Fitzpatrick Elizabeth M, Dos Santos Johnny Cesconetto, Grandpierre Viviane, Whittingham JoAnne
Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8L1, Canada; Child Hearing Lab, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Ontario K1H 8M5, Canada.
Audiology and Speech-Language Pathology, Federal University of Espírito Santo, Marechal Campos Avenue, Number 1468 - Maruípe, Vitória, Espírito Santo 29043-900, Brazil.
Int J Pediatr Otorhinolaryngol. 2017 Sep;100:160-167. doi: 10.1016/j.ijporl.2017.06.039. Epub 2017 Jul 1.
Several studies have shown that early identification of childhood hearing loss leads to better language outcomes. However, delays in the confirmation of hearing loss persist even in the presence of well-established universal newborn hearing screening programs (UNHS). The objective of this population-based study was to document the proportion of children who experienced delayed confirmation of congenital and early onset hearing loss in a UNHS program in one region of Canada. The study also sought to determine the reasons for delayed confirmation of hearing loss in children.
Population level data related to age of first assessment, age of identification and clinical characteristics were collected prospectively for all children identified through the UNHS program. We documented the number of children who experienced delay (defined as more than 3 months) from initial audiologic assessment to confirmation of hearing loss. A detailed chart review was subsequently performed to examine the reasons for delay to confirmation.
Of 418 children identified from 2003 to 2013, 182 (43.5%) presented with congenital or early onset hearing loss, of whom 30 (16.5%) experienced more than 3 months delay from initial audiologic assessment to confirmation of their hearing disorder. The median age of first assessment and confirmation of hearing loss for these 30 children was 3.7 months (IQR: 2.0, 7.6) and 13.8 months (IQR: 9.7, 26.1) respectively. Close examination of the factors related to delay to confirmation revealed that for the overwhelming majority of children, a constellation of factors contributed to late diagnosis. Several children (n = 22; 73.3%) presented with developmental/medical issues, 15 of whom also had middle ear dysfunction at assessment, and 9 of whom had documented family follow-up concerns. For the remaining eight children, additional reasons included ongoing middle ear dysfunction for five children, complicated by family follow-up concerns (n = 3) and mild hearing loss (n = 1) and the remaining three children had isolated reasons related to family follow-up (n = 1) or mild hearing loss (n = 2).
Despite the progress made in the early detection of pediatric hearing loss since UNHS, a substantial number of children referred for early assessment can experience late confirmation and intervention. In particular, infants with developmental and/or medical issues including middle ear disorders are at particular risk for longer time to confirmation of hearing loss.
多项研究表明，早期识别儿童听力损失可带来更好的语言发育结果。然而，即便存在成熟的新生儿听力普遍筛查项目（UNHS），听力损失确诊延迟的情况仍持续存在。这项基于人群的研究旨在记录加拿大某一地区UNHS项目中先天性和早发性听力损失确诊延迟的儿童比例。该研究还试图确定儿童听力损失确诊延迟的原因。
前瞻性收集通过UNHS项目识别出的所有儿童的首次评估年龄、识别年龄及临床特征等人群层面的数据。我们记录了从首次听力评估到听力损失确诊经历延迟（定义为超过3个月）的儿童数量。随后进行详细的病历审查，以探究确诊延迟的原因。
在2003年至2013年识别出的418名儿童中，182名（43.5%）患有先天性或早发性听力损失，其中30名（16.5%）从首次听力评估到听力障碍确诊经历了超过3个月的延迟。这30名儿童首次评估和听力损失确诊的中位年龄分别为3.7个月（四分位间距：2.0，7.6）和13.8个月（四分位间距：9.7，26.1）。仔细研究与确诊延迟相关的因素发现，对于绝大多数儿童而言，一系列因素导致了诊断延迟。部分儿童（n = 22；73.3%）存在发育/医学问题，其中15名在评估时还伴有中耳功能障碍，9名有记录在案的家庭随访问题。其余8名儿童的其他原因包括5名儿童持续存在中耳功能障碍，并伴有家庭随访问题（n = 3）和轻度听力损失（n = 1），其余3名儿童的原因分别与家庭随访（n = 1）或轻度听力损失（n = 2）有关。
尽管自UNHS实施以来在小儿听力损失早期检测方面取得了进展，但大量被转诊进行早期评估的儿童仍可能经历确诊延迟和干预延迟。特别是患有包括中耳疾病在内的发育和/或医学问题的婴儿，确诊听力损失的时间较长的风险尤其高。
