Hearing assessment and childhood hearing loss — structured clinical encounter

Structured encounter testing the approach to a baby who refers on the newborn hearing screen: the 1-3-6 milestones, the diagnostic auditory brainstem response and how it distinguishes conductive from sensorineural loss, the search for congenital CMV, and the family-centred plan for early intervention and rehabilitation.

structured clinical encounter3 min readVerification in progress

Prompt

A term baby refers on both ears of the otoacoustic emissions newborn hearing screen. You are the paediatric registrar working through the screening milestones, the diagnostic confirmation, the search for an aetiology including congenital cytomegalovirus, and the family-centred plan for early intervention.

Station brief (candidate)

You are the paediatric registrar on the postnatal ward. A term baby, born after an unremarkable pregnancy, refers on the otoacoustic emissions newborn hearing screen in both ears. The parents are anxious and have many questions. The team asks you to explain the screening programme timeline, the diagnostic test that will confirm or exclude a loss, how that test distinguishes conductive from sensorineural hearing loss, what to look for in the aetiology, and the plan if a permanent loss is confirmed. The baby was noted to have a few petechiae at birth and a slightly small head circumference, but is feeding well and is otherwise normal. You have 12 minutes with the team and 5 minutes for examiner discussion. [6]

Paediatrics Fellowship Pro

You have read the opening of this case. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References6Show ledger

[1]Korver AMH; Smith RJH; Van Camp G; Schleiss MR; et al Congenital hearing loss. Nat Rev Dis Primers, 2017.PMID 28079113
[2]Butcher E; Dezateux C; Cortina-Borja M; Knowles RL Prevalence of permanent childhood hearing loss detected at the universal newborn hearing screen: Systematic review and meta-analysis. PLoS One, 2019.PMID 31295316
[4]Kraft CT; Malhotra S; Boerst A; Thorne MC Risk indicators for congenital and delayed-onset hearing loss. Otol Neurotol, 2014.PMID 25251299
[5]Sininger YS; Cone-Wesson B; Folsom RC; Gorga MP; et al Identification of neonatal hearing impairment: auditory brain stem responses in the perinatal period. Ear Hear, 2000.PMID 11059700
[6]Watkin PM; Baldwin M Identifying deafness in early childhood: requirements after the newborn hearing screen. Arch Dis Child, 2011.PMID 21047829
[7]Vos B; Noll D; Whittingham J; Pigeon M Cytomegalovirus - A risk factor for childhood hearing loss: A systematic review. Ear Hear, 2021.PMID 33928914