Risk factors for early childhood hearing loss

Risk factor	Comments and examples
Parent/caregiver concerns regarding hearing	Parents/caregivers concerns that may raise suspicion for hearing loss in the child include: Erratic response or inattention to sound Delayed or abnormal speech and language development Other developmental concerns
Family history of permanent childhood hearing loss	A positive family history places the child at increased risk However, many children with genetic hearing loss do not have affected relatives because genetic hearing loss often has an autosomal recessive inheritance pattern
NICU graduate	Important risk factors for hearing loss among NICU graduates include: NICU stay ≥5 days Very low birth weight (<1500 g) Perinatal asphyxia and neonatal encephalopathy Requiring mechanical ventilation or ECMO Requiring exchange transfusion for hyperbilirubinemia Congenital and neonatal infections (refer to separate category below) Exposure to ototoxic drugs (refer to separate category below)
Infections
Congenital infections	Examples include: CMV (most common infectious cause) Zika virus
CNS infections	Bacterial meningitis Encephalitis
Chronic or recurrent ear infections (AOM and OME)	AOM and OME are associated with conductive hearing loss
Ototoxic drug exposure	Examples include: Chemotherapy (eg, cisplatin) Aminoglycosides (particularly with chronic exposure) Loop diuretics (particularly when used in early infancy)
Head trauma	Particularly basal skull and temporal bone fractures
Syndromes associated with hearing loss*	Numerous genetic syndromes (well over 100) are associated with early hearing loss*
Craniofacial or ear malformations	Examples include: Cleft lip and/or palate Anomalies of temporal bone Congenital microcephaly Microtia or ear dysplasia
Chronic exposure to loud noises	Particularly if the exposure occurs over extended periods of time and at high volume

This table summarizes factors that are associated with increased risk of early hearing loss in infancy and childhood. Children with ≥1 of these risk factors generally warrant referral for formal audiologic assessment at least once in infancy or early childhood. For further details, refer to UpToDate's topic on screening and evaluation of hearing loss in children.

NICU: neonatal intensive care unit; ECMO: extracorporeal membrane oxygenation; CMV: cytomegalovirus; CNS: central nervous system; AOM: acute otitis media; OME: otitis media with effusion (also called serous otitis media).

* Refer to separate UpToDate content for a discussion of genetic causes of hearing loss.

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Risk factors for early childhood hearing loss