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¿Por que la detección temprana de la hipoacusia es importante para su hijo?

Aproximadamente dos a cuatro de cada 1000 niños en los Estados Unidos nacen sordos o hipoacúsicos, haciendo de la pérdida auditiva la alteración más común al nacimiento. Muchos estudios han mostrado que el diagnóstico temprano de la hipoacusia es crucial para el desarrollo del lenguaje, habilidades cognitivas y psicosociales.

El tratamiento es más exitoso si la pérdida auditiva es identificada tempranamente, preferentemente durante el primer mes de vida. Todavía una cada cuatro niños nacidos con severa pérdida auditiva no recibe un diagnóstico hasta la edad de tres años o más.

¿Cuando se debe evaluar la audición de un niño?

La primera oportunidad para evaluar la audición de un niño es en el hospital apenas nacido. Si la audición del niño no es evaluada antes de irse del hospital se recomienda su evaluación durante el primer mes de vida. Si los exámenes indican una posible pérdida en la audición se deberá buscar una evaluación más profunda lo más pronto posible, preferentemente entre el primero y los seis meses de vida.

¿Es obligatoria la evaluación de pérdida auditiva?

En los últimos años las organizaciones de salud, incluyendo la Academia Americana de Otorrinolaringología han trabajado para remarcar la importancia de un screening o tamizaje precoz en todos los recién nacidos para buscar pérdida de la audición. Estos esfuerzos han dado sus resultados. En 2003 más del 85 por ciento de todos los recién nacidos en Estados Unidos fueron evaluados buscando pérdida auditiva. De hecho casi todos los estados han realizado leyes que obligan a alguna forma de evaluación de los recién nacidos antes de dejar el hospital. Esto todavía deja a más de un millón de bebes que no son evaluados para pérdida auditiva antes de abandonar el hospital.

¿Como se realiza la evaluación?

Dos exámenes son usados para evaluar la pérdida auditiva en niños y recién nacidos. Ellos son:

A.  Otoemisiones acústicas (OAE) que consiste en colocar un audífono de esponja en el canal auditivo para medir si el oído responde correctamente al sonido. En los chicos con una audición normal, un eco medible se producirá cuando el sonido es emitido a través del audífono. Si no se mide ningún eco puede indicar pérdida de la audición.

B.  Potenciales evocados de tronco (BERA) es un examen más complejo. Audífonos son colocados en los oídos y electrodos se colocan en la cabeza y oídos. El sonido es emitido a través de los audífonos mientras los electrodos miden como el cerebro del niño responde al sonido.

Si alguno de los exámenes indica una potencial pérdida auditiva, el médico sugerirá un seguimiento y evaluación a cargo de un otorrinolaringólogo.

Signos de pérdida de audición en el niño

La hipoacusia puede ocurrir en la infancia tardía, luego que el recién nacido abandonó el hospital. En estos casos, los padres, abuelos y demás personas de que cuidan al niño son frecuentemente los primeros en advertir que algo ocurre con la audición de ese chico. Incluso si su audición fue evaluada en el momento de nacer se debe continuar estando alerta a señales de pérdida auditiva tales como:

  • No reacciona de ninguna forma frente a sonidos intensos e inesperados.
  • No se despierta frente a sonidos de gran intensidad
  • No gira su cabeza en la dirección de la voz que le habla.
  • No es capaz de seguir o entender instrucciones
  • Pobre desarrollo del lenguaje
  • Habla muy fuerte o no usa las habilidades de lenguaje apropiadas para su edad.

Si su niño muestra alguno de estos signos debe indicárselos al médico

¿Qué sucede si mi niño tiene hipoacusia?

La pérdida auditiva en niños puede ser transitoria o permanente. Es importante que la pérdida auditiva sea evaluada por un médico que pueda indagar acerca de los problemas que puedan causar esta hipoacusia, tales como la otitis media (infección del oído), excesiva formación de cera en el oído, malformaciones congénitas o pérdida auditiva genética.

Si se ha determinado que la hipoacusia es permanente, el uso de audífonos puede ser necesario para amplificar el sonido que llega al oído del niño. La cirugía de oído puede ser útil para restaurar o mejorar significativamente la audición en algunos casos. Para aquellos con pérdidas profundas que no se benefician suficientemente con audífonos puede ser considerado un implante coclear. A diferencia de los audífonos, el implante coclear evita las partes dañadas del sistema auditivo y estimula directamente el nervio permitiendo al niño escuchar sonidos más fuerte y en forma más clara.

Usted deberá decidir si su niño se comunicará en forma primaria con lenguaje hablado o de señas y buscar una intervención temprana para prevenir retrasos del lenguaje. Los estudios indican que la rehabilitación de la pérdida auditiva a la edad de los seis meses prevendrá consecuentes retrasos de lenguaje. Otras estrategias de comunicación como la terapia de audición verbal, lectura de labios y lenguaje de señas pueden también ser usadas en conjunto con la terapia con audífonos o el implante coclear o bien en forma independiente.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Why is Early Childhood Hearing Screening Important for Your Child?

