Other infections that cause hearing loss are prominent in different
parts of the world. Hearing loss from HIV is prevalent in South Africa,
for example, and congenital rubella remains a problem in India.
10
Pharmacologic ototoxicity is also an environmental cause of newborn
and infant hearing loss. One example involves mutation of a mito-
chondrial gene that results in extreme sensitivity to aminoglycosides
and resultant ototoxicity. Without aminoglycoside exposure, the
affected child would hear normally.
11
Screening
Screening infants for hearing loss was first described in 1964 by
Marion Downs, an audiologist who used behavioral screening of
newborns. She documented severe to profound hearing loss at a
rate very similar to today’s figures. The state of Rhode Island was
the first to mandate neonatal hearing screens in 1989, followed
by Hawaii and then Colorado in 1993. In 1993, an NIH confer-
ence endorsed the testing, which spread throughout the nation over
the next 10 years. In Washington state, newborn hearing testing is
not mandated but is encouraged by the Department of Health.
12
The United States defines hearing loss as a sensorineural loss of 35 dB
or more in either ear. Thirty to 40 percent of neonatal losses are unilat-
eral.
13
Two screening methods are used. The automated auditory brain-
stem response measures the neural response to a repeated sound.
The otoacoustic emissions (OAE) test detects the faint sound caused
by movement of the outer hair cells. The OAE may appear normal in
deaf children who have a lesion of the auditory nerve, so it cannot be
used alone in screening. With these two tests, the age for firmly diag-
nosing neonatal hearing loss has dropped to 2 to 3 months. Unlike
prior testing, the test failure rate has dropped to under 0.5 percent.
About half of the children who fail or are referred for further testing
are later demonstrated to have normal hearing. “Referred” is the
preferred term, used so as not to unduly frighten parents.
14
A diagnosis of hearing loss confirmed at an early age is very impor-
tant for normal child development. Early intervention has been shown
to improve language, reading, and communication development.
A child must hear words in order to learn to speak. Without sound,
the auditory cortex of the brain does not develop normally, and it
is uncoupled from vision. When intervention is delayed, portions of
the brain dedicated to sound are commandeered by other systems
and cannot be retrieved later.
15
Difficult Patient? Think of
ACEs
By Barbara K. Gehrett, MD
10. “Newborn Hearing Screening.”
11. “Newborn Hearing Screening.”
12.
http://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/
HealthcareProfessionsandFacilities/ PatientCareResources/EarlyHearingLoss/
ResourcesforProviders/LawsandRegula
, accessed May 25, 2016.
13. “Newborn Hearing Screening.”
14. “Newborn Hearing Screening.”
15. “Profound Deafness in Childhood.”
hearing loss, cont.
Most physicians have encountered difficult patients at one
time or another in their careers. While each situation may
be different, closer study often reveals a common factor:
Many patients who are resistant to help have experienced
what are called ACEs.
What are ACEs?
Adverse childhood events (ACEs) are types of trauma that occur
in childhood. The original list of eight types has been expanded
to nine or 10, depending on the author. ACEs are grouped into
three broad categories: household dysfunction, abuse, and neglect.
How did this term originate?
Dr. Vincent Felitti was frustrated that many of his successful Kaiser
weight loss patients dropped out of the program and regained their
weight. He began to interview them and somewhat serendipitously
found a surprising rate of childhood sexual abuse. When colleagues
confirmed his findings, he started a larger study.
Who has ACEs?
The answer is that a remarkable number of people have ACEs.
Between 1995 and 1997, the Felitti and Anda survey studied
over 17,000 Kaiser enrollees and identified ACEs in two-thirds of
them. These were primarily college-educated, white adults with an
average age of 57.
ACEs reported by the Kaiser study:
Household dysfunction
Substance abuse: 27%
Parental separation
or divorce: 23%
Mental illness: 17%
Battered mother: 13%
Criminal behavior: 6%
Abuse
Psychological: 11%
Physical: 28%
Sexual: 21%
Neglect
Emotional: 15%
Physical: 10%
6
The Bulletin
