircular canals, rotatory testing (0.16, 0.04, and 0.01 Hz) and cervical vestibular evoked myogenic potential (cVEMP) testing with bone conduction stimulation. Caloric testing was added in children older than 3 years of age.

RESULTS

Overall, group analysis in our sample of 73 CI-ears did not reveal any significant impact on the vestibular function, except for a significantly shortened ipsilateral N1 latency of the cVEMP responses (p = 0.027) after CI. Complete ipsilateral loss of function after implantation was seen in 5% (3/54) of all CI-ears on the video head impulse testing, in 0% (0/10) on the caloric test and in 2% (1/52) on the cVEMP, notably all patients deafened by a congenital cytomegalovirus infection.

CONCLUSIONS

The impact of CI on the vestibular function in our dataset was limited. Therefore, the many advantages of simultaneous bilateral implantation may outweigh the risk for vestibular damage postoperatively. However, the impact on the vestibular function may be dependent on various factors (e.g., etiology of the hearing loss), and the clinical outcome is still difficult to predict. Vestibular assessment remains thus an important aspect in the pediatric CI population; first because the vestibular function should be considered in the decision-making process on (simultaneous or sequential bilateral) CI and second because it is essential to reveal a possible additional sensory deficit, allowing an opportunity for rehabilitation to improve the overall outcome of these children.

Community-Based Hearing and Vision Screening in Schools in Low-Income Communities Using Mobile Health Technologies

Introduction Globally, more than 50 million children have hearing or vision loss. Most of these sensory losses are identified late due to a lack of systematic screening, making treatment and rehabilitation less effective. Mobile health (mHealth), which is the use of smartphones or wireless devices in health care, can improve access to screening services. mHealth technologies allow lay health workers (LHWs) to provide hearing and vision screening in communities. Purpose The aim of the study was to evaluate a hearing and vision school screening program facilitated by LHWs using smartphone applications in a low-income community in South Africa. Method Three LHWs were trained to provide dual sensory screening using smartphone-based applications. The hearScreen app with calibrated headphones was used to conduct screening audiometry, and the Peek Acuity app was used for visual acuity screening. Schools were selected from low-income communities (Gauteng, South Africa), and children aged between 4 and 9 years received hearing and vision screening. Screening outcomes, associated variables, and program costs were evaluated. Results A total of 4,888 and 4,933 participants received hearing and vision screening, respectively. Overall, 1.6% of participants failed the hearing screening, and 3.6% failed visual acuity screening. Logistic regression showed that female participants were more likely to pass hearing screening (OR = 1.61, 95% CI [1.11, 2.54]), while older children were less likely to pass visual acuity screening (OR = 0.87, 95% CI [0.79, 0.96]). A third (32.5%) of referred cases followed up for air-conduction threshold audiometry, and one in four (25.1%) followed up for diagnostic vision testing. A high proportion of these cases were confirmed to have hearing (73.1%, 19/26) or vision loss (57.8%, 26/45). Conclusions mHealth technologies can enable LHWs to identify school-age children with hearing and/or vision loss in low-income communities. This approach allows for low-cost, scalable models for early detection of sensory losses that can affect academic performance.

Ophthalmic Abnormalities among Children Treated with Cochlear Implants

OBJECTIVES

To review the ocular abnormalities in children treated with cochlear implant.

MATERIALS AND METHODS

A total of 51 children (29 boys, 22 girls) who were under 18 years old, presented previously with severe to profound hearing loss, and underwent cochlear implantation surgery were included in this study prospectively. A detailed ophthalmic examination, including refraction, best corrected visual acuity, ocular motility, slit-lamp biomicroscopy, and dilated fundus examination, was performed for each patient.

RESULTS

Mean age of the patients was 80.10±38.64 (range, 18-168) months. A total of 13 (25.4%) children had at least 1 ophthalmic abnormality. The majority of the detected ophthalmic abnormalities were hyperopia and astigmatism (6 patients had hyperopia, 5 had astigmatism, and 2 had hyperopia plus astigmatism). Strabismus (esotropia) was found in 2 patients, 2 patients had refractive amblyopia, and 2 patients had nystagmus. Moreover, 3 patients had microcornea, 2 patients had cataract, and 1 patient had epiblepharon. Optic disc coloboma (3 patients), choroidal coloboma (1 patient), and pigmentary abnormality (1 patient) were noticed on fundus examination. Congenital rubella syndrome (2 patients), Waardenburg's syndrome (1 patient), and CHARGE syndrome (coloboma, heart defects, choanal atresia, growth retardation, genital abnormalities, ear abnormalities) (1 patient) were also present.

CONCLUSION

Children treated with cochlear implant should be consulted with an ophthalmologist to identify any treatable ocular abnormality.

Etiological Work-up in Referrals From Neonatal Hearing Screening: 20 Years of Experience

BACKGROUND

Confirmation of permanent hearing loss in a newborn should be followed by a search for an underlying etiology because this may impact hearing loss management and counselling.

METHODS

Retrospective chart review of all newborns seen at a tertiary referral center after referral from newborn hearing screening over a 20-year period. The changes in the diagnostic protocol over the years are outlined and the most recent protocol includes targeted next-generation sequencing using a panel for known hearing loss causing genes, in all cases of bilateral sensorineural hearing loss (SNHL).

