It has long been recognised that timely recognition of congenital hearing loss allows for the morbidity of hearing loss to be minimised. Due to the difficulties with identifying hearing loss in babies, combined with readily available screening technologies, many countries have adopted universal newborn hearing screening programmes. The Kingdom of Saudi Arabia is an interesting nation to study in this regard. Despite its high income, newborn hearing screening was, until recently, confined to the larger cities. In this study, over 1000 patients were retrospectively identified from audiology clinics in four hospitals in two cities. The hearing thresholds and demographics of these patients were studied. There are some aspects of the study that make interpretation difficult. The study was conducted in 2015, when there was a heterogenous pattern of newborn screening in the country. Indeed, three of the four hospitals included in this study have a newborn screening programme. Another issue complicating interpretation is the challenge of identifying those children with progressive hearing loss. Equally, identification of a post-natal hearing loss due, for example, to aminoglycoside toxicity or similar, can skew the mean age of identification of those children with a truly congenital hearing loss. This can be seen in the results, where the mean age of identification is 3.2 years, but the median age is just 2.5 years. Nevertheless, the age of identification appears to be higher than might be considered ideal. Not only can this compromise language acquisition and educational attainment, it makes management of these patients more difficult. For example, cochlear implant assessment of older children without a history of adequate amplification is much more complex than children under the age of one. That prior parental concern about the child’s hearing was associated with sensorineural loss highlights that accessibility of healthcare may be a factor, however the authors rightly emphasise universal newborn screening as the best way of addressing this issue. In 2016 such a programme was introduced, so we look forward to seeing a follow-up study to see if the age of identification has reduced as we would expect.

Age of identification of sensorineural hearing loss and characteristics of affected children: findings from two cross-sectional studies in Saudi Arabia.
Alkahtani R, Rowan D, Kattan N, Alwan NA.
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Robert Nash

BM BCh, MA(Oxon), MRCS, MA, DOHNS, FRCS (ORL-HNS), Great Ormond Street Hospital, London, UK.

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