Higher Risk Of Hearing Loss Research Articles

Risk Factors of Sensorineural Hearing Loss in Patients With Ischemic Stroke

We investigated risk factors of sensorineural hearing loss (SHL) in patients with early stage of ischemic stroke (IS). Our study consisted of 60 patients with IS who were treated at Department of Neurology, Medical University of Gdansk between 2006 and 2007. A multivariate stepwise linear regression was used to identify the risk factors that were related to SHL as measured by pure-tone average (0.5, 1, and 2 kHz), the high-tone average (4, 6, and 8 kHz), the pure-tone middle-tone average (0.5, 1, 2, and 4 kHz), and the overall average (0.5, 1, 2, 4, 6, and 8 kHz). The following factors were included in the analysis: age, sex, smoking habit, addiction to alcohol, presence of tinnitus and vestibular symptoms, arterial hypertension, cardiac ischemic disease, hyperlipidemia, diabetes, number of risk factors, neurologic state at the admission, localization of stroke, cause of stroke, number of ischemic focuses, the side and diameter of ischemic focuses, the result of directional hearing acuity angle test, results of certain laboratory tests, blood morphology parameters, and coagulogram. Values for p less than 0.05 were considered significant. Our analysis suggests the presence of the following risk factors of SHL in patients with IS: 1) older age (>60 yr); 2) male sex; 3) presence of tinnitus; 4) arterial hypertension; 5) lacunar type of stroke; 6) presence of multiple ischemic focuses; 7) presence of bilateral ischemic focuses; 8) changes in blood cell count; and 9) disturbances of agglutination. The highest risk of hearing loss in the group of IS patients occurred at older people, particularly men with tinnitus, lacunar stroke, multiple, bilateral ischemic focuses, and arterial hypertension. A negative statistically significant influence of decreased level of red cells, platelets, and hematocrit value on hearing loss was found. Abnormally lowered levels of activated partial thromboplastin time, activated partial thromboplastin time ratio, prothrombin index, and abnormal lowered level of international normalized ratio statistically impaired hearing.