RESULTS

Permanent hearing loss was confirmed in 235 of 1,002 neonates. A complete etiological work-up was performed in 138 cases of SNHL (77 bilateral and 61 unilateral), with the underlying cause found in 77.9% and in 67.2% of patients respectively. Genetic causes explained 55 (58.4%) of bilateral cases and in 17 a genetic cause was identified by the gene panel. Pathogenic variants in GJB2 and MYO15A explained most cases of nonsyndromic SNHL. Waardenburg syndrome was the most frequent syndromic cause. Cochlear nerve deficiency and congenital cytomegalovirus infection accounted for the majority of unilateral SNHL.Other causes of congenital hearing loss were conductive hearing loss (n = 12) and auditory neuropathy/dyssynchrony (n = 9).

CONCLUSION

Implementation of targeted next-generation sequencing in the etiological work-up improves the diagnostic yield in congenital SNHL, leaving only about 20% of bilateral and 30% of unilateral cases unsolved.

Medical Referral Patterns and Etiologies for Children With Mild-to-Severe Hearing Loss

OBJECTIVES

To (1) identify the etiologies and risk factors of the patient cohort and determine the degree to which they reflected the incidence for children with hearing loss and (2) quantify practice management patterns in three catchment areas of the United States with available centers of excellence in pediatric hearing loss.

DESIGN

Medical information for 307 children with bilateral, mild-to-severe hearing loss was examined retrospectively. Children were participants in the Outcomes of Children with Hearing Loss (OCHL) study, a 5-year longitudinal study that recruited subjects at three different sites. Children aged 6 months to 7 years at time of OCHL enrollment were participants in this study. Children with cochlear implants, children with severe or profound hearing loss, and children with significant cognitive or motor delays were excluded from the OCHL study and, by extension, from this analysis. Medical information was gathered using medical records and participant intake forms, the latter reflecting a caregiver's report. A comparison group included 134 children with normal hearing. A Chi-square test on two-way tables was used to assess for differences in referral patterns by site for the children who are hard of hearing (CHH). Linear regression was performed on gestational age and birth weight as continuous variables. Risk factors were assessed using t tests. The alpha value was set at p < 0.05.

RESULTS

Neonatal intensive care unit stay, mechanical ventilation, oxygen requirement, aminoglycoside exposure, and family history were correlated with hearing loss. For this study cohort, congenital cytomegalovirus, strep positivity, bacterial meningitis, extracorporeal membrane oxygenation, and loop diuretic exposure were not associated with hearing loss. Less than 50% of children underwent imaging, although 34.2% of those scanned had abnormalities identified. No single imaging modality was preferred. Differences in referral rates were apparent for neurology, radiology, genetics, and ophthalmology.

CONCLUSIONS

The OCHL cohort reflects known etiologies of CHH. Despite available guidelines, centers of excellence, and high-yield rates for imaging, the medical workup for children with hearing loss remains inconsistently implemented and widely variable. There remains limited awareness as to what constitutes appropriate medical assessment for CHH.

Ophthalmologic Abnormalities in Children with Congenital Sensorineural Hearing Loss

Objective: To review a single center experience with the diagnosis of visual impairment in patients with sensorineural hearing loss (SNHL) and propose a diagnostic algorithm. Study Design: Retrospective study of patients with SNHL who were diagnosed with ophthalmologic abnormalities in the course of evaluation. Setting: University children's hospital and university-associated eye institute. Subjects and Methods: Children with the diagnosis of sensorineural hearing loss aged 0-18 who received a formal ophthalmology examination between the dates of December 2000-December 2016 were included for analysis. Children were identified using ICD-9 and ICD-10 billing codes. Primary measures included diagnosis of SNHL, ophthalmologic diagnoses, and referral source. Results: Two hundred and sixty-nine patients with SNHL met inclusion criteria. One hundred and thirty-one (48.5%) of these patients had an ophthalmic abnormality. When evaluating referral source, patients referred by a pediatrician following failed vision screen or visual complaint were more likely to have an ophthalmologic finding (61%, n = 147) when compared to referral by an otolaryngologist following diagnosis of SNHL (9.6%, n = 73). Seventeen of the 131 (13%) patients with at least one ophthalmic abnormality had an abnormality that was deemed unlikely to be detected by routine screening. Conclusion: Our study agreed with previously published works that there is a high rate of ophthalmic abnormalities in patients with SNHL. Evaluation of referral source for ophthalmology evaluation suggests that routine referral by otolaryngologists in patients with SNHL may not be an efficient means of identifying patients with treatable ophthalmic disease. Reliance on school and office screenings to detect ophthalmic abnormalities, prior to referral, is likely a more efficient model, even among patients with SNHL.

Prevalence of ophthalmic disorders among hearing-impaired school children in Guntur district of Andhra Pradesh

Purpose:

To estimate the prevalence, causes, and risk factors for visual impairment (VI) among children of school for hearing-impaired (HI) in Guntur district of Andhra Pradesh, India.

