Errors in Hearing Evaluation and the Prescription of Hearing Aids for Infants with Hearing Loss in Khorasan Razavi Province
Abstract
Background and Aim: Early detection and intervention for hearing loss are vital for optimal language development in infants. However, various errors may arise during hearing evaluations and the prescription of hearing aids. This study aimed to identify these errors in Khorasan Razavi Province, Iran.
Methods: This registry-based study involved 485 infants who did not pass the hearing screening. Data were collected from the “Congenital and Acquired Hearing Loss Cohort Registry in Khorasan Razavi.” Infants underwent diagnostic evaluations, with follow-ups lasting up to three years.
Results: Out of 485 infants, only 237 completed the electrophysiologic diagnostic tests; eight were diagnosed with hearing loss (3.37%). Hearing aids were prescribed for five infants, one was a cochlear implant candidate, and three received rehabilitation. A telephone follow-up of 485 cases revealed based on speech and language development checklist that 36 infants (7.42%) exhibited a language/speech delay greater than 6 months. Most important identified errors included loss to follow up (248 out 485, 51.13%), late diagnosis or intervention (189 out 237, 79.74%), not using appropriate test batteries (163 out 237, 68.77%), neglecting tone-burst ABR or ASSR (75 out 237, 31.64%), not employing behavioral tests even for older children (154 out 237, 64.97%), providing intervention without establishing accurate thresholds for severe/profound hearing loss (5 out 5, 100%).
Conclusion: Several errors exist in the evaluation and prescription of hearing aids for infants, especially in cases of severe-to-profound hearing loss. Adhering to standard guidelines and addressing these errors can enhance the quality of hearing assessment and intervention services.
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14. Jafarzadeh S, Khadem-Rezaiyan M. [Policy Brief A Guideline for Telephone Interviews in Biomedical Studies]. Medical Journal of Mashhad University of Medical Sciences. 2025;68(5):1629-33. [DOI:10.22038/mjms.2026.94988.5250]. Persian
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18. American Academy of Pediatrics, Joint Committee on Infant Hearing. Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Pediatrics. 2007;120(4):898-921. [DOI:10.1542/peds.2007-2333]
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20. Ching TY, Dillon H, Marnane V, Hou S, Day J, Seeto M, et al. Outcomes of early- and late-identified children at 3 years of age: findings from a prospective population-based study. Ear Hear. 2013;34(5):535-52. [DOI:10.1097/AUD.0b013e3182857718]
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22. Gorga MP, Johnson TA, Kaminski JR, Beauchaine KL, Garner CA, Neely ST. Using a combination of click- and tone burst-evoked auditory brain stem response measurements to estimate pure-tone thresholds. Ear Hear. 2006;27(1):60-74. [DOI:10.1097/01.aud.0000194511.14740.9c]
23. Hunter LL, Blankenship CM, Gunter RG, Keefe DH, Feeney MP, Brown DK, et al. Cochlear Microphonic and Summating Potential Responses from Click-Evoked Auditory Brain Stem Responses in High-Risk and Normal Infants. J Am Acad Audiol. 2018;29(5):427-42. [DOI:10.3766/jaaa.17085]
24. Diefendorf AO. Assessment of Hearing Loss in Children. In: Katz J, Chasin M, English K, Hood LJ, Tillery KL, editors. Handbook of clinical audiology. 7th ed. Baltimore: Wolters Kluwer Health; 2015. p. 459-76.
25. Swanepoel D, Hugo R. Estimations of auditory sensitivity for young cochlear implant candidates using the ASSR: preliminary results. Int J Audiol. 2004;43(7):377-82. [DOI:10.1080/14992020400050048]
26. Haddadi Aval M, Abdollahi F, Jafarzadeh S. Auditory rehabilitation based on auditory verbal therapy approach on children with bilateral sensory-neural hearing loss. Aud Vestib Res. 2020;29(3):172-7. [DOI:10.18502/avr.v29i3.3850]
27. Lansbergen SE, Versfeld N, Dreschler WA. Exploring Factors That Contribute to the Success of Rehabilitation with Hearing Aids. Ear Hear. 2023;44(6):1514-25. [DOI:10.1097/AUD.0000000000001393]
28. Bagatto M, Moodie S, Scollie S, Seewald R, Moodie S, Pumford J, et al. Clinical protocols for hearing instrument fitting in the Desired Sensation Level method. Trends Amplif. 2005;9(4):199-226. [DOI:10.1177/108471380500900404]
29. Almufarrij I, Munro KJ, Dillon H. Does probe-tube verification of real-ear hearing aid amplification characteristics improve outcomes in adult hearing aid users? A protocol for a systematic review. BMJ Open. 2020;10(7):e038113. [DOI:10.1136/bmjopen-2020-038113]
30. Ferraro J. electrocochleography. In: Roeser RJ, Valente M, Hosford-Dunn H, editors. Audiology Diagnosis. 2nd ed. New York: Thieme Medical Publishers; 2007. p. 400-25.