New State Laws Enhance EHDI Programs

You have accessThe ASHA LeaderSchool Matters1 May 2008New State Laws Enhance EHDI ProgramsMaine, Tennessee Enact Legislation; States Consider ASHA Model Bill Rend Al-Mondhiry Rend Al-Mondhiry Google Scholar More articles by this author https://doi.org/10.1044/leader.SCM1.13072008.5 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In New state laws are on the books in Maine and Tennessee that enhance early hearing detection and intervention (EHDI) efforts, reflecting a national trend to improve EHDI programs. Maine’s governor approved legislation April 17 to help ensure that newborns with suspected or confirmed hearing loss receive the necessary follow-up care in a timely manner from qualified professionals. The legislation implements the recommendations of a working group that studied the effectiveness and timeliness of early identification and intervention for children with hearing loss. The new law requires a hospital or birthing center to schedule a newborn whose screening result is “refer” for a follow-up audiology appointment. Parental approval is necessary. The appointment must be scheduled prior to discharge, and the hospital or center must notify the newborn’s primary care provider in writing of the screening result and appointment prior to discharge. In addition, the Maine Department of Health and Human Services’ Newborn Hearing Program must report to a joint standing committee of the legislature about barriers to access to audiologists for the continued evaluation of hearing loss in newborns. Tennessee’s governor signed legislation April 21 to enhance the state’s newborn hearing screening program by mandating hearing screenings and follow-up care for all newborns. “Claire’s Law” requires that every newborn infant in Tennessee be screened for hearing loss before discharge from the hospital, unless the child’s parents object on religious grounds. For children born outside a hospital setting, or in a hospital that does not provide screening, the attending health care professional must refer the child to the Department of Health or to an appropriate provider for a hearing screening. In addition, any medical or audiologic provider performing follow-up tests must report the results. Children who do not pass the hearing screening test are then referred to the Tennessee Early Intervention System (TEIS) of the Department of Education for follow-up. Children who have been identified with hearing loss or are at high risk for hearing loss must also be referred to the TEIS. Finally, the law requires certain insurance plans to cover hearing screenings. New Model Bill This movement toward improvement of EHDI programs is supported by ASHA’s new model EHDI Phase II bill. Phase I, launched in 1999, focused on expanding universal newborn screening and other policies; Phase II is designed to help states reduce the number of infants lost to follow-up after hearing screening, expand early intervention services, and promote culturally sensitive family support programs. The model bill recently underwent extensive peer review and was revised based on suggestions and comments of ASHA members and various EHDI stakeholders, including the Centers for Disease Control and Prevention, the Joint Committee on Infant Hearing, and the National Center for Hearing Assessment and Management at Utah State University. The bill was presented at ASHA’s 2008 State Association Workshop in Saratoga Springs, N.Y., to introduce state leaders to EHDI Phase II. ASHA will help targeted states consider introducing appropriate aspects of the model bill into their legislatures. ASHA has updated its EHDI talking points to reflect new developments in research, technology, and key components of EHDI Phase II found in the model state bill. The talking points emphasize the importance of follow-up and tracking of children with hearing loss, addressing privacy concerns, and recognizing the need to detect and manage mild, unilateral, and late-onset hearing loss in children. The talking points will be useful in educating policymakers as states advocate for implementation of Phase II of EHDI. More information is available at ASHA’s Legislation and Advocacy Web site. Author Notes Rend Al-Mondhiry, director of state legislative and regulatory advocacy, can be reached at [email protected]. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 13Issue 7May 2008 Get Permissions Add to your Mendeley library History Published in print: May 1, 2008 Metrics Current downloads: 72 Topicsasha-topicsleader_do_tagasha-article-typesleader-topicsCopyright & Permissions© 2008 American Speech-Language-Hearing AssociationLoading ...

Hearing impairment and socioeconomic factors: a population-based survey of an urban locality in southern Brazil

To provide the first population-based data on deafness and hearing impairment in Brazil. In 2003, a cross-sectional household survey was conducted of 2,427 persons 4 years old and over. The study population was composed of 1,040 systematically chosen households in 40 randomly selected census tracts (dwelling clusters) in the city of Canoas, which is in the state of Rio Grande do Sul, in southern Brazil. Hearing function was evaluated in all subjects by both pure-tone audiometry and physical examination, using the World Health Organization Ear and Hearing Disorders Survey Protocol and definitions of hearing levels. The socioeconomic data that were gathered included the amount of schooling of all individuals tested and the income of the head of the household. It was found that 26.1% of the population studied showed some level of hearing impairment, and 6.8% (95% confidence interval (CI) = 5.5%-8.1%) were classified in the disabling hearing impairment group. The prevalence of moderate hearing loss was 5.4% (95% CI = 4.4%-6.4%); for severe hearing loss, 1.2% (95% CI = 0.7%-1.7%); and for profound hearing loss, 0.2% (95% CI = 0.03%-0.33%). The groups at higher risk for hearing loss were men (odds ratio (OR) = 1.54; 95% CI = 1.06-2.23); participants 60 years of age and over (OR = 12.55; 95% CI = 8.38-18.79); those with fewer years of formal schooling (OR = 3.92; 95% CI = 2.14-7.16); and those with lower income (OR = 1.56; 95% CI = 1.06-2.27). These results support advocacy by health policy planners and care providers for the prevention of deafness and hearing impairment. The findings could help build awareness in the community, in universities, and in government agencies of the health care needs that hearing problems create.