Methods:

Children between 6 and 16 years of age available in all the 12 special schools for HI were examined. Visual acuity (VA) testing, ocular motility, and examination of anterior and posterior segment for all children were done. Those having VA of less than 6/12 in better eye underwent cycloplegic refraction. For definition of VI, as per World Health Organization (WHO), VA of better eye was considered. HI was also classified as mild, moderate, severe, and profound as per WHO definitions. Examination for systemic diseases and other associated disabilities was also done.

Results:

In all, 402 children underwent examination. Ophthalmic abnormality was seen in 64 children with a prevalence of 15.9% [95% confidence interval (CI) 14.9%–16.8%], and VI was seen in 29 children with a prevalence of 7.2% (95% CI 4.9%–10.2%). Refractive errors [29 (7.2%)], retinitis pigmentosa (RP) [16 (4%)], and squint [8 (2%)] were the major ophthalmic abnormalities. Thirty-five (54.7%) of the abnormalities were either preventable or treatable. The major cause of VI was refractive error (18) followed by RP (5). Twenty of them (69%) with VI in this study group were treatable. Twenty-two (75.9%) children with eye problem were newly diagnosed. The only risk factor for VI was being mentally challenged (odds ratio: 5.63; 95% CI: 1.89–16.8).

Conclusion:

The prevalence of ophthalmic abnormalities and VI in school for HI was high, and the majority of them were not detected so far. As most of them are easily treatable, it is highly recommended to conduct regular eye examinations in these schools.

Expectations and Experience of Children with Unilateral Cochlear Implantation: A Parental Perspective

To find out parental expectations regarding outcomes of unilateral cochlear implantation prior to surgery and experience received by them after cochlear implantation and 1 year of regular auditory verbal therapy, with respect to the communication abilities, social skills and participation. Total of 200 parents of hearing impaired children participated in the study. A closed ended questionnaire containing 13 questions were used to collect the data. The participants were instructed to complete all the questions provided based on their expectations and experiences. The descriptive statistics were used to determine the frequency and percentage. Among 200 parents, almost all (95%) of the parents expected to have improvement in all the subscale of communication abilities, social skills and participation. 68.5% of the parents experienced improvement in their child's communication abilities, such as, response to quiet sounds, repetition of words without seeing speaker's face, elimination of use of gestures, easy communication and verbal expression for needs, thoughts and feelings. 76% of the parents experienced improvement in social skills and participations, such as, good relationship with elders, siblings and peers, making friends outside the family, actively participating in the activity done by other children and easily accepted by peers in the classroom. A large number of parents met with their expectations and a small proportion of families were found to be disappointed due to high hopes and unrealistic expectation before implantation, which had adverse effect on the children's performance.

Contrast Sensitivity Abnormalities in Deaf Individuals

Purpose:

Hearing impaired children are heavily dependent on their sense of vision to develop efficient communication skills; any contrast sensitivity defect can negatively impact their lives because they are not able to use auditory stimuli to recognize probable dangers in the world around them. The purpose of this study was to determine the contrast sensitivity abnormalities in deaf individuals.

Methods:

In this cross-sectional study, contrast sensitivity of 15- to 20-year-old high-school boys with hearing disability from Tehran, Iran were evaluated. Sixty-four eyes were tested for contrast sensitivity and refractive error. All subjects had an intelligence quotient (IQ) >70. We investigated their contrast sensitivity with Vector vision CVS-1000 in 4 different spatial frequencies.

Results:

Profound hearing loss was noted in 50% of the subjects. The frequency of contrast sensitivity abnormalities in 4 different spatial frequencies varied between 51.6% and 65.6%. The largest abnormalities were recorded at 18 cycles per degree. Only 12.5% of deaf students had corrected distance visual acuity (CDVA) greater than zero (in LogMAR). The abnormalities in contrast sensitivity showed no correlation with the type or severity of hearing loss.

Conclusion:

Hearing impaired boys are at a greater risk for contrast sensitivity abnormalities than boys with normal hearing. The larger frequency of contrast sensitivity abnormalities in high spatial frequencies than in other frequencies may demonstrate greater defects in the central visual system compared with the periphery in individuals with hearing loss.

Molecular diagnostics for hereditary hearing loss in children

INTRODUCTION

Hearing loss (HL) is the most common birth defect in industrialized countries with far-reaching social, psychological and cognitive implications. It is an extremely heterogeneous disease, complicating molecular testing. The introduction of next-generation sequencing (NGS) has resulted in great progress in diagnostics allowing to study all known HL genes in a single assay. The diagnostic yield is currently still limited, but has the potential to increase substantially. Areas covered: In this review the utility of NGS and the problems for comprehensive molecular testing for HL are evaluated and discussed. Expert commentary: Different publications have proven the appropriateness of NGS for molecular testing of heterogeneous diseases such as HL. However, several problems still exist, such as pseudogenic background of some genes and problematic copy number variant analysis on targeted NGS data. Another main challenge for the future will be the establishment of population specific mutation-spectra to achieve accurate personalized comprehensive molecular testing for HL.