2. Bussé AML, Hoeve HLJ, Nasserinejad K, Mackey AR, Simonsz HJ, Goedegebure A. Prevalence of permanent neonatal hearing impairment: systematic review and Bayesian meta-analysis. Int J Audiol. 2020;59(6):475-485. [DOI:10.1080/14992027.2020.1716087]
3. Shojaei E, Jafari Z, Gholami M. Effect of Early Intervention on Language Development in Hearing-Impaired Children. Iran J Otorhinolaryngol. 2016;28(1):13-21. [DOI:10.22038/ijorl.2016.6035]
4. Yoshinaga-Itano C, Sedey AL, Coulter DK, Mehl AL. Language of early- and later-identified children with hearing loss. Pediatrics. 1998;102(5):1161-71. [DOI:10.1542/peds.102.5.1161]
5. Netten AP, Rieffe C, Theunissen SC, Soede W, Dirks E, Korver AM, et al. Early identification: Language skills and social functioning in deaf and hard of hearing preschool children. Int J Pediatr Otorhinolaryngol. 2015;79(12):2221-6. [DOI:10.1016/j.ijporl.2015.10.008]
6. Littman TA, Blankenship KK, Koenig JA. Fitting hearing aids on infants and children: a primer for otolaryngologists. Otolaryngol Clin North Am. 2002;35(4):791-801. [DOI:10.1016/s0030-6665(02)00050-6]
7. Bagatto MP, Moodie ST, Seewald RC, Bartlett DJ, Scollie SD. A critical review of audiological outcome measures for infants and children. Trends Amplif. 2011;15(1):23-33. [DOI:10.1177/1084713811412056]
8. Krishnan LA. Universal newborn hearing screening follow-up: a university clinic perspective. Am J Audiol. 2009;18(2):89-98. [DOI:10.1044/1059-0889(2009/09-0003)]
9. Joint Committee on Infant Hearing. Year 2019 position statement: principles and guidelines for early hearing detection and intervention programs. J Early Hear Detect Interv. 2019;4(2):1-44. DOI:10.15142/fptk-b748.
10. Mehta K, Watkin P, Baldwin M, Marriage J, Mahon M, Vickers D. Role of Cortical Auditory Evoked Potentials in Reducing the Age at Hearing Aid Fitting in Children with Hearing Loss Identified by Newborn Hearing Screening. Trends Hear. 2017;21:2331216517744094. [DOI:10.1177/2331216517744094]
11. Taiji H, Morimoto N, Minami S. False negative error in newborn hearing screening. Pediatric Otorhinolaryngology Japan. 2009;30(1):47-53. [DOI:10.11374/shonijibi.30.47]
12. McCreery RW, Bentler RA, Roush PA. Characteristics of hearing aid fittings in infants and young children. Ear Hear. 2013;34(6):701-10. [DOI:10.1097/AUD.0b013e31828f1033]
13. Marcoux A, Hansen M. Ensuring accuracy of the pediatric hearing aid fitting. Trends Amplif. 2003;7(1):11-27. [DOI:10.1177/108471380300700103]
14. Jafarzadeh S, Khadem-Rezaiyan M. [Policy Brief A Guideline for Telephone Interviews in Biomedical Studies]. Medical Journal of Mashhad University of Medical Sciences. 2025;68(5):1629-33. [DOI:10.22038/mjms.2026.94988.5250]. Persian
15. American Speech-Language-Hearing Association. Guidelines for the Audiologic Assessment of Children From Birth to 5 Years of Age [Guidelines]. 2004. Available from www.asha.org/policy. 2004.