Approximately two to four of every 1,000 children in the United States are born deaf or hard-of-hearing, making hearing loss the most common birth disorder. Many studies have shown that early diagnosis of hearing loss is crucial to the development of speech, language, cognitive and psychosocial abilities. Treatment is most successful if hearing loss is identified early, preferably within the first few months of life. Still, one in every four children born with serious hearing loss does not receive a diagnosis until 14 months old.

When Should a Child’s Hearing Be Tested?

The first opportunity to test a child’s hearing is in the hospital shortly after birth. If your child’s hearing is not screened before leaving the hospital, it is recommended that screening be done within the first month of life. If test results indicate a possible hearing loss, get a further evaluation as soon as possible, preferably within the first three to six months of life.

Is Early Hearing Screening Mandatory?

In recent years, health organizations across the country, including the American Academy of Otolaryngology – Head and Neck Surgery, have worked to highlight the importance of screening all newborns for hearing loss. These efforts are working. Recently, many states have passed Early Hearing Detection and Intervention legislation. A few other states regularly screen the hearing of most newborns, but have no legislation that requires screening. So, check with your local authority or hospital for screening regulations.

How Is Screening Done?

Two tests are used to screen infants and newborns for hearing loss. They are otoacoustic emissions (OAE), and auditory brain stem response (ABR). Otoacoustic emissions involves placing a sponge earphone in the ear canal to measure whether the ear can respond properly to sound. In normal-hearing children, a measurable echo should be produced when sound is emitted through the earphone. If no echo is measured, it could indicate a hearing loss.

Auditory brain stem response is a more complex test. Earphones are placed on the ears and electrodes are placed on the head and ears. Sound is emitted through the earphones while the electrodes measure how your child’s brain responds to the sound.

If either test indicates a potential hearing loss, your physician may suggest a follow-up evaluation by an otolaryngologist.

Signs of Hearing Loss in Children

Hearing loss can also occur later in childhood. In these cases, parents, grandparents and other caregivers are often the first to notice that something may be wrong with a young child’s hearing. Even if your child’s hearing was tested as a newborn, you should continue to watch for signs of hearing loss, including:

  • Not reacting in any way to unexpected loud noises,
  • Not being awakened by loud noises,
  • Not turning his/her head in the direction of your voice,
  • Not being able to follow or understand directions,
  • Poor language development, or
  • Speaking loudly or not using age-appropriate language skills.
  • If your child exhibits any of these signs, report them to your doctor.

What Happens If My Child Has a Hearing Loss?

Hearing loss in children can be temporary or permanent. It is important to have hearing loss evaluated by a physician who can rule out medical problems that may be causing the hearing loss, such as otitis media (ear infection), excessive earwax, congenital malformations or a genetic hearing loss.

If it is determined that your child’s hearing loss is permanent, hearing aids may be recommended to amplify the sound reaching your child’s ear. Ear surgery may be able to restore or significantly improve hearing in some instances. For those with certain types of very severe hearing loss who do not benefit sufficiently from hearing aids, a cochlear implant may be considered. Unlike a hearing aid, the implant bypasses damaged parts of the auditory system and directly stimulates the hearing nerve, allowing the child to hear louder and clearer sound.

Research indicates that if a child’s hearing loss is remedied by age six months, it will prevent subsequent language delays. You will need to decide whether your deaf child will communicate primarily with oral speech and/or sign language, and seek early intervention to prevent language delays. Other communication strategies such as auditory verbal therapy, lip reading and cued speech may also be used in conjunction with a hearing aid or cochlear implant, or independently.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Why Is Early Childhood Hearing Screening Important For Your Child?

Every day in the United States, approximately 1 in 1,000 newborns (or 33 babies every day) is born profoundly deaf with another two to three out of 1,000 babies born with partial hearing loss, making hearing loss the number one birth defect in America. Many studies have shown that early diagnosis of hearing loss is crucial to the development of speech, language, cognitive and psychosocial abilities. Treatment is most successful if hearing loss is identified early, preferably within the first month of life. Still, one in every four children born with serious hearing loss does not receive a diagnosis until age three or older.

Why is it Important to Have My Baby’s Hearing Screened Early?

The most important time for a child to be exposed to and learn language is in the first three years of life. In fact, children begin learning speech and language in the first six months of life. Research suggests that those who have hearing impairment and get intervention have better language skills than those who don’t. The earlier you know about deafness or hearing loss, the sooner you can make sure your child benefits from strategies that will help him or her learn to communicate.

How Early Should I Have My Baby’s Hearing Screened?