Dual sensory impairment in special schools in South-Eastern Nigeria

In a cross-sectional study to determine the magnitude of dual sensory impairment (DSI-combined hearing and vision loss) in children in single-disability special education schools, children in schools for the blind and schools for the deaf in four states in South-East Nigeria were examined by an ophthalmologist and otorhinolaryngologist to determine the level of their disability and to identify other disabilities if any. Participants were all students with childhood blindness or childhood deafness. The magnitude and causes of DSI and the burden of undetected DSI were the main outcome measures. A total of 273 students were examined. About 7% of these students had DSI out of which over 60% (12/19) was previously undetected. There was more DSI in the blind schools than in the deaf schools (p=0.003). There is a large burden of undetected DSI in children in special schools in Nigeria. There is a need to create awareness of this problem and advocate appropriate screening, rehabilitative and educational strategies for children who have it.

Congenital hearing loss

Congenital hearing loss (hearing loss that is present at birth) is one of the most prevalent chronic conditions in children. In the majority of developed countries, neonatal hearing screening programmes enable early detection; early intervention will prevent delays in speech and language development and has long-lasting beneficial effects on social and emotional development and quality of life. A diagnosis of hearing loss is usually followed by a search for an underlying aetiology. Congenital hearing loss might be attributed to environmental and prenatal factors, which prevail in low-income settings; congenital infections, particularly cytomegalovirus infection, are also a common risk factor for hearing loss. Genetic causes probably account for the majority of cases in developed countries; mutations can affect any component of the hearing pathway, in particular, inner ear homeostasis (endolymph production and maintenance) and mechano-electrical transduction (the conversion of a mechanical stimulus into electrochemical activity). Once the underlying cause of hearing loss is established, it might direct therapeutic decision making and guide prevention and (genetic) counselling. Management options include specific antimicrobial therapies, surgical treatment of craniofacial abnormalities and implantable or non-implantable hearing devices. An improved understanding of the pathophysiology and molecular mechanisms that underlie hearing loss and increased awareness of recent advances in genetic testing will promote the development of new treatment and screening strategies.

Usher's Syndrome: Evaluation of the Vestibular System with Cervical and Ocular Vestibular Evoked Myogenic Potentials and the Video Head Impulse Test

OBJECTIVE

The Usher's syndrome (USH) is composed of a group of inherited disorders characterized by a dual sensory impairment of the audiovestibular and visual systems. Despite the established hearing loss, few authors have investigated vestibular dysfunction in these patients.The aim of this article is to investigate otolith or ampullary dysfunction in a group of patients affected by USH by means of a diagnostic protocol using caloric vestibular tests, cervical vestibular evoked myogenic potentials (C-VEMPs), ocular vestibular evoked myogenic potentials (O-VEMPs), and video head impulse test (v-HIT) to show any selective damage of the vestibular nerve and also to identify if it is present in patients with a previous diagnosis of USH Type II.

STUDY DESIGN

Prospective study with C-VEMPs, O-VEMPs, and v-HIT.

SETTING

Tertiary referral center.

PATIENTS

Fifteen patients with USH.

INTERVENTION

Evaluation of otolith dysfunction with caloric test, C-VEMPs, and O-VEMPs and the measurement of the vestibular-ocular reflex using the v-HIT.

RESULTS

Only three cases showed normal values of all the vestibular tests performed. O-VEMPs and C-VEMPs appeared pathologic in nine and seven cases, respectively. V-HITs showed ampullary dysfunction in 10 patients. In our study, eight of the 11 patients belonging to the group of USH Type II showed a pathologic response to at least one of the vestibular tests performed.

CONCLUSION

Today, in patients affected by USH, any vestibular diagnostic protocol must include VEMPs and v-HIT to confirm the vestibular damage, identify selective deficit of the vestibular nerve, and provide useful information for a correct classification of USH.

Impact of correcting visual impairment and low vision in deaf-mute students in Pune, India

Aim:

Settings:

Methods:

Statistical Analysis:

Results:

Conclusion:

Eye problems in children with hearing impairment

PURPOSE

To compare the prevalence of refractive errors, amblyopia, and strabismus between hearing-impaired and normal children (7-22 years old) in Mashhad.

METHODS

In this cross-sectional study, cases were selected from hearing-impaired children in Mashhad. The control group consisted of children with no hearing problem. The sampling was done utilizing the cluster sampling method. All of the samples underwent refraction, cover test, and visual examinations.

RESULTS

254 children in the hearing-impaired group (case) and 506 children in the control group were assessed. The mean spherical equivalent was 1.7 ± 1.9 D in the case group, which was significantly different from the control group (0.2 ± 1.5) (P < 0.001). The prevalence of hyperopia was 57.15% and 21.5% in deaf and normal children, respectively, but myopia was mostly seen in the control group (5.5% versus 11.9%, P = 0.007). The mean cylinder was 0.65 ± 1.3 D and 0.43 ± 0.62 D in deaf and normal subjects, respectively (P = 0.002). 12.2% of deaf subjects and 1.2% of normal subjects were amblyopic (P < 0.001), and the prevalence of strabismus was 3.1% in the case group and 2.6% in the control group (P = 0.645).

CONCLUSION

In a comparison of children of the same ages, hearing-impaired children have significantly more eye problems; therefore, a possible relation between deafness and eye problems must exist. Paying attention to eye health assessment in hearing-impaired children may help prevent adding eye problems to hearing difficulties.

