Clinical Case · Trainee

A passed screen, a later concern

Vignette

A 14-month-old who passed the newborn screen is brought because speech is not developing as expected. The child was known to have congenital cytomegalovirus infection.

Audiogram

-10020406080100120500 Hz1k Hz2k Hz4k HzHearing level (dB HL)
O Right earX Left ear
Estimated thresholds by ear. O = right, X = left.

Test findings

VRA with inserts shows a bilateral sloping moderate-to-severe loss, worse than would be expected for a child who passed the newborn screen. Tympanograms are normal.

Diagnostic question

How is a normal newborn screen reconciled with this result?