The first opportunity to test a child’s hearing is in the hospital shortly after birth. If your child’s hearing is not screened before leaving the hospital, it is recommended that screening be done within the first month of life. If hearing loss is suspected, make sure an otolaryngologist orders tests for your baby’s hearing by three months of age. If hearing loss is confirmed, it’s important to consider the use of hearing devices and other communication options by six months of age.

Is Early Hearing Screening Mandatory?

In 2003, more than 85 percent of all newborns in the United States were screened for hearing loss. In fact, some 39 states have passed legislation requiring some form of hearing screening of newborns before they leave the hospital. This still leaves more than a million babies who are not screened for hearing loss before leaving the hospital.

How Is Screening Done?

Two tests are used to screen infants and newborns for hearing loss. They are:

Otoacoustic Emissions (OAE):

Involves placement of a sponge earphone in the ear canal to measure whether the ear can respond properly to sound. In normal-hearing children, a measurable “echo” should be produced when sound is emitted through the earphone. If no echo is measured, it could indicate a hearing loss.

Auditory Brain Stem Response (ABR):

Earphones are placed on the ears and electrodes are placed on the head and ears. Sound is emitted through the earphones while the electrodes measure how your child’s brain responds to the sound.

Signs of Hearing Loss in Children

Hearing loss can also occur later in childhood, after a newborn leaves the hospital. In these cases, parents, grandparents and other caregivers are often the first to notice that something may be wrong with a young child’s hearing. Even if your child’s hearing was tested as a newborn, you should continue to watch for signs of hearing loss. including:

  • Not reacting in any way to unexpected loud noises
  • Not being awakened by loud noises
  • Not turning his/her head in the direction of your voice
  • Not being able to follow or understand directions
  • Poor language development
  • Speaking loudly or not using age-appropriate language skills

If your child exhibits any of these signs, report them to your doctor.

What Happens If My Child Has Hearing Loss?

Hearing loss in children can be temporary or permanent. It is important to have hearing loss evaluated by a physician who can rule out medical problems that may be causing the hearing loss, such as otitis media (ear infection), excessive earwax, congenital malformations or a genetic hearing loss. If it is determined that your child’s hearing loss is permanent, hearing aids may be recommended to amplify the sound reaching your child’s ear. Ear surgery may be able to restore or significantly improve hearing in some instances.

For those with certain types of profound hearing loss who do not benefit sufficiently from hearing aids, a cochlear implant may be considered. Unlike a hearing aid, a cochlear implant bypasses damaged parts of the auditory system and directly stimulates the hearing nerve and allows the child to hear louder and clearer sound.

You will need to decide whether or not your deaf child will communicate primarily with oral speech and/or sign language, and seek early intervention to prevent language delays. Research indicates that habilitation of hearing loss by age six months will prevent subsequent language delays. Other communication strategies such as auditory verbal therapy, lip reading and cued speech may also be used in conjunction with a hearing aid or cochlear implant, or independently.

Is My Baby’s Hearing Normal?

If you think that your child has hearing loss, you might be right. The following checklist will assist in determining whether or not your child might have a hearing loss. Please read each item carefully and check only those factors that apply to you, your family or your child.

During pregnancy did…

  • Mom have German measles, a viral infection or flu?
  • Mom drink alcoholic beverages?

Did your newborn baby (birth to 28 days of age)…

  • Weigh less than 3.5 pounds at birth?
  • Have an unusual appearance of the face or ears?
  • Have jaundiced (yellow skin) at birth and had an exchange blood transfusion?
  • Stay in neonatal intensive care unit (NICU) for more than five days?
  • Receive an antibiotic medication given through a needle in a vein?
  • Have meningitis?
  • Fail newborn hearing screening test?

Did your infant baby (29 days of age to two years)…

  • Received an antibiotic medication given through a needle in a vein?
  • Have meningitis?
  • Have a neurological disorder?
  • Have a severe injury with a fracture of the skull with or without bleeding from the ear?
  • Have recurring ear infection with fluid in ears for more than three months?

Does one or more individual(s) of your family…

  • Have permanent or progressive hearing loss that was present or developed early in life?

Response to the Environment (Speech and Language Development)

My Newborn (Birth to 6 months)…

  • Does not startle, move, cry or react in any way to unexpected loud noises
  • Does not awaken to loud noises
  • Does not freely imitate sound
  • Cannot be soothed by voice alone
  • Does not turn his/her head in the direction of my voice

My Young Infant (6 through 12 months)…

  • Does not point to familiar persons or objects when asked
  • Does not babble or babbling has stopped
  • By 12 months is not understanding simple phrases such as wave “bye-bye” or “clap hands” by listening alone

My Infant (13 Months through two Years)…

  • Does not accurately turn in the direction of a soft voice on the first call
    Is not alert to environment sounds
  • Does not respond on first call
  • Does not respond to sounds or does not locate where sound is coming from
  • Does not begin to imitate and use simple words for familiar people and things around the home
  • Does not sound like or use speech like other children of similar age
  • Does not listen to TV at a normal volume
  • Does not show consistent growth in the understanding and the use of words to communicate

If your child has one of more of these indicators you should take him or her to a physician, preferably an otolaryngologist, for an ear examination and a hearing test. This can be done at any age, as early as just after birth.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Three million children under the age of 18 have some hearing loss, including four out of every thousand newborns. So, every parent and caregiver should be watchful of the signs of hearing loss in his or her child and seek a professional diagnosis. Hearing loss can increase the risk of speech and language developmental delays.

