about Audiology & Otolaryngology
When infants with hearing loss receive timely and appropriate diagnostic and family-centered early intervention services, typical language, cognitive and social development for such infants is likely. Ideally, the newborn screening is completed before a baby is 1 month of age. If a baby does not pass the newborn screening, the next step is Diagnostic Audiology. The initial diagnostic tests must be completed as soon as possible so that any potential hearing loss can be diagnosed before 3 months of age. A baby identified with a hearing loss should be fit with hearing aids (if appropriate) and referred to and enrolled in an early intervention program well before 6 months of age.
The diagnostic evaluation is typically performed by a pediatric audiologist. A pediatric audiologist is a professional with a master’s or doctoral degree in Audiology and the technical expertise and desire to work with infants and children. The audiologist performs a series of tests to determine if a hearing loss exists, and, if so, the type (part of the auditory system affected), degree (how much hearing loss exists) and configuration (frequencies or pitches that are affected) of the loss.
This concept of audiologic diagnoses and management as a process in the young child needs to be conveyed to the parents, who do not understand that the process often goes on for many years. Multiple visits are needed in order to define the exact configuration, degree, and nature of the hearing loss; monitor for possible changes; and alter management strategies as the child’s auditory skills develop. Setting parental expectations early in the process will help them in their planning for their child. In addition, audiologists who provide services to children need to plan for this and offer appropriately long appointments so as to be able to complete assessments. Flexibility for different appointment options is essential to accommodate the child’s and family’s schedule.
In some Texas communities, audiologists provide these services to infants and young children, but they do not consider themselves to be a “pediatric audiologist.” These providers are usually vital to a given community as they may be the only audiology provider within a large geographic area and/or are the only provider that is comfortable seeing infants and young children. If you are an audiology provider who fits this description, we admire your efforts to meet the needs of your community and encourage you to explore the resources on this website and links to other websites, many of whom offer continuing education opportunities in pediatric focused audiology practices.
Early Hearing Detection & Intervention – Pediatric Audiology Links to Services (EHDI-PALS) is a web-based link to information, resources, and services for children with hearing loss. At the heart of EHDI-PALS is a national web-based directory of facilities that offer pediatric audiology services to young children who are younger than five years of age. We encourage every practicing audiologist serving infants and/or young children in the state of Texas to join the EHDI-PALS portal so that families and Texas EHDI providers can locate your practice/services in one simple step, regardless of where the family lives or the provider practices.
Although universal newborn hearing screening is designed to identify infants who have congenital hearing loss, it is important to acknowledge that some infants may have mild losses that are not detected initially and become more severe over time (progressive loss). Other children experience a permanent hearing loss at some point after birth (late-onset or delayed-onset loss). If a child has unilateral, mild, or chronic conductive hearing loss or is “at risk” for progressive or delayed-onset hearing loss, audiologic monitoring is recommended. See JCIH Risk indicators, appendix A.
Early hearing detection and intervention enable children with all types and degrees of hearing loss to have an increased likelihood of better communication, better performance in school, and a better quality of life. Otolaryngologists are physicians whose specialty includes determining the etiology of hearing loss. They also identify related risk indicators for hearing loss, including syndromes that involve the head and neck, and evaluate and treat ear diseases.
An otolaryngologist with expertise in evaluating and treating infants and young children with hearing loss will offer the most appropriate care. These professionals with working knowledge of early childhood hearing loss can determine if medical and/or surgical intervention may be appropriate. When medical and/or surgical intervention is provided, the otolaryngologist is involved in the long-term monitoring and follow-up with the infant’s medical home.
The otolaryngologist’s evaluation includes a comprehensive medical history to identify the presence of risk factors for early-onset childhood permanent hearing loss. Otolaryngologists commonly refer children with diagnosed hearing loss to a geneticist for further evaluation. A genetics evaluation and counseling can provide families with information on etiology of hearing loss, prognosis for progression, associated disorders (eg, renal, vision, cardiac), and the likelihood of recurrence in future offspring. This information may influence parents’ decision-making regarding intervention options for their child. (Joint Committee on Infant Hearing, Year 2007 Position Statement. PEDIATRICS Volume 120, Number 4, October 2007, p. 907)
Approximately 15% of genetic hearing loss is part of a syndrome; hence, the recognition of hearing impairment may be the initial clue to a more involved diagnosis.
Information from the otolaryngologist’s evaluation is required to determine eligibility for early intervention services through the ECI/deaf education early intervention partnership in Texas. Given that otolaryngology is a specialty area in which a subset of this profession actually specializes in ears, many communities across the state have limited providers in which families are able to access care. This often results in extended appointment timelines for families, well outside the 1-3-6 protocols. It’s important to know that otolaryngology information may be provided to the early intervention team for eligibility purposes (to initiate early intervention services) by the child’s primary care provider/pediatrician, however it is essential that the early intervention team encourage and assist families when appropriate to be seen and followed by an otolaryngologist for long-term care purposes. Both ECI and TEA have made recommendations that this be written as an objective on the family’s Individualized Family Service Plan (IFSP) when an otolaryngologist is absent from the child’s medical team at the time early intervention services are initiated.The otolaryngologist provides information and participates in the assessment of candidacy for amplification, assistive devices, and surgical intervention, including reconstruction, bone-anchored hearing aids, and cochlear implantation. Otolaryngologists (commonly referred to as Ear, Nose and Throat doctors, or ENTs) are typically involved in children’s care by the 3 month timeframe, concurrent with audiology, as these professionals work collaboratively together to ensure the child and family moves seamlessly through the amplification process during the diagnostic phase of EHDI.