Statistical Analysis of Hearing Loss among Navy Personnel

Hearing loss is one of the most common disabilities among sailors. Service members are posted to a variety of stations. Many of these posts have high noise levels, and particular ratings have high exposure. If assignments of higher risk can be identified, then focused prevention programs can be implemented. The focus of this study was to determine how hearing loss relates to service time spent aboard ships. To investigate which duty stations and ratings are at high risk for hearing loss, this study looked at medical hearing test records for nearly 268,000 enlisted sailors over the period of 1979 to 2004. Using both logistic and logarithmic binomial analyses, the study found that enlisted sailors who spent one-half of a 30-year Navy career assigned to a surface warship had a 13-percentage point higher probability of leaving the service with a reduction in the ability to hear, compared with someone who spent his or her whole career in a shore billet. If the same sailor spent two-thirds of his or her 30-year Navy career assigned to a surface warship, then the probability of hearing loss at the end of his or her career would increase by another 5 percentage points.

Universal neonatal hearing screening: The Siena (Italy) experience on 19,700 newborns

Background Hearing loss (HL) is likely to be the most common congenital abnormality in humans, with a reported prevalence of 1 to 3 per 1000 live births. Early detection and intervention is critical to prevent the adverse consequences of a delayed diagnosis on speech, language and cognitive development. As 33–50% of all congenital HLs cannot be detected in a selective hearing risk, use of universal neonatal hearing screening (UNHS) programs is expanding. Aims We tested the value of a UNHS protocol, based on a two-stage strategy of Transient Evoked Otoacoustic Emissions (TEOAEs) in all infants, followed by diagnostic auditory brainstem response (ABR) testing in those infants who did not meet TEOAE pass criteria and those infants at high risk for hearing loss. Methods TEOAES (292 DP Echoport OAE Analyzer) served as the initial screen, followed by diagnostic ABR (Amplaid MK12) in newborns that did not meet pass criteria for TEOAEs. Additionally, all infants at high audiologic risk according to the Joint Committee on Infant Hearing received a diagnostic ABR evaluation. Of 21,125 total live births, 19,700 were tested (April 1, 1998–July 31, 2006). Accuracy of the UNHS strategy in predicting congenital HL was evaluated by calculating sensitivity, specificity, positive predictive value and negative predictive value. Results Prevalence for all HLs in the neonatal period was 1.78/1000 l.b. (35/19,700), with bilateral HL in 1.42/1000 l.b. (28/19,700) [low risk rate: 0.43/1000 l.b. (8/18,356); high risk infants rate: 14.88/1000 l.b. (20/1344)]. All the HL infants were diagnosed < 3 and received intervention < 6 months age. ROC curves results showed 100% sensitivity (95% C.I.: 89.0–100) and 99.3% specificity (95% C.I.: 99.2–99.4) of the two-stage strategy in detecting congenital HLs [area under the ROC curve: 0.997 (95% C.I.: 0.995–0.997)]. Conclusions (1) The epidemiology of congenital HLs widely justifies UNHS; (2) a two-stage TEOAE and diagnostic ABR screening for congenital HL is feasible, minimally invasive and accurate in the early detection of congenital HL; and (3) a congenital HL screening strategy based exclusively on the use of TEOAEs should always consider the possibility of false negative cases.