16. Findlen UM, Davenport CA, Cadieux J, Gehred A, Frush Holt R, Vaughn LM, et al. Barriers to and Facilitators of Early Hearing Detection and Intervention in the United States: A Systematic Review. Ear Hear. 2023;44(3):448-59. [DOI:10.1097/AUD.0000000000001312]
17. Subbiah K, Mason CA, Gaffney M, Grosse SD. Progress in Documented Early Identification and Intervention for Deaf and Hard of Hearing Infants: CDC's Hearing Screening and Follow-up Survey, United States, 2006-2016. J Early Hear Detect Interv. 2018;3(2):1-7. [DOI:10.26077/6sj1-mw42]
18. American Academy of Pediatrics, Joint Committee on Infant Hearing. Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Pediatrics. 2007;120(4):898-921. [DOI:10.1542/peds.2007-2333]
19. Joint Committee on Infant Hearing; American Academy of Audiology; American Academy of Pediatrics; American Speech-Language-Hearing Association; Directors of Speech and Hearing Programs in State Health and Welfare Agencies. Year 2000 position statement: principles and guidelines for early hearing detection and intervention programs. Joint Committee on Infant Hearing, American Academy of Audiology, American Academy of Pediatrics, American Speech-Language-Hearing Association, and Directors of Speech and Hearing Programs in State Health and Welfare Agencies. Pediatrics. 2000;106(4):798-817. [DOI:10.1542/peds.106.4.798]
20. Ching TY, Dillon H, Marnane V, Hou S, Day J, Seeto M, et al. Outcomes of early- and late-identified children at 3 years of age: findings from a prospective population-based study. Ear Hear. 2013;34(5):535-52. [DOI:10.1097/AUD.0b013e3182857718]
21. Kanne TJ, Schaefer L, Perkins JA. Potential pitfalls of initiating a newborn hearing screening program. Arch Otolaryngol Head Neck Surg. 1999;125(1):28-32. ]DOI:10.1001/archotol.125.1.28]
22. Gorga MP, Johnson TA, Kaminski JR, Beauchaine KL, Garner CA, Neely ST. Using a combination of click- and tone burst-evoked auditory brain stem response measurements to estimate pure-tone thresholds. Ear Hear. 2006;27(1):60-74. [DOI:10.1097/01.aud.0000194511.14740.9c]
23. Hunter LL, Blankenship CM, Gunter RG, Keefe DH, Feeney MP, Brown DK, et al. Cochlear Microphonic and Summating Potential Responses from Click-Evoked Auditory Brain Stem Responses in High-Risk and Normal Infants. J Am Acad Audiol. 2018;29(5):427-42. [DOI:10.3766/jaaa.17085]
24. Diefendorf AO. Assessment of Hearing Loss in Children. In: Katz J, Chasin M, English K, Hood LJ, Tillery KL, editors. Handbook of clinical audiology. 7th ed. Baltimore: Wolters Kluwer Health; 2015. p. 459-76.
25. Swanepoel D, Hugo R. Estimations of auditory sensitivity for young cochlear implant candidates using the ASSR: preliminary results. Int J Audiol. 2004;43(7):377-82. [DOI:10.1080/14992020400050048]
26. Haddadi Aval M, Abdollahi F, Jafarzadeh S. Auditory rehabilitation based on auditory verbal therapy approach on children with bilateral sensory-neural hearing loss. Aud Vestib Res. 2020;29(3):172-7. [DOI:10.18502/avr.v29i3.3850]
27. Lansbergen SE, Versfeld N, Dreschler WA. Exploring Factors That Contribute to the Success of Rehabilitation with Hearing Aids. Ear Hear. 2023;44(6):1514-25. [DOI:10.1097/AUD.0000000000001393]
28. Bagatto M, Moodie S, Scollie S, Seewald R, Moodie S, Pumford J, et al. Clinical protocols for hearing instrument fitting in the Desired Sensation Level method. Trends Amplif. 2005;9(4):199-226. [DOI:10.1177/108471380500900404]
29. Almufarrij I, Munro KJ, Dillon H. Does probe-tube verification of real-ear hearing aid amplification characteristics improve outcomes in adult hearing aid users? A protocol for a systematic review. BMJ Open. 2020;10(7):e038113. [DOI:10.1136/bmjopen-2020-038113]
30. Ferraro J. electrocochleography. In: Roeser RJ, Valente M, Hosford-Dunn H, editors. Audiology Diagnosis. 2nd ed. New York: Thieme Medical Publishers; 2007. p. 400-25.
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| Infant diagnostic errors Hearing Impaired Rehabilitation early intervention hearing aids | ||
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How to Cite
1.
Jafarzadeh S. Errors in Hearing Evaluation and the Prescription of Hearing Aids for Infants with Hearing Loss in Khorasan Razavi Province. Aud Vestib Res. 2026;.
