What are the next steps if a 5-month-old infant shows signs of hearing loss?

Management of Suspected Hearing Loss in a 5-Month-Old Infant

A 5-month-old infant showing signs of hearing loss should be immediately referred to an audiologist experienced in pediatric hearing assessment for comprehensive audiological evaluation, followed by appropriate medical evaluations and early intervention if hearing loss is confirmed.

Initial Recognition and Assessment

• At 5 months, infants should be able to correctly localize sounds in a horizontal plane and begin to imitate sounds or reciprocally vocalize with adults 1
• Signs of possible hearing loss at this age include:
  • Failure to localize to sound sources
  • Limited or absent vocalization
  • Lack of response to name or familiar voices
  • Minimal startle response to loud sounds 1

Diagnostic Pathway

Step 1: Immediate Audiological Referral

• Refer directly to a pediatric audiologist with expertise in evaluating infants with hearing loss 1
• The audiological assessment should include:
  • Auditory Brainstem Response (ABR) testing (essential for infants under 3 years) 1
  • Otoacoustic emissions (OAEs) 1
  • Tympanometry to assess middle ear function 1
  • Review of family history and risk factors for hearing loss 1

Step 2: Medical Evaluation (if hearing loss is confirmed)

• Otolaryngologist evaluation is essential for complete diagnostic assessment 1
• Medical workup may include:
  • Imaging of temporal bone to identify structural defects 1
  • Genetic testing (e.g., Connexin gene abnormalities) 1
  • Evaluation for metabolic disorders when indicated 1
• Ophthalmologic examination by a specialist experienced in evaluating infants 1
• Genetics consultation should be offered to the family 1

Intervention Timeline

• For confirmed hearing loss, amplification devices should be fitted within 1 month of diagnosis 1
• Early intervention services should begin no later than 6 months of age 1
• The goal is to minimize delays in speech, language, and cognitive development that can result from untreated hearing loss 2

Intervention Options

• All infants with any degree of bilateral or unilateral permanent hearing loss should be considered eligible for early intervention services 1
• Intervention options may include:
  • Hearing aids for mild to moderate bilateral sensorineural hearing loss 3
  • Cochlear implants for severe to profound bilateral sensorineural hearing loss 1
  • Speech-language therapy 1
  • Family education and support 1

Multidisciplinary Team Approach

• The hearing healthcare team should include 1:
  • Audiologist
  • Otolaryngologist
  • Speech-language pathologist
  • Early intervention specialists
  • Medical home provider

Important Considerations

• Early identification and intervention are critical for optimal speech and language development 2
• Parents should receive culturally sensitive information about all communication options and available hearing technologies in an unbiased manner 1
• Both home-based and center-based intervention options should be offered 1
• Regular follow-up is essential to monitor progress and adjust interventions as needed 1

Potential Pitfalls to Avoid

• Delaying referral while "waiting to see if it improves" - early intervention is crucial 1
• Missing neural hearing loss (auditory neuropathy/dyssynchrony) - occurs in approximately 13.4% of infants with severe to profound hearing loss 4
• Focusing only on hearing aids without addressing comprehensive early intervention needs 1
• Failing to recognize that over 90% of children with permanent hearing loss are born to parents with normal hearing, who may need significant support and education 1