Visual performance and ocular abnormalities in deaf children and young adults: a literature review

Visual defects are common in deaf individuals. Refractive error and ocular motor abnormalities are frequently reported, with hyperopia, myopia, astigmatism and anomalies of binocular vision, all showing a greater prevalence in deaf individuals compared with the general population. Near visual function in deaf individuals has been relatively neglected in the literature to date. Comparisons between studies are problematic due to differences in methodology and population characteristics. Any untreated visual defect has the potential to impair the development of language, with consequences for education more generally, and there is a need to improve screening and treatments of deaf children.

Ophthalmologic findings in a pediatric cochlear implant population

PURPOSE

To report ocular findings in a cohort of children requiring pediatric cochlear implant and to evaluate the usefulness of routine ophthalmologic examination in such children.

METHODS

This was a prospective study of ophthalmologic assessment of 47 consecutive children aged 10 months to 12 years from the cochlear implant program of our hospital.

RESULTS

All children underwent complete ocular assessment consisting of orthoptic and ophthalmo-logic examination, including cycloplegic refraction. A total of 18 children (38.3%) had some form of ocular abnormality, with the majority (14 patients, 29.8%) having refractive errors. Hypermetropia was the most common refractive error (21.3%), followed by astigmatism (8.5%). Strabismus was found in 6 patients, with esotropia being the most common type. Other ocular findings included ptosis (1 patient) and epicanthal folds (3 patients). During the follow-up period, 9 children were fitted with glasses, 3 underwent occlusion therapy, 2 underwent strabismus surgery, and 1 underwent ptosis surgery.

CONCLUSIONS

Thorough orthoptic and ophthalmologic examination is useful for ensuring optimal visual function in children undergoing cochlear implantation.

Pediatric primary care physicians' practices regarding newborn hearing screening

OBJECTIVE

Approximately 2 to 3 out of 1000 infants are born with hearing loss in the United States each year. Pediatric primary care physicians (PCPs) can play an important role in ensuring that infants with hearing loss are identified early and provided appropriate services. In this study, pediatric PCPs were surveyed about their practices regarding early hearing detection and intervention.

METHODS

Responses from the 2008 DocStyles survey were used to examine patient, physician, and practice variables associated with actions consistent with the 2007 Joint Committee on Infant Hearing position statement, which includes follow-up protocols for medical home providers.

RESULTS

Pediatricians working in a group setting were more likely to receive hearing screening results than were those in individual practices or hospitals and clinics. Family/general physicians with heavier caseloads were more likely to receive hearing screening results for their pediatric patients than were those with lighter caseloads. Few pediatric PCPs reported contacting their state's early hearing detection and intervention program if they knew that an infant failed the newborn hearing screening. Although high proportions of pediatric PCPs reported referring an infant with hearing loss to an otolaryngologist, only about half reported referring a child with risk factors for hearing loss for audiological and speech-language assessment, even if the parents expressed concern or if the results of a developmental screening indicated a possible delay. Few respondents reported referring an infant with hearing loss under their care to an ophthalmologist.

CONCLUSIONS

This study highlights the need to improve infrastructure for pediatric PCPs to receive and request infant hearing screening results to facilitate reporting and coordinate follow-up services for infants identified with hearing loss.

Findings from multidisciplinary evaluation of children with permanent hearing loss

OBJECTIVES

To describe clinical findings from a multidisciplinary program for children with permanent hearing loss (PHL).

METHODS

Retrospective chart review at a tertiary care children's hospital.

PATIENTS

Two hundred patients charts were selected from the population of 260 children with permanent hearing loss presenting between July 2005 and December 2006.

MAIN OUTCOME MEASURES

PHL etiology; radiographic findings; clinical findings by genetics, ophthalmology, developmental pediatrics, speech pathology, and aural rehabilitation.

RESULTS

Etiology of hearing loss was determined in 60% of subjects. Genetic causes of hearing loss were identified or presumed (positive history of first degree relative with hearing loss) in 27% of the children. Structural ear anomalies were found in 20% of children. Among the 36% of children with CNS imaging, abnormal findings were noted in 32%. There were a high rate of ophthalmological findings (53%) among children seen by ophthalmology (n = 105). Neurodevelopmental evaluations were completed in 58% of subjects and clinically significant findings were noted in 68%. Of the 61% of children who receiving received speech/language evaluations, 77% required intervention. Over half of the 40% of subjects who had an aural rehabilitation evaluation needed therapy. There were not significant differences in rates of findings for children with mild or unilateral hearing loss as compared to children with more severe degrees of hearing loss.

CONCLUSIONS

Interdisciplinary medical evaluation of children with PHL allows for the identification and treatment of clinically significant ophthalmologic, neurodevelopmental, genetic, and speech/language disorders. A high rate of CNS and temporal bone abnormalities were identified. These findings provide an understanding of the importance of considering thorough medical and developmental evaluations among children who are deaf/hard of hearing.

Etiological diagnosis in the hearing impaired newborn: proposal of a flow chart

OBJECTIVE

Most industrialized countries have introduced some form of universal newborn hearing screening program. Both identification and rehabilitation of hearing loss in newborns have evolved to an acceptable standard and the need for a standardized etiological protocol is emerging.

