Genetics, developmental anomalies, and intrauterine infections and exposures are common prenatal causes of deafness.
DepartmentCase StudyâPrimary CareInfant With Failed Hearing Screening: Considerations for the PNP in Primary Care
Section snippets
Case Presentation
A 14-day-old Hispanic boy presents to the clinic for his 2-week health maintenance examination. His mother denies any concerns. She states that the infant failed his hearing test while he was in the newborn nursery; however, she perceives that he âhears just fine.â She reports that he does not cry very often and does not startle in response to loud noises or family activities. She denies concerns about his growth and development.
The infant failed three oto-acoustic emission (OAE) screenings in
Prenatal/Maternal Information
The childâs mother (gravida 3, para 3, abortus 0) obtained prenatal care within the first trimester of her pregnancy. Prenatal laboratory tests were negative for drugs, alcohol, group B streptococcus, and the TORCH complex: toxoplasmosis, other infections (such as hepatitis B, syphilis, and herpes zoster), rubella, cytomegalovirus (CMV), and herpes simples. The mother did not have gestational diabetes, preeclampsia, or any hospitalizations prior to delivery. A 36-week fetal ultrasound confirmed
Differential Diagnosis
Many differential diagnoses may be considered for an infant who has failed a hearing screening. Hearing loss is categorized by conductive hearing loss (CHL), sensorineural hearing loss (SNHL), and mixed CHL and SNHL. CHL is caused by physical anomalies of the outer and inner ear, as well as by diseases (e.g., otosclerosis and osteogenesis imperfecta) and craniofacial malformations (e.g., Pierre-Robin sequence and branchial-oto-renal [BOR] spectrum disorders) (American Academy of Pediatrics, 2007
Patient Follow-up
The parents took the infant to an audiologist within a week of the 2-week well-child check appointment. An unsedated auditory brainstem response (ABR), a distortion product, and transient evoked OAE testing were performed. This revealed absent responses at all frequencies tested, confirming abnormal outer hair cell function bilaterally. It was determined that this infant was not hearing speech sounds at all. Bilateral hearing aids were recommended, pending otolaryngology recommendations and
Case Study Questions
- 1.
When an infant who has failed a hearing screening presents for an initial examination, what information should the PNP elicit with regard to the prenatal, perinatal, and postnatal history?
- 2.
What components must the PNP include in the physical examination of this infant?
- 3.
In this scenario, what is the significance of the infantâs preauricular pit?
- 4.
In addition to the aforementioned findings, why would the PNP be concerned about the presence of a supernumerary nipple?
- 5.
What additional tests should be
Case Study Answers
1. When an infant who has failed a hearing screening presents for an initial examination, what information should the PNP elicit with regard to the prenatal, perinatal, and postnatal history?
The timing of deafness can be classified according to the onset in relation to the childâs birth: prenatal, perinatal, and postnatal. Genetics, developmental anomalies, and intrauterine
Long-term Follow-up and Implications For the PNP
This patient will need continual follow-up with the audiologist, otolaryngologist, and cochlear team (if cochlear implants are performed). He also will need aggressive and consistent follow-up with speech and sign language therapy. Additional appointments with the pediatric cardiologist and ophthalmologist will be determined on the basis of genetic findings. This patient will receive state early intervention services for the first three years of his life.
This family is beginning a long journey
Robin J. Henson, Adjunct Faculty DNP Program, Texas Womanâs University, Dallas, TX.
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Cited by (0)
Robin J. Henson, Adjunct Faculty DNP Program, Texas Womanâs University, Dallas, TX.
Karla McHughes, Family Nurse Practitioner Student, Texas Womanâs University, Dallas, TX.
Conflicts of interest: None to report.