Page 90 - Portuguese Journal - SPORL - Vol 61. Nº1
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The diagnosis should be made as early The risk factors newly reported in the medical
as possible to reduce the potential literature justify the proposal of a revised
developmental consequences. Tools such as algorithm for UNHS. The objective of this study
universal neonatal hearing screening (UNHS) , was to develop and propose an algorithm
2
regular follow-up in a child health clinic by a for the screening, early diagnosis, and rapid
general practitioner or pediatrician, awareness referral of children at risk of hearing loss, to
of the main risk factors for hearing loss during be applied not only in primary care child and
childhood, and rapid hospital referral protocols adolescent health monitoring but also in
are essential for improving the prognosis of pediatric and otorhinolaryngology clinics.
childhood deafness.
In Portugal, the Group for Screening and Materials and Methods
Intervention in Childhood Deafness (Grupo This literature review was conducted by
de Rastreio e Intervenção da Surdez Infantil - searching the PubMed, NCBI, American
GRISI) has set the following goals: identify all Academy of Pediatrics (AAP), and Surgeon
children with hearing loss by three months General (Direcção Geral de Saúde) websites
of age and ideally start the intervention by using the terms “childhood hearing loss”,
six months of age. Currently, the available “infant hearing loss”, “neonatal screening”,
2
audiological equipment for universal “auditory screening”, and “hearing risk
screening and diagnosis is easily accessible factors”. The following were consulted: the
and manageable and permits objective, non- recommendations of the UNHS, GRISI (2007) ,
2
invasive, and even automatic assessment AAP , EUSCREEN Vision & Hearing 2021 ,
3,4
5
of hearing. The two major strategies used in Joint Committee on Infant Hearing (JCIH) ,
6
this context are acoustic otoemissions (AOs) and Societé Française de Pédiatrie . For topics
13
and auditory evoked potentials (AEP). AOs are introduced recently about premature NBs, we
sounds originating in the cochlea, namely in used the chronological age.
response to an auditory stimulus, which can
be recorded by a microphone in the external Results
auditory canal. There are two major groups of The main risk factors for childhood hearing loss
AOs, spontaneous and evoked. In the latter, we requiring referral to an otorhinolaryngology
identify transient AOs and distortion products, consultation were determined based on
both of which can be tested in neonatal the previously existing clinical standards
hearing screening with equal efficiency. 9–11 In in Portugal 2 and recommendations of
response to an auditory stimulus, AEPs record international societies (Table 1). 3,5,6 Previous
waves with different latencies corresponding studies have also described reassessment
to different points in the auditory pathway timings for different clinical situations,
from the cochlea to the cerebral cortex. They such as the extension of serial audiological
are an objective measure of auditory function, assessment until six years of age for children
allow estimation of the hearing thresholds who underwent extracorporeal membrane
of the patient, and may contribute to the oxygenation (ECMO) or had intrauterine
14
topodiagnosis. Both AOs and AEPs, alone or cytomegalovirus (CMV) infection (Table
combined, enable the identification of NBs 2) . In the context of child and adolescent
15
with a hearing loss greater than 35 or 40 dB health surveillance, warning signs have been
2
HL. 5,6,9 Nevertheless, even children who pass proposed for different developmental stages
the screening test at birth and therefore do that should lead to a referral to a specialty
not appear to have neonatal hearing loss physician for audiological examination. 8,12
should be followed-up in a child health clinic
for monitoring signs of late hearing loss and
referred to a specialty physician if required. 2,8,12
90 Portuguese Journal of Otorhinolaryngology - Head and Neck Surgery
