18 March 2019 Author : João Pitorra Monteiro Such behaviour can be mistaken for lack of attention , but it can conceal hearing problems. A diagnosis should be obtained as soon as possible. It is estimated that child deafness affects between 1 and 3 per 1000 healthy newborn babies and 20 to 40 per 1000 at-risk newborn babies. It therefore has a far higher incidence than other neonatal diseases included in the national early detection programme (hypothyroidism and phenylketonuria). This is why it is so important to screen hearing in all newborn babies , not just those that are known to be at risk, as this group represents only 50% of the cases of deafness. What is the point of hearing tests for babies? The main objectives for carrying out hearing tests on children are: To diagnose potential hearing deficits before the child is 3 months old; To implement all elements of rehabilitation treatment in the child before it reaches the age of 6 months; it should be remembered that deafness can be congenital or acquired. The last few decades have seen a significant reduction in cases of deafness related to pre-, peri- and post-natal pathology. However, the number of cases in which deafness is genetic, or where the cause is unknown, remain the same. How can child deafness be misread at the consultation? As a result of the socio-economic and welfare deficiencies in Portugal, infectious causes of neurosensory deafness continue to be prevalent, and include: Rubella; Cytomegalovirus infection; Toxoplasmosis; Syphilis. Post-natal deafness is more common in adulthood, although it may occur in children as the result of problems such as: Bacterial, viral or parasitic infections; Trauma; Foreign bodies; Sound trauma. At the consultation we try to discover the possible causes of deafness by gathering information on the patient’s background, with particular emphasis on: History of pharmaceutical use, infection and trauma; Family members, blood relations and birth defects. In the objective examination , we place particular importance on otological testing and the investigation of head and neck defects , as well as defects in other organs and systems. This examination is always accompanied by audiometric testing and, where necessary, by imaging tests such as CT and MRI scans. How is the level of hearing assessed in hearing screening for babies? We use behavioural tests and objective tests to test the hearing, of which the most important are: Conditioned Orientation Reflex (COR test); Conditioned Play Audiometry (block test); Tympanometry; Brainstem auditory evoked potentials (BAEP); Otoacoustic emissions (OAE). The choice of these tests depends on the following factors: Age; The child’s psychomotor development; Auditory level; Involvement of other organs. Our concerns begin in the period immediately after birth when, as a rule, otoacoustic emissions are usually assessed. A small non-invasive test is performed to record the existence or absence of effective functioning of the auditory cells in the inner ear. If the test is negative , it should be repeated 30 days later . If it is still negative, auditory evoked potentials should be tested at 3 months; these will definitely be able to determine the child’s effective degree of hearing. In the case of severe or profound deafness , the best option is to make an early referral for prosthetic adaptation and follow-up by a multidisciplinary team, together with speech therapy and special learning support (sign language, auditory training and lip reading). Where the child is found to be totally deaf , there is the option to refer him or her for cochlear implantation ; this should be done as soon as possible after the first year of the child’s life. Why should children’s hearing be screened before they start school? Pre-school hearing screening is essential and should be carried out systematically in children without hearing complaints aged between 3 and 6. Nasopharyngeal allergic and infectious factors in children can lead to changes in the middle ear, which can then cause it to not function correctly and give rise to hearing loss, together with serious discharge from the middle ear. The warning signs to look out for at home can be: Speaking loudly; Sitting very close to the TV; Not responding immediately to parents. This behaviour is often confused with thinking the child is distracted, when in fact this is not the case. There is medical treatment for this condition, and if this doesn’t work the insertion of a tympanostomy tube will resolve the situation. As stated above, hearing loss in children requires early diagnosis and rehabilitation. The otolaryngologist plays an essential role in this process; specifically in coordinating and organising the professionals involved in the treatment. Meet the otorhinolaryngology team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
