Early Diagnosis and Management of Hearing Loss in Medically Fragile Children

Abstract

Newborns and young children with serious medical problems pose a challenge to the success of universal newborn hearing screening. The need for ototoxic medications to rescue the critically ill child increases the risk for hearing loss that is already high due to the underlying disease. Congenital cytomegalovirus infection, aggressive life support including extracorporeal membrane oxygenation, and platinum-based chemotherapy to treat childhood cancer are cause to closely monitor hearing once health care attention turns from rescue to recovery. Algorithms for surveillance for hearing loss help reduce the time delay between the adventitious onset of hearing loss and the diagnosis and intervention. Understanding the relative risk for hearing loss for the individual child can help clinicians counsel families regarding the anticipated need for audiologic intervention. Assuring adequate hearing habilitation includes objective verification of audiologic interventions, as this young and ill patient population often cannot communicate the appropriateness of hearing aid settings. The use of FM systems is quite often necessary given the steeply sloping configuration of ototoxic hearing loss, and candidacy for cochlear implant may be complicated, but certainly not contraindicated, in children with complex medical histories.