Hispanics May Face Higher Risk for Hearing Loss from iPods, Other MP3 Players

You have accessThe ASHA LeaderASHA News1 Dec 2006Hispanics May Face Higher Risk for Hearing Loss from iPods, Other MP3 Players Marat Moore Marat Moore Google Scholar More articles by this author https://doi.org/10.1044/leader.AN1.11172006.3 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In An ASHA press conference during the Miami Beach convention drew the media spotlight to the problem of higher usages of personal audio technology—and the potentially higher risk of hearing loss—among Hispanic teens and adults. Media generated at the press conference, which featured a panel of experts on noise-induced hearing loss, has already reached more than 15 million people through broadcast and print coverage, most of it national in scope. The higher risk of hearing loss was gleaned from an ASHA-commissioned poll. Through the poll, ASHA demonstrated its long-standing commitment to multicultural and international outreach, and its recognition of demographic trends affecting ASHA members. At 43 million, Hispanics comprise the nation’s largest minority and will represent nearly 25% of the U.S. population in 30 years. “Personal audio technology has obvious cross-cultural and cross-border popularity,” ASHA President Alex Johnson said. “We are acting on our responsibility to get our message of safe usage out—especially now, on the eve of the holiday shopping season.” The press conference was held to release the results of the poll, conducted by Zogby International, showing that Hispanic teens and adults in the United States report they are listening to popular iPod and other MP3 players for longer periods and at higher volumes than all teens and all adults. The new polling indicates that more than half of U.S. Hispanic teens typically play the iPod at very loud or somewhat loud volume levels, compared to 41% of all teens surveyed in similar ASHA-commissioned polling last winter. This polling—the first of its kind—is the latest aspect of “America: Tuned In Today…But Tuned Out Tomorrow?,” a public education campaign ASHA launched at the beginning of 2006. The initiative encourages safe usage of personal audio technology, recommending safety measures such as keeping volume levels within the maximum safe limit of 85 dB and limiting listening time. According to the poll, a “typical iPod session” lasted from one to four hours for 42% of U.S. Hispanic teens, compared with 30% of all teens who listen for that duration. In addition, 14% percent of Hispanic teens listen for four hours or more; for all teens, that figure is 11%. In addition, although Hispanic adults in many cases are less likely than all adults in the United States to use personal audio technology, when they use it, they are more likely to use it less safely in general. Nearly half of U.S. Hispanic adults report that they typically play the iPod very loud or somewhat loud, compared to 38% of all adults who were surveyed last winter, according to the poll results. Hispanic adults in the United States also may have a higher rate of hearing loss symptoms, although the cause of the symptoms is not established. For example, 30% of Hispanic adults report turning up the volume on their TV sets and radios—compared with 26% of all adults—and indicate that they are more likely to say “what” or “huh” during conversations, according to the Zogby study. “Louder and longer is not an advisable way to use personal audio technology,” said Alina Paz, an audiologist and speech-language pathologist with Miami Dade County Public Schools. “Eventually, that increases the risk of noise-induced hearing loss, which is permanent.” For complete information about the polling, visit ASHA’s Web site. Information about sound-isolating earphones can be found at a new special ASHA bilingual Web site for young children, parents, and educators, www.listentoyourbuds.org. Author Notes Marat Moore, is the managing editor of The ASHA Leader. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 11Issue 17December 2006 Get Permissions Add to your Mendeley library History Published in print: Dec 1, 2006 Metrics Downloaded 124 times Topicsasha-topicsleader_do_tagleader-topicsasha-article-typesCopyright & Permissions© 2006 American Speech-Language-Hearing AssociationLoading ...

Selecting neonates with congenital cytomegalovirus infection for ganciclovir therapy

The objective of this study is to look for evidence based or scientific guidelines for selection of newborns with congenital cytomegalovirus (CMV) infection that might benefit from treatment with ganciclovir. A literature search was conducted involving the MEDLINE database and the Cochrane Collaboration Library. Abstracts were reviewed to select pertinent articles dealing with ganciclovir therapy in neonates. References from selected articles as well as from reviews were screened for additional relevant articles. In total, 13 case reports (16 patients in all), three descriptive uncontrolled studies (20 patients in all), two randomized dose-comparative studies (54 patients in all) and one randomized controlled study (42 patients) were identified. All reported patients presented with central nervous system manifestation of CMV infection. Only the randomized controlled study showed a reduction of hearing deterioration in the treated group. Published predictors of hearing loss in congenitally CMV infected children allow identification of candidates that might benefit from treatment. Studies so far are promising but of insufficient number to make evidence based recommendations about indications for treatment of congenital CMV. As such, studies are very difficult to conduct and treatment of infants at high risk of hearing loss may appear justified. There is scientific data to help clinicians in selecting a subgroup of infants that is at higher risk of hearing deterioration and therefore might benefit the most from ganciclovir therapy.

Despite high risk of hearing loss, many percussionists play unprotected

In Brief The authors report that even though percussionists know the hazards of noise-induced hearing loss, all too many don't take proper precautions against it.