METHODS

Extensive literature search to determine which investigations can help identifying the cause of congenital hearing loss and how to limit extensive testing in these children by taking into account the most prevalent causes.

FINDINGS

A stepwise approach to detect the cause of hearing loss in children with congenital sensorineural hearing loss was developed.

CONCLUSION

In general it is advised to first rule out Cx26/Cx30 and infectious causes (cytomegalovirus and, if indicated, toxoplasmosis and rubella), and to preserve more extensive investigations for those children in whom these causes do not explain the hearing loss.

Improving detection of blindness in childhood: the British Childhood Vision Impairment study

OBJECTIVES

In industrialized countries, there are established programs of childhood vision screening and surveillance, but little is known about their performance. We investigated the patterns of presentation/detection and early treatment of a nationally representative cohort of children with severe visual impairment or blindness (SVI/BL) in 1 year (2000) in the United Kingdom.

METHODS

All children who were younger than 16 years and had a new diagnosis of SVI/BL were identified by active surveillance through the British Ophthalmological and Pediatric Surveillance Units. Data that were collected up to 1 year after diagnosis included sociodemographic characteristics, detection of SVI/BL, nonophthalmic disorders/impairments, ophthalmic findings, and early management.

RESULTS

Of 439 identified children, 65% were younger than 1 year at diagnosis, 28% were of nonwhite ethnicity, and 40% in the worst quintile of deprivation score. A total of 77% had associated nonophthalmic disorders/impairments. Although 70% had established symptoms or signs at diagnosis by a health professional, parents had suspected blindness in only 47%. A quarter of isolated SVI/BL was detected through routine vision screening; however, 46% of children's SVI/BL and associated nonophthalmic disorders/impairments were diagnosed through a clinical surveillance examination undertaken because of high risk for a specific eye disease.

CONCLUSIONS

The "patient journey" of children with visual impairment is markedly influenced by the presence of additional impairments/chronic diseases. Parents' understanding of normal visual development needs to be improved. Increasingly, new evidence-based formal programs of clinical (ophthalmic) surveillance are needed in response to the changing population of children who are at risk for blinding eye disease.

Parents' views on changes in their child's communication and linguistic and socioemotional development after cochlear implantation

Our aim was to obtain versatile information on the communication and socioemotional development of implanted children in their everyday environment. We studied 18 children implanted unilaterally at the mean age of 3 years 4 months. All had normal nonverbal intelligence, but 8 (44%) had concomitant problems. Their parents filled out semistructured questionnaires at 6 months and then annually 1-5 years after activation. Parents reported a change from use of signs to speech, and changes in the children's vocal behavior and spoken language development. They also reported that children had calmed down and showed an increased sense of self-confidence and safety with an expanded social life. The greatest changes started to take place 1 year after implantation. Five years after implantation, two thirds of children were judged to be as independent as their age peers. We conclude that changes in communication pave the way to benefits in psychosocial development after implantation.

Screening for ophthalmic disorders and visual impairment in a Nigerian school for the deaf

PURPOSE

To detect the presence of ophthalmic abnormalities and visual impairment in deaf students.

METHODS

A cross-sectional survey of all students in the school for the deaf was conducted following ethical clearance from the Ministry of Health. Age, sex, and previous eye examination was recorded for each student as well as visual acuity, penlight eye examination, intraocular pressure, dilated funduscopy, and refraction (when applicable). Data were analyzed with SPSS version 11 and statistical significance inferred at p<0.05.

RESULTS

The 156 (100%) students at the school for the deaf with age range 6-25 years, mean +/- standard deviation of 15.6+/-3.3 years, and modal age of 14 years were studied. A total of 110 (70.5%) had no previous eye examination, 2 (1.3%) students were blind, 5 (3.2%) were visually impaired, 4 (2.6%) had unilateral visual impairment, and 4 (2.6%) had unilateral blindness. Blindness was caused by Usher syndrome in 1 (50%) and bilateral pigmented macular scar in 1 (50%) patient. Uncorrected refractive errors were the leading cause of unilateral visual impairment (75%), visual impairment (60%), and unilateral blindness (50%). Ocular abnormality was present in 53 (34%) students while uncorrected refractive error (18.6%), retina changes (7%), and allergic conjunctivitis (3.8%) were the leading disorders. Previous eye examination was more common among primary school students (p<0.0001) and students with ocular abnormalities (p=0.046).

CONCLUSIONS

Institutions for deaf children should be aware of the high prevalence of ophthalmic disorders and the importance of vision to development of a deaf child, and conduct an initial and periodic eye examination for every intake.

Visual impairment in the hearing impaired students

Background:

Ocular problems are more common in children with hearing problems than in normal children. Neglected visual impairment could aggravate educational and social disability.

Aim:

To detect and treat visual impairment, if any, in hearing-impaired children.

Setting and Design:

Observational, clinical case series of hearing-impaired children in schools providing special education.

Materials and Methods:

Hearing-impaired children in selected schools underwent detailed visual acuity testing, refraction, external ocular examination and fundoscopy. Ocular motility testing was also performed. Teachers were sensitized and trained to help in the assessment of visual acuity using Snellen's E charts. Refractive errors and squint were treated as per standard practice.

