The reasons that pediatricians did not refer or recheck children who failed the initial screening were not obtained in the Archives of Pediatric and Adolescent Medicine study, either prospectively or retrospectively, in an effort to avoid altering the physicians’ plan of action. However, in the Otolaryngology–Head and Neck Surgery article, the primary reasons for delay in diagnosis, from the parents’ perspectives, included:
Explore This IssueSeptember 2009
- Difficulty in obtaining an appointment for additional testing.
- Delay from trying to obtain a referral from the primary care physician.
- Multiple screening or diagnostic tests.
- Poor medical advice.
This study indicates that parents feel at somewhat of a loss as to how to best proceed in being an advocate for their child regarding hearing screening. They identified a need for early counseling of families early in the screening process and a greater emphasis on primary care involvement and education.
The Otolaryngologist’s Role
Albert H. Park, MD, of the University of Utah School of Medicine, Division of Otolaryngology–Head and Neck Surgery, and primary author of the Otolaryngology–Head and Neck Surgery study, feels that otolaryngologists should be more involved in pediatric hearing screening earlier on in the process. He stresses that a failed screening does not necessarily indicate a hearing loss. The most common reason for initial failure of a screening is middle ear fluid, according to Dr. Park. He says that an otolaryngologist is best equipped with the necessary training and expertise necessary to differentiate between a failed screening due to middle ear fluid—or excessive wax buildup—rather than actual hearing loss. Dr. Park states, “Children with middle ear fluid often undergo multiple screening tests, a big cost for all of us to have to incur. Often, if we can medically or surgically treat that fluid, the loss may resolve. Otolaryngologists are in the best position to pick up on that and render the appropriate treatment.”
Medical Staff and Parental Education
With 14% of parents reporting that they were not aware that their child had failed initial screening, and 15% reporting they received no information regarding follow-up, the parental survey published in Otolaryngology–Head and Neck Surgery clearly indicates that there is a need for better education of hospital personnel and primary care physicians and staff regarding the implications of a failed hearing screening and appropriate follow-up.
Dr. Park advocates a multidisciplinary approach, including social workers and individuals familiar with resources available to families, both with regard to testing and with financial options for those children requiring interventions. He states that it is very important that the primary care physician or pediatrician maintain an active role in the screening and treatment of hearing loss, providing the recommended “medical home.” This team approach can help better equip parents with the knowledge and direction to be effective advocates for their children.