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Pediatric points: hearing loss in children.

Two to three out of every 1,000 children in the United States are born with some degree of hearing loss. For this reason, all states now routinely screen newborns' hearing before they leave the hospital or birthing center. Certain risk factors increase a baby's chances of being deaf or hearing impaired. Significant jaundice and certain antibiotics can affect a child's hearing. A family history of deafness also puts a baby at risk.

Even after newborns have passed their hearing screens, we (pediatricians and parents alike) must remain vigilant because in addition to congenital deafness, children can also acquire hearing loss at any point during childhood. Again, certain medications, such as some chemotherapy agents, are well known to damage hearing. In addition, illness or injury can also have deleterious effects on hearing. This results in an additional one to three children per 1,000 being picked up beyond those identified at birth. In addition to universal hearing screening of all newborns, the American Academy of Pediatrics also recommends subjective screening of children up to the age of four years when most children can reliably respond to pure-tone audiometry.

In caring for our children's aural health, it is important to be mindful of the noise levels to which our kids can be exposed. Traditionally, it has been adults who are at risk for this kind of hearing loss due to exposure to noise in war zones or in occupational settings. But with increasingly more children listening to music through headphones or ear buds, concern has been growing regarding what this kind of exposure is doing to our children's hearing.

Exposure to loud music through personal electronic devices is increasing. In a recent study out of Harvard Medical School, Harvard School of Public Health and the Massachusetts Eye and Ear Infirmary, the prevalence of loud headphone music exposure increased from 19.8% in the late 1980s and early 1990s to 34.8% in the mid-2000s. And although the incidence of hearing loss did increase slightly during that time frame, the results are not statistically significant.

What did increase was one specific kind of hearing loss called noise-induced threshold shifts, or NITS, in female youth. NITS for females reached levels seen previously only in boys. The reason may be that girls are going to concerts and listening to music on personal devices at the same rates as their male peers, although the Harvard study didn't have enough information on those specific behaviors to draw firm conclusions.

Still, caution may be the word here. It may turn out to be that the effects from exposure to noise are cumulative and may only become apparent later in one's twenties or even later. Also, studies in other countries have come to different conclusions about noise and hearing. In France, adolescents who attended two or more rock concerts a month had an increase in average hearing thresholds than controls.

The bottom line for me after reading these studies is to make kids and parents aware of the potential danger of loud music exposure. But, it may be hard to define how loud is too loud. Dr. Brian Fligor, an audiologist and Director of Diagnostic Audiology at Children's Hospital Boston says, "Your typical listener is not at risk if [they are] listening in a quiet situation, but if [they are] in a noisier situation, such as commuting, [they] very easily [are] going to be at risk." Therefore, selecting devices that block out background noise can be helpful.

Robert Beiny, Vice Chair or the Association of Independent Hearing Health Care Professionals in Europe uses a "rule of 60s" when it comes to regulating music. His advice is to keep volume at 60% of maximum and limit listening to only 60 minutes.

Sounds good to me.

Carolyn Roy-Bornstein is a pediatrician in private practice. She has been interviewed on radio and television about the new concussion guidelines for student athletes. Her memoir Crash: A Mother, a Son, and the Journey from Grief to Gratitude explores her own family's experience with her son's traumatic brain injury at the hands of a drunk driver. Read more at her web site

By Carolyn Roy-Bornstein, MD
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Author:Roy-Bornstein, Carolyn
Publication:Pediatrics for Parents
Geographic Code:1USA
Date:Jan 1, 2013
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