Statistical Analysis:

Excel software was used for data entry and SSPS for analysis.

Results:

The study involved 901 hearing-impaired students between four and 21 years of age, from 14 special education schools. A quarter of them (216/901, 24%) had ocular problems. Refractive errors were the most common morbidity 167(18.5%), but only 10 children were using appropriate spectacle correction at presentation. Fifty children had visual acuity less than 20/80 at presentation; after providing refractive correction, this number reduced to three children, all of whom were provided low-vision aids. Other common conditions included strabismus in 12 (1.3%) children, and retinal pigmentary dystrophy in five (0.6%) children.

Conclusion:

Ocular problems are common in hearing-impaired children. Screening for ocular problems should be made mandatory in hearing-impaired children, as they use their visual sense to compensate for the poor auditory sense.

Ophthalmological screening of a paediatric cochlear implant population: a retrospective analysis and 12-year follow-up

AIMS

To determine the nature and prevalence of ophthalmological findings for a cohort of children in a paediatric cochlear implant program and to assist the clinician in devising an investigative plan for this population.

METHODS

Retrospective medical record review of children who underwent multichannel cochlear implantation at a tertiary care hospital between February 1996 and July 2008.

RESULTS

In all, 141 children (mean age 28 months, range 16 months to 9 years) had complete medical record documentation consisting of orthoptic and opthalmological examination, including cycloplegic refraction. A total of 59 children (41.8%) had ocular abnormalities with refractive errors being the most common abnormality. Hypermetropia was the most common refractive error and was found in 21 children (14.8%). Strabismus was found in six patients, with constant esotropia being the most common. Ocular pathology (excluding refractive or muscle abnormalities) were found in nine patients (6.3%). Three patients had syndromes associated with ocular findings including Waardenburg and Usher syndrome. During the follow-up period, 14 children were fitted with prescription lenses, 3 had strabismus surgery, and 2 underwent ptosis.

CONCLUSIONS

Routine orthoptic and ophthalmologic examination can be beneficial in the initial evaluation of children assessed for cochlear implants. Electroretinography is useful in evaluating children with unexplained congenital sensorineural hearing loss, suggestive symptoms including night blindness, unexplained reduction in visual acuity, or delayed motor milestones. Routine yearly follow-up may aid in the detection of changing refractive errors and the possibility of later-onset retinal degeneration.

Development of speech intelligibility and narrative abilities and their interrelationship three and five years after paediatric cochlear implantation

This study sought to determine the level of speech intelligibility, narrative abilities, and their interrelationship in 18 Finnish children implanted at the average age of three years, four months. Additionally, background factors associated with speech intelligibility and storytelling ability were examined. Speech intelligibility was examined by means of an item identification task with five listeners per child. Three and five years after activation of the implant, the children reached average intelligibility scores of 53% and 81%, respectively. The story generation abilities of the implanted children exceeded their hearing age by one year, on average. This was found after comparing their results with those of normally-hearing two- to six-year-olds (N = 49). According to multiple regression analysis, comorbidity (number of additional needs), chronological age, and/or age at activation usually explained from 46% to 70% of the variation in speech intelligibility and narrative abilities. After controlling for age, communication mode, and number of additional needs, speech intelligibility and ability to narrate were statistically significantly associated with each other three years after activation, but not anymore five years after activation.

Development of a partial Balint's syndrome in a congenitally deaf patient presenting as pseudo-aphasia

We present a 56 year-old, right-handed, congenitally deaf female who exhibited a partial Balint's syndrome accompanied by positive visual phenomena restricted to her lower right visual quadrant (e.g., color band, transient unformed visual hallucinations). Balint's syndrome is characterized by a triad of visuo-ocular symptoms that typically occur following bilateral parieto-occipital lobe lesions. These symptoms include the inability to perceive simultaneous events in one's visual field (simultanagnosia), an inability to fixate and follow an object with one's eyes (optic apraxia), and an impairment of target pointing under visual guidance (optic ataxia). Our patient exhibited simultanagnosia, optic ataxia, left visual field neglect, and impairment of all complex visual-spatial tasks, yet demonstrated normal visual acuity, intact visual fields, and an otherwise normal neurocognitive profile. The patient's visuo-ocular symptoms were noticed while she was participating in rehabilitation for a small right pontine stroke. White matter changes involving both occipital lobes had been incidentally noted on the CT scan revealing the pontine infarction. As the patient relied on sign language and reading ability for communication, these visuo-perceptual limitations hindered her ability to interact with others and gave the appearance of aphasia. We discuss the technical challenges of assessing a patient with significant barriers to communication (e.g., the need for a non-standardized approach, a lack of normative data for such special populations), while pointing out the substantial contributions that can be made by going beyond the standard neuropsychological test batteries.

