Screening and early diagnosis of hearing loss in children requires timely assessment and prompt treatment of affected patients, in order to avoid delays in language acquisition, learning difficulties, and problems with social integration.

        Certain general principles should be reiterated here, based on BIAP recommendations 12/1, 12/2, 12/3, 21/1, 24/1, the Joint Committee on Infant Hearing (1984), ASHA position statements 36, 38-41 (1994), the European Consensus Statement on Neonatal Screening (Milan, May 1998), and on long-term clinical experience:

- the maternity ward is an ideal environment to demonstrate to the parents the sensory (and in particular the auditory) capabilities of their new baby.

- during early childhood, the basis of screening lies in the recognition of "alarm signals" by all who enter into contact with the child.  This requires simple but careful observation of auditory, vocal, and language-related behaviours by caretakers.  Special attention must be paid to children a high risk of hearing loss.  Effective screening is only possible if high-quality information concerning the warning signs of hearing loss is transmitted to paediatricians, maternity ward personnel, day-care and pre-school workers, school physicians.  All of the above must be empowered to make relevant observations, but also to take into consideration remarks by the parents (whose role is primordial, and whose observations are often quite exact).

        In addition to examination by an ENT specialist, several techniques for screening and confirmation of the diagnosis of hearing loss are available; furthermore, these techniques are constantly evolving.  They include behavioural audiometry and impedancemetry, OAE, BERA, etc.  Many of these techniques (including OAE and BERA) are applicable at birth;, recent technical progress allows their use as part of a systematic approach to screening of newborns.  Their use by an experienced team is the only guarantee of reliability, and permits either early diagnosis or reassurance of the absence of pathology.

        The follow-up of any anomaly detected on screening must be immediate, appropriate to the degree of hearing loss suspected, and be performed by an clinician with experience in paediatric audiology.  This should be associated with an etiologic work-up.

        In countries or regions where paediatric audiological care is unavailable or of marginal quality, arrangements must be provided for provision of screening and early diagnosis, to the extent that these children can benefit from acquisition of spoken or signed language.
 
 
 
 
 

            Montpellier, May 2000.