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AAP Grand Rounds 21:2 (2009)
© 2009 American Academy of Pediatrics

Ear Pits, Skin Tags, and Hearing Loss

Investigators from Chaim Sheba Medical Center and Tel-Aviv University in Israel retrospectively reviewed the medical records of infants born at the Chaim Sheba Medical Center and screened for hearing impairment from January 1, 1997 to July 1, 2004, to (1) compare the prevalence of hearing impairment (HI) in infants with and without preauricular skin tags and/or ear pits (PSEP) and (2) assess the effectiveness of transient-evoked otoacoustic emissions (TEOAE) as a hearing screening tool.

PICO Question: Are neonates with preauricular skin tags and pits at increased risk for hearing impairment? Question type: Prognosis Study design: Retrospective cross-sectional

 

The total population of children was divided into three groups: (1) low risk for HI; (2) high risk for HI; and (3) very high risk for HI.^1,2 Criteria for high risk included neonatal intensive care unit care for >48 hours, hyperbilirubinemia requiring exchange transfusion, in utero infection, and family members with sensory neural hearing loss. Criteria for very high risk included auricular deformities or associated syndromes (eg, Goldenhar).

Hearing was assessed in all infants using TEOAE. Infants at risk for HI, including those with PSEP, also had an auditory brainstem response (ABR) test within one month after discharge and audiological follow-ups until three years of age. Low risk infants who did not pass the initial TEOAE screening test were referred for ABR testing. Hearing impairment was defined as unilateral or bilateral sensory neural hearing loss or conductive or mixed hearing loss of >25 dB HL in the 500–4000 Hz frequency region based on ABR testing.³

Of the 68,484 infants born during the time period, 65,051 were categorized as low, 3,406 as high, and 39 as very high risk for HI, respectively. A total of 637 (0.93%) had PSEP. Overall, the prevalence of hearing impairment in infants with PSEP was significantly higher than in infants without tags and pits (0.8% vs 0.15%). Among infants with low risk of HI, the odds ratio (OR) for PSEP as a risk factor for HI was 6.7 (95% CI, 1.59-27.88). PSEP was also associated with a significantly increased risk for HI for infants in the high risk group (OR 4.1), but not for those in the very high risk group (OR 1.4; 95% CI, 0.11–18.0).

The authors conclude that infants with PSEP are at increased risk for permanent HI and that TEOAE was an effective hearing screening tool in the population studied.

Commentary by Donald Schiff, MD, FAAP

University of Colorado School of Medicine and The Children’s Hospital, Aurora, CO

 
Dr. Schiff has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Key Words: hearing impairment • ear pits • preauricular skin tags

Although it is accepted that major craniofacial anomalies are an important risk factor for HI, whether minor anomalies such as PSEP discovered at birth are significant risk factors is more controversial. Limited and conflicting data have previously been reported regarding the incidence of HI associated with isolated PSEP.^4,5 In this study, PSEP was associated with an increased risk of HI, although the increased risk was not as high as observed by other investigators.^4–6 However, the results of the study contradict other reports of no permanent HI in infants with isolated PSEP.^7,8 Much of the difference in the results of these studies may be related to the selection of the study population.

The association of PSEP with permanent HI identified in this study on a large, unselected population from Israel adds another observation made in the newborn nursery which can profoundly affect the course of a child’s life. Although only a minority of children born with PSEP have permanent HI, the early identification of HI enables pediatricians and families to work together to plan interventions for reducing the ill effects (eg, speech and language deficits, emotional and academic difficulties) of delayed diagnosis of hearing loss.

References

1. AAP Joint Committee on Infant Hearing. Pediatrics. 1995;95:152–156.[Abstract/Free Full Text]
2. Joint Committee on Infant Hearing. Am J Audiol. 2000;9:9–29.[Free Full Text]
3. Dalzell L, et al. Ear Hear. 2000;21:118–130.[CrossRef][Medline]
4. Kankkunen A, et al. Acta Paediatr Scand. 1987;76:143–146.[Medline]
5. Kugelman A, et al. Acta Paediatr. 1997;86:170–172.[Medline]
6. Hayes D. Otolaryngol Head Neck Surg. 1994;110:39–45.[CrossRef][Medline]
7. Firat Y, et al. Eur Arch Otorhinolaryngol. 2008;265:1057–1060.[Medline]
8. Francois M, et al. Audiology. 1995;34:1–5.[CrossRef][Medline]

This Article Extract Full Text (PDF) Take the CME quiz: Vol. 21 No. 1, January 2009 Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Schiff, D. Search for Related Content PubMed Articles by Schiff, D.