What is appropriate management for transient conductive hearing loss identified via a screening program?

Mr Andrew Geyl¹

¹Sydney Children’s Hospital, Randwick, Australia

Background:
Sydney Children’s Hospital is one of the 4 centres performing neonatal diagnostic assessment in NSW (SWISH). In the 20 years of SWISH we have assessed many thousands of babies, of which around 20 % have had a conductive hearing loss.

Some of these would be targeted for early hearing assessments for other reasons such as a cleft palate or other craniofacial abnormalities, postnatal meningitis, or a very low birth weight, but a significant proportion would otherwise not have had their hearing assessed as neonates.

In this last case, the hearing loss is an incidental finding that does not have a clear, unified, state-wide evidence-based protocol for management – and yet we find 371 patients referred to us over the past twenty years, with an average of about 18 per year.

This is a large number of non-targeted patients and for whom there has been no clear state-wide evidence-based protocol for management.

As clinicians, we want to know the answers to questions such as:

• When should a patient be referred for specialist management – at a particular age, or only if there is a particular level of hearing loss, or after a number of failed tympanometry assessments?
• Should bone conduction thresholds be assessed at the initial ABR, or laster on in the hope that middle ear effusion might resolve?

Method:
A retrospective review of patient records from 2002 to 2022, including only patients that had no risk factors for a conductive hearing loss, recording if and when a patient’s tympanometry became normal. For a given patient, we define “resolved” as normal tympanometry for both ears, and otherwise “unresolved”.

Results:

• Middle ear involvement rarely resolves before age 3 months’ age.
• Average hearing loss can be help determine if middle ear function will resolve sooner.

Biography:

Andrew Geyl has 30 years experience as an audiologist, and 18 of those involved with the NSW neonatal hearing screening, SWISH. He has a special interest in neonatal hearing diagnostics and management.