No Child is too Young to Have a Hearing Test

What are the high-risk factors for hearing loss?

The Joint Committee on Infant Hearing (1990) of the American Speech and Hearing Association has expanded the criteria used to identify neonates and infants who may be at risk for sensorineural hearing impairment. If any of the following factors are present, the child should be referred for a hearing test.

NEONATES (birth – 28 days)

  1. Family history of hearing loss.
  2. Congenital infection such as toxoplasmosis, syphilis, rubella, cytomegalovirus and herpes.
  3. Craniofacial anomalies.
  4. Birth weight less than 1500 grams.
  5. Hyperbilirubinemia.
  6. Ototoxic medications (e.g. aminoglycosides)
  7. Bacterial meningitis.
  8. Severe depression at birth, which may include infants with Apgar scores of 0-3 at five minutes.
  9. Prolonged mechanical ventilation for a duration equal to or greater than 10 days.
  10. Stigmata or other findings associated with a syndrome known to include sensorineural hearing loss (e.g. Usher’s syndrome).

INFANTS (29 days to two years)

  1. Parent or caregiver’s concern about hearing, speech, language or developmental delay or both.
  2. Bacterial meningitis.
  3. Neonatal risk factors that may be associated with progressive sensorineural hearing loss (e.g., cytomegalovirus).
  4. Head trauma.
  5. Stigmata or other findings associated with syndromes known to include sensorineural hearing loss.
  6. Ototoxic medications (e.g., aminoglycosides).
  7. Children with neurodegenerative disorders such as neurofibromatosis.
  8. Childhood infectious diseases known to be associated with sensorineural hearing loss (e.g., mumps).

What is the impact of delayed diagnosis?

Late diagnosis of hearing impairment often results in major delays in the child’s speech and language development. Early diagnosis will mitigate the emotional and financial cost to the family and the health-care system.

How can you help with early diagnosis?

Listen to the parents when they first voice their concern about their child’s hearing and speech. Shah et al (1978) reviewed 200 questionnaires completed by parents of hearing-impaired children in Toronto. The average delay in diagnosis from the time hearing loss was suspected until the audiologic assessment was completed was 11.5 months. This is much too long.

Results of a questionnaire (Taylor et al 1992) surveying 558 Ontario physicians revealed that only 32 per cent placed considerable emphasis on parental suspicions.

You can help by referring the child to an audiologist, an ear-nose-and-throat specialist whose expertise is hearing, or a centre that specializes in pediatric assessments.

Remember:  No child is too young to have a hearing test.

Have the child fitted with a hearing aid

  • Most children have some residual hearing that can be improved with hearing aids.
  • Even newborns can be fitted with hearing aids by an audiologist.
  • Hearing aids are usually fitted on both ears.
  • Today’s hearing aids are both powerful and small.
  • The audiologist will follow the child on a regular basis to monitor the fit of the hearing aid and the hearing loss.


1. Task Force on Child Hearing Impairment, 1985. Information Kit on Childhood Hearing Impairment, Health and Welfare Canada.
2. Shah CP, Chancellor D, and Dale R, 1978. Delay in referral of children with impaired hearing. Volta Review 80:207
3. Taylor K, Kelner M, and Bourgeault I, 1989. Physician Response to Childhood Hearing Impairment. Physician Behavior Research Unit, Department of Behavioral Science, Faculty of Medicine, University of Toronto. (To obtain a copy of this survey, contact Kathryn Taylor, PhD, York University Centre for Health Studies, 214 York Lanes, 4700 Keele Street, North York, Ontario, M3J 1P3, Telephone 416-231-0256.

Prepared for the Child Welfare Committee of the Ontario Medical Association by Cheryl Galloway, director department of communication disorders. The Hospital for Sick Children, Toronto, Ontario.

We would like to acknowledge the contribution of VOICE for Hearing-Impaired Children who were instrumental in initiating this project.

Ontario Medical Review, May 1993

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