Page 95 - Portuguese Journal - SPORL - Vol 61. Nº1

4. Algorithm for the identification of children Based on the suggestions of Yoshinaga-Itano
at risk of hearing loss, namely during et al and of the National Program for Child
8
consultation of child and adolescent health and Adolescent Health (Programa Nacional
monitoring in the primary health care setting de Saúde Infanto-Juvenil) , which has been
12
(Algorithm 2) (figure 2) in force in Portugal since 2013, we created a
Children followed in the child and adolescent list of potential changes in the child’s normal
health monitoring consultation in the development that may indicate a higher
primary health care setting should undergo risk of hearing loss and the need for an ORL
an audiological evaluation with an evaluation with an audiological assessment.
otorhinolaryngologist if a delay in development Some European countries have recently
(namely in speech development) or behavioral established a new universal hearing screening
problems such as autism spectrum disorders at the age of four years. However, because this
are detected. Because of the negative impact measure still lacks cost-benefit evidence, we
3,4
on the child’s development, a high degree of chose not to include this suggestion in the
suspicion of hearing loss should be maintained designed algorithm. 35,36
even in children who apparently do not have
a developmental delay or behavioral issues. Discussion
If a risk factor for hearing loss is identified at The present algorithm proposes to extend the
any stage of the follow-up, the child should be current scope of referral for pediatric hearing
referred for an audiological evaluation with an screening in Portugal to other pediatric ages
otorhinolaryngologist within less than 15 days and suggests updates to the present clinical
in case of bacterial meningitis. 4 guidelines with the introduction of new risk

Figure 2
Algorithm 2 – Scheme of organization to identify children at risk of hearing loss during child and
adolescent health monitoring consultation in the primary health care setting

Suspected hearing loss?
1 Month Is not startled by a loud sound, does not turn eyes/head toward voice
4 Months Does not react to a familiar voice
Does not look, does not react to sounds (rattle, cup, spoon), does not
6-9 Months
vocalize/vocalizes in a monotonous tone of voice
12 Months Does not respond to a voice
15 Months Does not communicate needs by pointing or vocalizing
18 Months Does not vocalize spontaneously, does not respond when called
2 Years Does not understand what he/she is told, does not use intelligible words
3 Years Incomprehensible language
4-5 Years Not fluent, many phonetic replacements/stuttering
6-8 Years Does not respond in the whisper voice test

Abbreviations: AEP, Auditory Evoked Potentials; OAE, otoacoustic emissions; C, Consultation; ORL, Otorhinolaryngology;
FM, Family Medicine; SNHL,sensorineural hearing loss

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