Most common co-morbidities of congenital hearing impairment
Clinically, when we see a child with congenital hearing impairment, we should almost automatically think — “What else should I actively look for?”
Here are the 5 most common co-morbidities you’ll encounter in practice:
1️⃣ Speech and Language Delay
This is the most universal and predictable co-morbidity.
Expressive language delay
Receptive language difficulties
Articulation disorders
Even mild bilateral loss can significantly affect phonological development if not identified early.
Early amplification + auditory-verbal therapy changes the trajectory dramatically.
2️⃣ Developmental Delay (Global or Specific)
Especially in syndromic cases or children with:
Congenital infections
Hypoxic injury
Genetic syndromes
Motor delay may coexist, particularly in children with vestibular dysfunction (inner ear involvement).
3️⃣ Visual Problems
Very important and often under-screened.
Refractive errors
Retinitis pigmentosa (e.g., in Usher syndrome)
Structural eye anomalies
Because hearing-impaired children rely heavily on visual input, even minor visual defects become functionally significant.
4️⃣ Cardiac Anomalies
Seen in syndromic conditions like:
Jervell and Lange-Nielsen syndrome (long QT + deafness)
CHARGE syndrome
Down syndrome
An ECG is not a luxury in bilateral congenital SNHL — it’s prudent.
5️⃣ Thyroid and Metabolic Disorders
Particularly:
Pendred syndrome (hearing loss + thyroid dysfunction)
Iodine metabolism defects
Some inborn errors of metabolism
Thyroid screening is often overlooked in rural setups.
Bonus (Very Common in NICU Graduates)
Cerebral palsy
Autism spectrum disorder
Learning disorders
Not rare in children with risk factors like prematurity, hyperbilirubinemia, or perinatal asphyxia.
A Practical Pediatric Take-Home
When you diagnose congenital hearing impairment, think in 3 directions simultaneously:
- Brain 2. Eyes 3. Heart
And always ask: Is this isolated, or syndromic?
SCREENING CHECKLIST
For Special Teachers in Hearing-Impaired Schools
श्रवणदोष असलेल्या मुलांच्या शाळेतील विशेष शिक्षकांसाठी तपासणी यादी
(If repeatedly observed, inform parents and advise medical review.)
(वारंवार दिसल्यास पालकांना कळवा व वैद्यकीय तपासणी सुचवा.)
1) VISION CONCERNS | दृष्टीसंबंधी अडचणी
- Squinting or sitting very close to board
फळ्याजवळ बसणे किंवा डोळे बारीक करून पाहणे - Frequent eye rubbing
वारंवार डोळे चोळणे - Difficulty copying from board
फळ्यावरून उतरवताना अडचण - Poor night vision
संध्याकाळी / कमी प्रकाशात नीट न दिसणे - Bumping into objects
वस्तूंना धडकणे
2) SPEECH & COMMUNICATION | भाषा व संवाद
- No improvement despite hearing aid / cochlear implant
श्रवणयंत्र / कॉक्लिअर इम्प्लांटनंतरही प्रगती न होणे - Regression in speech
आधी येणारे शब्द कमी होणे - Poor lip-reading ability
ओठ वाचण्यात अडचण - Limited vocabulary for age
वयानुसार शब्दसंग्रह कमी असणे
3) DEVELOPMENT & LEARNING | विकास व शिक्षण
- Difficulty understanding simple instructions
सोप्या सूचना समजण्यात अडचण - Poor attention span
लक्ष कमी वेळ टिकणे - Very slow academic progress compared to peers
इतर मुलांच्या तुलनेत खूप कमी शैक्षणिक प्रगती - Hyperactivity or repetitive behaviours
अतिचंचलपणा किंवा सारखीच कृती पुन्हा पुन्हा करणे
4) BALANCE & MOTOR SKILLS | समतोल व हालचाल कौशल्य
- Frequent falls
वारंवार पडणे - Poor coordination
हालचालीत समन्वय कमी असणे - Avoids playground activities
खेळांपासून दूर राहणे - Delayed fine motor skills (writing, buttoning)
बारीक हालचाली उशिरा येणे (लेखन, बटण लावणे)
5) CARDIAC WARNING SIGNS | हृदयासंबंधी लक्षणे
- Unexplained fainting episodes
कारण नसताना बेशुद्ध पडणे - Sudden dizziness
अचानक चक्कर येणे - Family history of sudden death
कुटुंबात अचानक मृत्यूचा इतिहास
6) GROWTH & THYROID CONCERNS | वाढ व थायरॉईड संदर्भातील अडचणी
- Poor growth
अपेक्षेपेक्षा वाढ कमी असणे - Swelling in neck
मानेजवळ सूज दिसणे - Persistent lethargy
सतत थकवा / सुस्ती
URGENT REFERRAL NEEDED | तात्काळ डॉक्टरांकडे पाठवा
- Sudden change in behaviour
वर्तनात अचानक बदल - Loss of previously acquired skills
आधी आलेली कौशल्ये कमी होणे - Repeated fainting , unconciousness
वारंवार चक्कर येणे, बेशुद्ध पडणे - Sudden reduction in hearing response
ऐकण्याची प्रतिक्रिया अचानक कमी होणे
Note for Teachers:
If something feels unusual for this child, trust your observation and inform parents and authorities.
शिक्षकांसाठी सूचना:
मुलामध्ये काही वेगळे किंवा असामान्य वाटल्यास, आपल्या निरीक्षणावर विश्वास ठेवा आणि पालकांना व वरिष्ठाना कळवा.
– विद्यावाचस्पति डॉ. अनिल मोकाशी (बालरोगतज्ञ)
एमबीबीएस, एमडी, डीसीएच, एफआयएपी,
पीएचडी (मुलांची वाढ व विकास)
