Otolaryngology (ENT) Evaluation
The ENT physician should have expertise in childhood hearing loss. The ENT physician is responsible for investigating the etiology of hearing loss and for determining whether medical or surgical intervention may be an appropriate option. In addition, the ENT physician provides information about and participates in the assessment of the options for amplification, assistive listening devices, and cochlear implantation. The ENT physician should participate in the long-term monitoring of the child's hearing in partnership with the primary care team.
Ophthalmologic Examination
Children with hearing loss often have vision problems. The role of the ophthalmologist is to assess for the presence of syndromic visual loss associated with hearing loss, such as in Usher's syndrome. Evaluation for more common types of visual impairment, including refractive error, is essential for children who will likely be strong visual learners.
Genetic Evaluation and Counseling
Half of all hearing loss is genetic. The purpose of the evaluation performed by a clinical geneticist is to determine the cause of hearing loss, identify other medical issues that are associated with hearing loss, and develop long-term medical management plans based on associated conditions.

Primary Care providers are encouraged to make these referrals. See MDH Guidelines for Primary Care and Medical Home Providers (updated 2017) (PDF)

Tips For Improvement

Misconception: Abnormal OAE's along with flat tympanograms (normal volume) confirms a conductive hearing loss

Clinical Fact: Diagnostic ABR including bone conduction testing is needed in combination with OAE's and tympanograms for a complete diagnosis of type and degree of hearing loss in each ear

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Misconception: Infants who need diagnostic testing with an audiologist must be sedated.

Clinical Fact: Younger infants (ideally between four to eight weeks of age) can typically be tested without need for sedation.

More Hearing Screening Myths and Clinical Facts (PDF)

Best Practice Guidelines

Resources

National

2019 Joint Committee on Infant Hearing Position Statement

Supplement to the JCIH 2007 Position Statement: Principles and Guidelines for Early Intervention After Confirmation That a Child Is Deaf or Hard of Hearing

Clinical Practice Guideline: Otitis Media with Effusion (Update) 2016

Clinical Practice Guideline: Tympanostomy Tubes in Children, American Academy of Otolaryngology, 2013

Midwest Genetics Network - Region 4

Minnesota

Guidelines for Primary Care and Medical Home Providers

Guidelines for Otolaryngologists

Tools for Improvement

Strengthen Care Coordination

Enhancing Collaboration Between Primary and Subspecialty Care Providers for Children and Youth with Special Health Care Needs (PDF)

Partnering with your Doctor The Medical Home Approach: A guide for families of children with special health care needs -Midwest Genetics Network (English) (PDF) (Spanish) (Arabic)

The ENT Guide to the Newborn Hearing Diagnostic Process: Flowchart, Myths, and Facts (PDF)

Engage Families as Partners

EHDI Parent Resource Binder (PDF) features the Parent Roadmap (PDF) and offers more in depth information about hearing loss. Any child living in Minnesota that is newly identified with a hearing loss will receive a printed copy of this resource binder.

A Parent's Guide to Genetics and Hearing Loss (PDF) (English) (Spanish)

Questions You May Want to Ask Your Child's Medical Professional (PDF)

Questions You May Want to Ask Your Child's Genetics Team (PDF)

Questions You May Want to Ask Your Child's ENT Professional (PDF)

Questions You May Want to Ask Your Child's Speech-Language Pathologist (PDF)

Does My Child Have a Hearing Loss? Emergency & Community Health Outreach (English) (Hmong) (Somali) (Spanish)

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