Risk Indicators for Hearing Loss

  • Caregiver concern regarding hearing, speech, language, or developmental delay
  • Family history of permanent childhood hearing loss
  • Neonatal intensive care of more than 5 days or any of the following, regardless of length of stay: ECMO, assisted ventilation, exposure to ototoxic medications (gentamicin and tobramycin) or loop diuretics (furosemide/Lasix), and hyperbilirubinemia that requires exchange transfusion
  • In utero infections (i.e., CMV, herpes, rubella, syphilis, and toxoplasmosis)
  • Craniofacial anomalies, including those that involve the pinna, ear canal, ear tags, ear pits, and temporal bone anomalies
  • Physical findings, such as white forelock, that are associated with a syndrome known to include a sensorineural or permanent conductive hearing loss
  • Syndromes associated with hearing loss or progressive or late-onset hearing loss, such as neurofibromatosis, osteoporosis, and Usher syndrome; other frequently identified syndromes include Waardenburgh, Alport, Pendred, and Jervell and Lange-Nielson
  • Neurodegenerative disorders, such as Hunter syndrome, or sensory motor neuropathies, such as Friedreich ataxia and Charcot-Marie-Tooth syndrome
  • Culture-positive postnatal infections associated with sensorineural hearing loss, including confirmed bacterial and viral (especially herpes viruses and varicella); meningitis
  • Head trauma, especially basal skull/temporal bone fracture that requires hospitalization
  • Chemotherapy
  • Recurrent or persistent otitis media for at least 3 months

Infants with late onset hearing loss often have no identifiable risk factors. Therefore, a more inclusive strategy of surveillance for all children is recommended. All infants should be monitored for developmental milestones, auditory skills, middle ear effusion, and parental concerns about hearing, speech, and language. All infants should be evaluated with an objective, standardized screen of global development with a validated assessment tool at 9, 18, and 24-30 months, or at any time if the parent or caregiver has concern.

Healthcare providers should pay extra attention to hearing and speech-language development if a baby does not pass the newborn hearing screening test in one or both ears. However, every child’s hearing should be monitored periodically throughout early childhood because:

  • Mild (but still developmentally and educationally significant) hearing loss may be present even if a baby passes a screening test.
  • Hearing can change over time.

Middle ear status should be carefully assessed at all well-child visits by pneumatic otoscopy and/or tympanometry. Children with persistent middle ear effusion for 3 or more months should be referred for otologic evaluation.


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