Diagnostic Approach and Management of Unilateral Sensorineural Hearing Loss in Children

Diagnostic Evaluation

The American Academy of Pediatrics recommends genetic evaluation should be offered to all children with confirmed sensorineural hearing loss 1
Comprehensive audiologic evaluation by a pediatric audiologist is mandatory and should include air-conduction and bone-conduction pure tone thresholds, speech reception thresholds, and word recognition testing 2, 3
At age 6, conventional audiometry is appropriate using a fail criterion of >20 dB HL at one or more frequencies (500, 1000, 2000, 4000 Hz) 2, 3
Ear-specific testing with insert earphones is essential to accurately characterize unilateral hearing loss 2, 4
ABR testing should be performed to confirm sensorineural hearing loss and rule out auditory neuropathy/dyssynchrony, particularly if behavioral audiometry results are inconsistent 5, 3

The American Academy of Pediatrics recommends hearing aid fitting should occur within 1 month of confirmed hearing loss diagnosis if the family chooses amplification 1, 6
Children with unilateral hearing loss are at risk for speech and language delays and academic difficulties 6
All children with unilateral sensorineural hearing loss should be considered eligible for early intervention services, as approximately one-third experience significant language and academic delays 6
Services should be provided by professionals with expertise in hearing loss, including educators of the deaf, speech-language pathologists, and audiologists 1
Regular audiological reevaluations at 6-month intervals are essential to monitor for progression or changes in hearing function, although this specific recommendation is from Praxis Medical Insights, a similar recommendation is made by the American Academy of Pediatrics 6
Developmental monitoring should occur at regular intervals using norm-referenced instruments 6