Communication in the early stage of language development in children with CHARGE syndrome

CHARGE syndrome is characterized by multiple physical abnormalities, and impaired vision and hearing. In this pilot study, communication in the early stage of language development in three one- to eight-year-old children with CHARGE syndrome was explored using video recorded free-play interaction sessions and a parental questionnaire. The children mainly used gestures, but also vocalization and some signs. According to methods based on the Tait Video Analysis (2003) and the Communicative Intention Inventory (Coggins and Carpenter, 1981), the children used shared attention with their mothers most of the time, with initiations comprising almost half of all their communicative expressions. Intentional communication covered 15 to 18 per cent of the communicative acts. Suggestions for how individual characteristics of communication can be used in parental guidance are presented in the discussion.

Novel syndrome of cataracts, retinitis pigmentosa, late onset deafness and sperm abnormalities: a new Usher syndrome subtype with X-linked inheritance?

Tissues of the auditory, ocular and reproductive systems have some similarities in their protein families and structures. Consequently, syndromes comprising these systems are described. Hearing loss alone is a component of more than 400 known syndromes and is a common nonsyndromic congenital disorder. Here we describe a syndrome in five brothers with the distinctive presentation of late-onset progressive hearing loss, cataracts, retinitis pigmentosa, sperm motility and shape problems in a family from the Kurdish population in Iran. The clinical findings of these patients are presented in detail and compared to the classical Usher syndromes.

Cochlear implantations in visually impaired patients

We retrospectively review the cases to evaluate the outcome of cochlear implantation (CI) in patients with severe-to-profound hearing loss and visual impairment (VI). Six adults with severe or profound hearing loss and significant VI underwent multichannel CI. Follow-up period ranged from 17 months to 7 years. Case history, etiology of visual and hearing loss, and benefit from CI were evaluated. To measure the outcomes, we selected the pure-tone thresholds with CI, the speech discrimination scores (SDS) using the Japanese video SDS system, the speech perception rates using the Japanese CD SDS system by monosyllable and word, and the open-set and closed sentence score using live voice. All the patients live happily after CI. There was no significant difference between the present six patients and the patients with profound hearing loss without VI in evaluations of hearing and quality of life. CI can play a significant rehabilitative role in patients with severe hearing loss and VI.

Does cause of deafness influence outcome after cochlear implantation in children?

OBJECTIVES

The objective of this study was to evaluate long-term speech perception abilities of comparable groups of postmeningitic and congenitally deaf children after cochlear implantation.

METHODS

This prospective longitudinal study comprised 46 postmeningitic deaf children and 83 congenitally deaf children with age at implantation of < or = 5.6 years. Both groups were comparable with respect to educational setting and mode of communication and included children with additional disabilities.

RESULTS

Both postmeningitic and congenitally deaf children showed significant progress after implantation. Most (73% and 77%, respectively) could understand conversation without lip-reading or use the telephone with a known speaker 5 years after implantation, whereas none could do so before implantation. At the same interval, the postmeningitic and congenitally deaf children scored a mean open-set speech perception score of 47 (range: 0-91) and 46 (range: 0-107) words per minute, respectively, on connected discourse tracking. The respective mean scores at the 3-year interval were 22 and 29 correct words per minute, respectively. None of these children could score a single correct word per minute before implantation. The progress in both groups was statistically significant. When the 2 groups were compared, there was no statistically significant difference.

CONCLUSION

Postmeningitic and congenitally deaf children showed significant improvement in their auditory receptive abilities at the 3- and 5-year intervals after cochlear implantation. There was no statistically significant difference between the outcomes of the 2 groups, suggesting that, provided that children receive an implant early, cause of deafness has little influence on outcome. Although the prevalence of other disabilities was similar in both groups, for individual children, their presence may have profound impact. The study supports the concept of implantation early in life, irrespective of the cause of deafness.

Primary care physicians' knowledge, attitudes, and practices related to newborn hearing screening

OBJECTIVE

Universal newborn hearing screening focuses on providing the earliest possible diagnosis for infants with permanent hearing loss. The goal is to prevent or minimize the consequences of sensorineural hearing loss on speech and language development through timely and effective diagnosis and interventions. Pediatricians are in a key position to educate families about the importance of follow-up, if they are well informed. The objective of this study was to survey the attitudes, practices, and knowledge of primary care physicians in relation to newborn hearing screening and follow-up.

METHODS

A survey was created on the basis of input from focus groups with primary care physicians. Surveys (n = 12,211) were sent to primary care physicians in 21 states and 1 territory (Puerto Rico) regarding practices, knowledge, and attitudes related to universal newborn hearing screening. The response rate was 16.1% (n = 1968).

RESULTS

Physicians reported a high level of support for universal newborn hearing screening; 81.6% judged it to be very important to screen all newborns for hearing loss at birth. Although physicians reported confidence in talking with parents about screening results, they indicated a lack of confidence in discussing follow-up procedures and intervention needs. Several important gaps in knowledge were identified, and these represent priorities for education, as based on their relevance to medical management and parent support. Physicians expressed a strong preference for action-oriented resources.

CONCLUSION

Pediatricians and other primary care providers recognize the benefits of early detection and intervention for permanent hearing loss in infants. The current system of newborn hearing screening can be enhanced by strengthening the medical community's involvement in the process from screening to follow-up. Physician roles will be supported through the provision of action-oriented resources that educate parents about the importance of follow-up and that prepare professionals to incorporate appropriate surveillance procedures in daily practice.