Hearing Screening in the Neonatal Intensive Care Unit: Follow-Up of Referrals

The goal of this study was to examine the rate of diagnostic testing after newborn hearing screening (NHS) referral, evaluate timeliness of follow-up, and evaluate the use of multilevel auditory brainstem response (ABR) in screening of high-risk infants. Telephone interviews were conducted with parents of infants who had been admitted to a neonatal intensive care unit from 1999 to 2002 and referred on NHS. An ABR screen was combined with a multilevel ABR (40, 70, and 90 dB nHL) for referrals. Parents of 206 infants participated; 69% of the infants underwent diagnostic follow-up. Of those with follow-up, 37% had normal hearing, 38% had hearing loss, and parents were unsure of hearing test results for 25%. Follow-up by 6 months of age occurred for 13% in 1999, increasing to 31% by 2002. Infants who did not pass their screening in both ears had confirmed hearing loss in 56% vs. 25% in those who passed in 1 ear. Also, 67% of infants with bilateral pass levels of 90 dB nHL or more had confirmed hearing loss, vs. 32% in all others. Timely follow-up after NHS referral in our program has improved over time. Multilevel ABR may facilitate allocation of appropriate resources to track and ensure follow-up in infants at high risk for hearing loss.

Management of Hemorrhagic High Jugular Bulb with Adhesive Otitis Media in an Only Hearing Ear: Transcatheter Endovascular Embolization Using Detachable Coils

A 51-year-old woman had a hemorrhagic high jugular bulb protruding into the posterosuperior part of the tympanic cavity in her left ear. This (only hearing) ear had severe adhesive otitis media resulting in repetitive hemorrhage from the jugular bulb. Therefore, treatment to stop the bleeding was required. Since invasive middle ear surgery in an only hearing ear would involve a high risk of hearing loss and massive bleeding, transcatheter endovascular embolization using detachable coils was selected for this special case; it safely blocked the blood flow and preserved the patient's hearing level. This is the first such report in the otosurgical field, showing that transcatheter endovascular embolization using detachable coils was quite effective in a difficult case of a hemorrhagic high jugular bulb with severe adhesive otitis media in an only hearing ear.

Noise exposure and hearing loss among the traffic policemen working at busy streets of Jalgaon urban centre

Traffic police have a high risk of hearing loss due to road traffic noise exposure. Here estimates are made of typical sound levels prevailing at the work place environment of traffic policemen and measures obtained of the hearing status of policemen The study focused on the traffic policemen working for 10–12 h daily in a noisy environment. Data on self-reported health status was collected by questionnaire and an audiometry used to determine hearing threshold at high and low frequencies. Eighty-four percent of the sample reported hearing loss and defined at least some difficulty in hearing by one or both ears. The prevalence of audiometric hearing impairment defined as a threshold average greater than 25 dB(A) hearing level was 80% for binaural low frequency average (250, 500 and 1000 Hz), 70% for binaural mid-frequency average (1000, 2000, 3000 and 4000 Hz) and 46% for binaural high frequency average (3000, 4000, 6000 and 8000 Hz) in the traffic policemen.

Current concepts in universal newborn hearing screening and early hearing detection and intervention programs.

Newborns are routinely screened for hearing loss; screening typically occurs in the newborn nursery and newborn intensive care unit. Understanding the process and outcomes of initial hearing screening and ongoing early hearing detection and intervention programs (EHDI) are important roles of the newborn/neonatal intensive care (NICU) nurse. Infants that require NICU care are at higher risk of hearing loss and need close follow-up and repeat hearing testing throughout their first 3 years of life. Parents experience anxiety and worry related to potential hearing loss problems and need guidance, education, and information on infant hearing to ensure the best possible outcome for their infant.

