Guidelines for the diagnosis and intervention of hearing loss in infants

Human beings perceive the world through their senses. In all sensory experiences, people promote communication and social interaction through hearing, establish connections, participate in daily activities, sense danger and experience all kinds of life.

5% of the world’s population (about 360 million people) has hearing loss with hearing loss degree of disability, of which more than 32 million are children, mainly distributed in low-income countries.

Hearing plays an important role in children’s language learning, knowledge acquisition and social integration. Children with hearing loss have difficulties in receiving education and social interaction, so it will be very helpful if they can be diagnosed early and given appropriate intervention.

WHO estimates that about 60% of children’s hearing loss is avoidable. If hearing loss is inevitable, measures such as hearing reconstruction, education and empowerment are needed to help children develop their potential. To achieve this goal, both sides need to work together and take action.

What are the effects of children’s hearing loss without treatment?

In addition, children’s overall cognitive ability, social skills, life attitude and self-esteem will also be affected. Children who suffer from hearing loss but fail to get treatment often have poor academic performance, which will lead to poor job performance and reduced employment opportunities in adulthood. Communication difficulties may make children feel angry, depressed and lonely, produce lasting emotional and psychological trauma, and thus deeply affect the whole family. In addition, children are more vulnerable in areas where social resources are scarce, and children with hearing loss have a higher risk of injury due to their lack of perception of the surrounding environment. From a broader perspective, hearing loss will have a negative impact on the social and economic development of the country.

According to the Sixth National Census and the second national sample survey of disabled people, in 2010, the total number of disabled people in China was 85.02 million, including 20.54 million people with hearing impairment, second only to 24.72 million people with physical impairment. Every year, more than 300000 hearing impaired children are added in China (the population of Iceland is about 310000, which means that China is the country with the largest number of hearing impaired children in the world.

What are the causes of children’s hearing loss?

There are many causes of hearing loss, including congenital and acquired factors. The former refers to congenital hearing loss at birth or shortly after birth, and the latter refers to hearing loss in childhood. Hearing loss may be the result of multiple factors, but sometimes it is difficult to find out the exact cause. Possible causes of hearing loss in children include:

Genetic factors: about 40% of children’s hearing loss is caused by genetic factors. The evidence shows that the offspring of close relatives who marry or have close relatives have a higher probability of hearing loss. Congenital malformation of ear or auditory nerve caused by gene or environmental factors may be the cause of hearing loss.

Factors during labor: including premature delivery, low birth weight, neonatal asphyxia (refers to diseases caused by hypoxia at birth) and neonatal jaundice.

Infection: rubella and cytomegalovirus infection during pregnancy may cause hearing loss of newborn, in addition, meningitis, measles and mumps may also cause hearing loss. In low-income countries, chronic suppurative otitis media and other ear infections are very common. In addition to hearing loss, ear infections may also cause fatal complications.

Ear diseases: common ear diseases such as cerumen embolism (earwax accumulation) and eustachian tube blockage (non suppurative otitis media) caused by water in the ear canal can also cause hearing loss in children.

Noise: the use of smart phones, MP3 and other personal audio playing devices with large volume for a long time may cause hearing loss. High decibel noise such as fireworks and firecrackers may cause permanent hearing loss. In addition, the equipment noise of NICU can also cause hearing loss.

Drugs: used to treat neonatal infection, malaria, drug-resistant tuberculosis, cancer and other drugs, because of its ototoxicity, can lead to hearing loss. Ototoxic drugs are often used to treat common infections in children in many areas, especially in areas where drug use is not standardized.

The effect of hearing loss on individuals depends on a number of factors, including:

• age of onset: the first few years after birth is the most ideal period for the development of language ability, so the patients with congenital hearing loss or those with hearing loss soon after birth are the most seriously affected.

• level of hearing loss: from mild to extremely severe, the higher the level, the more seriously affected.

• age of discovery and intervention: early diagnosis and intervention of hearing loss is very important. The earlier the intervention is taken, the greater the chance for children to master oral English. The children’s hearing committee recommends that interventions begin before the age of six months. In addition, early diagnosis and intervention can significantly reduce the cost of education due to hearing loss in the later stage of children, and improve their ability to make a living in adulthood.

Environment: the overall living environment, including the services available, is also one of the serious factors. Children with hearing aids, cochlear implant, sign language and special education are more likely to reach the same level as their peers with normal hearing. The support of parents and families helps children integrate into society.

National standards and guidelines for intervention of hearing loss in infants

Since the middle and late last century, evidence-based audiology has been gradually used in overseas developed countries to screen children and school-age children. Hearing loss is the most common developmental disorder that can be found at birth. Because of late onset, late diagnosis and acquired hearing loss, the incidence of hearing loss is increasing in the whole school-age children. Lack of hearing screening and appropriate treatment for hearing loss in children not only have a profound impact on the economy, but also have a potential impact on children’s education, cognition and social development. The purpose of early detection of new hearing loss is to maximize the perception of speech and the acquisition of language skills.

Due to the late development of audiology in China, there has been a relatively rapid progress in various fields of audiology in the past decade. For a long time, China’s children’s audiology standards mainly draw lessons from foreign experience, combined with local characteristics, mainly based on the Guidance standard of “technical specifications for newborn hearing screening”. After continuous revision and implementation, there has been no national level standard for the intervention of infant hearing loss. In March this year, the nhfpc (National Health and Family Planning Commission of China) issued the national standards and guidelines for hearing loss intervention for infants and young children. Since then, China has its own standards for hearing loss intervention for infants and young children.

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