Hearing Loss and Preauricular Tags and Pits
ABSTRACT & COMMENTARY
Synopsis: Newborns with preauricular pits or tags may have conductive/sensorineural hearing impairment.
Source: Kugelman A, et al. Preauricular tags and pits in the newborn. Acta Paedriatr 1997;86:170-172.
Kugelman et al from haifa, israel, examined 4507 newborn infants and found that 26 (5.7/1000 live births) had preauricular tags or pits. They were assessed for hearing impairment with behavioral audomity on day three and brainstem-evoked response audiometry (BERA) at 4 months of age. Behavioral audiometry was abnormal in 7/20 (27%), and BERA was abnormal in 4/23 (17%) of these infants and revealed conductive and/or sensorineural hearing impairment. The incidence of hearing impairment in infants with isolated preauricular tags or pits was significantly higher than reported incidences in normal children.
The authors found 24 newborn infants with preauricular tags and two with bilateral preauricular pits. Seven of the 24 infants with tags had a positive family history of tags. Seven of the infants had abnormal behavioral audiometry tests, and BERA was abnormal in five of them. The authors conclude that the 17% incidence of conductive and/or sensorineural hearing impairment in children with preauricular pits or tags is more than 20 times greater than in other children. This emphasizes the importance of testing such children early so that intervention can be initiated to try to mitigate the consequences of hearing loss on development and communication.
COMMENT BY RICHARD EHRENRKANZ, MD
Testing for hearing loss in young infants has been a subject of great interest. In 1994, the Joint Committee on Infant Hearinga consortium of a number of interested organizationsissued a position statement that recommended "universal detection of infants with hearing loss as early as possible," a goal that could only be realized by universal neonatal screening. The Committee recommended the use of the physiologic testing measuresauditory brainstem response and otacoustic emissions rather than behavioral audiometry. Recognizing that universal testing was a goal that would not be attained in the foreseeable future because of cost and logistic concerns, the committee listed a number of clinical indicators that may be associated with an increased risk of hearing loss. These included "craniofacial anomalies, including those with morphological abnormalities of the pinna and ear canal." Preauricular tags and pits were not mentioned.
Preauricular tags and pits occur in 5-10/1000 newborns. Pits are dominantly transmitted defects, while tags are believed to be sporadic. Although hearing impairment has been previously reported in these children, this is the first assessment of its exact prevalence. Most of us have merely considered pedunculated tags as a cosmetic nuisance and ligated them with assurance. This report indicates that we should also seriously consider early testing for hearing.
References
1. Joint Committee on Infant Hearing, 1994. Position Statement. Pediatrics 1995;95:152-156.
2. Eklund H, et al. Major and minor malformations in newborns and infants up to one year of age. Acta Pediatric 1970;59:297-301.
3. Kankamer A, Thiringu K. Hearing loss in connection with preauricular tags. Acta Paediatr 1987;76:143-146.
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