The Otolaryngological Manifestations of Mitochondrial Disease and the Risk of Neurodegeneration With Infection

To report the nature and extent of hearing loss and other otolaryngological problems in patients with mitochondrial disease, and to document the risk of neurodegeneration with infection. Medical chart review and telephone interview of 40 patients with documented mitochondrial disease. An international referral center for the diagnosis and management of mitochondrial disorders. We describe 40 patients with a definitive diagnosis of mitochondrial disease. Thirty-three (82%) were younger than 15 years. Hearing loss was the most common clinical finding associated with mitochondrial disease. Twenty-eight (80%) of the 35 patients undergoing testing had hearing loss or significant auditory dysfunction. In 20 (57%) of these, brainstem conduction abnormalities were identified. Eight (30%) of the 27 patients had an abnormal number of recurrent upper respiratory tract infections, and 4 (50%) of these had life-threatening or neurodegenerative sequelae. Mitochondrial disease followed an episodic course, with periods of stasis or slow developmental progress, punctuated by neurodegenerative events in 18 (60%) of 30 patients. Intercurrent infection was recognized as a precipitant of neurodegenerative events in 13 (72%) of 18 patients with a history of episodic degeneration. Children and adults with mitochondrial disorders are at high risk for hearing loss and life-threatening complications of intercurrent infections. A constellation of audiologic abnormalities, multiorgan system involvement, and history of neuromuscular setbacks with infection strongly suggests mitochondrial disease. Knowledge of these features can lead to more rapid diagnosis and improved medical and surgical management for this special group of patients with fundamental defects in bioenergy metabolism.

Smoking as a Risk Factor in Sensory Neural Hearing Loss among Workers Exposed to Occupational Noise

The effect of smoking on hearing was investigated among 199 professional forest workers and 171 shipyard workers. The effect of age on hearing was corrected with Robinson's model for an audiologically screened population. The exposure of the subjects to noise and their history of tobacco smoking were examined, with special reference to blood pressure and occupational Raynaud's phenomenon. Smoking without the presence of any other risk factors did not increase the risk for sensory neural hearing loss, but smoking in combination with elevated blood pressure and occupational Raynaud's phenomenon put workers at higher risk for hearing loss than any of these factors alone.

How accurate is parent rating of hearing for children with otitis media?

To determine the accuracy of parent assessment of child hearing. Prospective study. Hospital-based pediatric otolaryngology practice in a metropolitan area. One hundred eighty-six children aged 6 months to 12 years (median age, 3.4 years) with chronic otitis media with effusion or recurrent acute otitis media enrolled in a quality-of-life study. Parents rated their child's hearing over the prior 4 weeks using a 7-point response scale. Otoscopic findings, static admittance, tympanometric width, and audiometric thresholds were recorded concurrently. Fifty children were reassessed to monitor changes in hearing. Correlation of parent hearing assessments with baseline hearing status (pure tone average for the better hearing ear) and with changes in hearing status. The hearing loss questions had good test-retest reliability (R=0.79) but did not correlate with audiometric results (R=-0.13; P=.09). Only when caregivers reported hearing to be an "extreme problem" were median hearing levels (31 dB) significantly greater than the median response (20 dB). Conversely, static admittance and tympanometric gradient were significant predictors of hearing levels (2-way analysis of variance, P<.01) and explained 44% of the ear-specific variations. Abnormal immittance measures in both ears had an 84% predictive value for hearing loss (20-dB hearing level or poorer), and normal immittance measures in both ears had a 76% predictive value for normal hearing. Caregiver assessments of change in hearing status did not correlate with changes in audiometric results (R=0.07; P=.65). Caregiver assessments of child hearing do not accurately predict hearing levels or changes in hearing status. Immittance measures can help identify children at low or high risk for hearing loss, but cannot substitute for audiometry.