Indicators for Hearing Loss

During pregnancy

  • Mother had German measles, a viral infection or flu.
  • Mother drank alcoholic beverages.

Newborn (birth to 28 days of age)

  • Weighed less than 3.5 pounds at birth.
  • Has an unusual appearance of the face or ears.
  • Was jaundiced (yellow skin) at birth and had an exchange blood transfusion.
  • Was in neonatal intensive care unit (NICU) for more than five days.
  • Received an antibiotic medication given through a needle in a vein.
  • Had meningitis.
  • Failed newborn hearing screening test

Family

  • Has one or more individuals with permanent or progressive hearing loss that was present or developed early in life.

Infant (29 days to 2 years)

  • Received an antibiotic medication given through a needle in a vein.
  • Had meningitis.
  • Has a neurological disorder.
  • Had a severe injury with a skull fracture, with or without bleeding from the ear.
  • Has recurring ear infections with fluid in ears for more than three months.

Response to the Environment

(speech and language development)

Newborn (Birth to 6 Months)

  • Does not startle, move, cry or react in any way to unexpected loud noises.
  • Does not awaken to loud noises.
  • Does not freely imitate sound.
  • Cannot be soothed by voice alone.
  • Does not turn his/her head in the direction of your voice.
  • Does not point to familiar persons or objects when asked.
  • Does not babble, or babbling has stopped.
  • By 12 months does not understand simple phrases by listening alone, such as “wave bye-bye,” or “clap hands.”

Infant (3 months to 2 years)

  • Does not accurately turn in the direction of a soft voice on the first call.
  • Is not alert to environmental sounds.
  • Does not respond on first call.
  • Does not respond to sounds or does not locate where sound is coming from.
  • Does not begin to imitate and use simple words for familiar people and things around the home.
  • Does not sound like or use speech like other children of similar age.
  • Does not listen to TV at a normal volume.
  • Does not show consistent growth in the understanding and the use of words.

Hearing tests: How, when, and why

If you suspect that your child may have hearing loss, discuss it with your doctor. Children of any age can be professionally tested.

Tests for newborns and infants under one year

Hearing tests are painless, and they normally take less than a half hour.

Newborns are tested with either the otoacoustic emissions (OAE) test or the automated auditory brainstem response (AABR) test. During the OAE test, a microphone is placed in the baby’’s ear. It sends soft clicking sounds, and a computer then records the inner ear’’s response to the sounds. In the AABR test the child must wear earphones. Sensors are placed on his/her head to measure brain wave activity in response to the sound.

For infants over six months of age, the diagnostic auditory brainstem response and the visual reinforcement audiometry (VRA) tests are commonly used. The diagnostic auditory brainstem response test is similar to the AABR test, but it provides more information. The VRA test presents a series of sounds through earphones. The child is asked to turn toward the sound, then he/she is rewarded with an entertaining visual image.

Tests for older children and adults

Children between two and four years old are tested through conditioned play audiometry (CPA). The children are asked to perform a simple play activity, such as placing a ring on a peg, when they hear a sound. Older children and adults may be asked to press a button or raise their hand.

All children should have their hearing tested before they start school. This could reveal mild hearing losses that the parent or child cannot detect. Loss of hearing in one ear may also be determined in this way. Such a loss, although not obvious, may affect speech and language.

Hearing loss can even result from earwax or fluid in the ears. Many children with this type of temporary hearing loss can have their hearing restored through medical treatment or minor surgery.

In contrast to temporary hearing loss, some children have nerve deafness, which is permanent. Most of these children have some usable hearing. Few are totally deaf. Early diagnosis, early fitting of hearing aids, and an early start on special educational programs can help maximize the child’’s existing hearing.

Please note that this article is not a substitute for an ear examination or a hearing test.

What you should do

If you have checked one or more of these indicators, your child might have hearing loss and you should take him or her for an ear examination and a hearing test. This can be done at any age, as early as just after birth.
If you did not check any of these factors but you suspect that your child is not hearing normally, even if your child’’s doctor is not concerned, have your child’’s hearing tested by an audiologist and when appropriate, have his or her speech evaluated by a speech and language pathologist. The test will not hurt your child.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery