DIAGNOSTIC DELAY IN CHILDREN WITH PROFOUN D HEARING IMPAIRMENT IN GERMANY

Objective: Early detection and adequate and timely rehabilitation of p rofound deafness in children is accepted as an important aim of preven tive child health care. Ideally, rehabilitation of congenital deafness should not be delayed beyond the age of six months. The present study seeks to determine whether this goal has been achieved in Germany in the 1990 s. Patients and methods: The medical charts of 314 profoundly hearing impaired pupils at the schools for the hearing impaired in Co logne, Germany, were reviewed. All available data on the time of first suspicion and the final diagnosis were collected. In addition, the fa milies of these children were interviewed using a standardized questio nnaire. Results: The mean age at first suspicion was 2.1 years, the me an age at the time of final diagnosis was 2.6 years (median: 2.0 years ). Breaking down the whole cohort into three subgroups according to th e year of birth revealed obvious differences between these subgroups. The final diagnosis for those born from 1974 to 1979 (n = 70) was conf irmed in 48.6% at the age of two years, in 46.3% for those born from 1 980 to 1985 (n = 121), and in 65.8% for those born from 1986 to 1991 ( n = 114) at the age of two. The diagnosis was significantly delayed fo r children of immigrants (n = 96), where the mean age at diagnosis was 3.7 years as opposed to 2.0 years for the native German population. O f the 314 children, 304 where supplied with hearing aids and five with cochlear implants. Once the audiological diagnosis had been establish ed, no further delay in rehabilitation was noticed. Conclusion: Althou gh highly sensitive, cost effective, and non-invasive screening method s (transient evoked otoacoustic emissions and auditory brainstem respo nse audiometry) for the early detection of profound inborn hearing imp airment are now available, the current state of early identification o f these disorders is inadequate. The reason for this is the lack of a universal and nationwide neonatal screening program. The results of th is study indicate that the pure availability of sophisticated screenin g methods is insufficient if they are not included in a universal scre ening program.