ASSESSMENT AND ANALYSIS OF NOISE POLLUTION IN THE MANUFACTURING INDUSTRY

Abstract. In the manufacturing industry, noise pollution is a growing threat and increases the risk of hearing loss and health problems for workers. The article aims to calculate the maximum working hours of workers exposed to excessive noise levels based on safe working conditions. Research shows that workers in critical departments are at a higher risk of hearing loss due to prolonged exposure to extreme noise levels. To reduce workplace noise pollution, employers should reduce noise, limit exposure time, implement shift work patterns and provide personal protective equipment, and train workers to protect against hazards. The study highlights the importance of monitoring workplace noise levels and control measures to limit excessive noise levels. Employers, employers and employees must work together to reduce workplace noise pollution, enabling effective strategies and controls to be implemented to improve worker health and productivity. Keywords: Noise pollution, evaluation of noise hazards, manufacturing industry

Assessment of the Proposed Draft American National Standard Method for Evaluating the Effectiveness of Hearing Conservation Programs

Using audiometric data, this study assessed the Draft American National Standard ANSI S12.13-1991 (DANS) method for evaluating the effectiveness of hearing conservation programs by comparing it against a standard epidemiologic method. Although the hearing conservation program of the study population was rated as "acceptable" (scale: acceptable, marginal, unacceptable) using the DANS method, the epidemiologic method found a 130% increased risk of hearing loss (relative risk = 2.3, 95% confidence interval = 0.8 to 6.5). In addition, study workers who were excluded from analyses for failing to comply with the DANS criteria were found to be at significantly increased risk of hearing loss (relative risk = 9.1, 95% confidence interval = 3.4 to 24.2). These data indicate that the DANS method may overestimate the effectiveness of hearing conservation programs and systematically exclude workers at high risk of hearing loss from analyses.

Hearing loss in children with congenital heart disease: a preliminary report

Life expectancy for children with serious congenital heart defects has dramatically increased in recent years due to advances in medical and surgical care. Anatomic studies of temporal bones in patients with non-syndromic congenital heart disease have demonstrated a high incidence of middle and inner ear anomalies. Systematic study of auditory function in these patients has not been reported. Fifty children with serious congenital heart disease have been evaluated with otologic examination and auditory brainstem-evoked response (ABR) testing. The patients ranged in age from 3 days to 17 years-8 months. Eight patients had hearing loss and normal otologic examinations, 14 patients had hearing loss and associated otitis media with effusion, and 28 patients had normal hearing by ABR testing. These results show a high incidence (16%) of hearing loss not associated with otitis media with effusion in the study population. We suggest that children with serious congenital heart disease are at high risk for hearing loss. This patient group will benefit from early identification, and appropriate medical and audiologic management.

Evaluation of Hearing in the High-Risk Infant

Preterm infants are at high risk for hearing loss. Included in this discussion are the etiology of hearing loss, methods of evaluation, and management of children with suspected hearing loss.

Language Development in a Group of Very Low-Birth-Weight Children Whose Postauricular Myogenic Response Was Tested in Infancy

A new instrument for the detection of the postauricular myogenic (PAM) response was used to test the hearing of 106 infants weighing less than or equal to 1,500 g when they were aged 1 to 21 months. Eighty-eight infants showed a positive response at 60 dB hearing level (HL) (normal). The other 18 did not respond; four were found to have sensory neural hearing loss and another six had conductive loss due to secretory otitis media. Of the 106 children, 90 aged 2 years or more (mean 27 months) were living in the United Kingdom, and their language development was assessed. It was normal in 67/75 children whose PAM response had been normal in infancy. The remaining eight children with normal PAM responses in infancy, had language delay. All eight children had problems that were thought to account for the delay, including three with mental retardation, three with cerebral palsy, and two whose families did not speak English. Language development was normal in 11/15 children tested whose PAM responses had been found to be abnormal, including all six whose secretory otitis media had been diagnosed and treated at the time of the PAM test. Delay in language development was found in 3/4 children with sensory neural hearing loss who were available for testing and in one child with overall developmental delay. It is concluded that a positive PAM response at 60 dB HL in infancy indicated hearing adequate for the development of normal speech in otherwise normal children among a group of infants at high risk of hearing loss.