Audiology Clinical Resources

Care paths and practice guidelines

We have produced a series of flow diagrams called “care paths” that outline recommendations regarding the timing of testing and frequency of audiological monitoring for various populations. The available care paths are shown below.

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BC Early Hearing Program (BCEHP) referral

All infants born in BC are referred for audiological services following newborn hearing screening (NHS) if they have the following results:

• NHS fail, no risk factors (PDF)
• NHS fail, BCEHP risk factors (PDF)
• NHS pass, BCEHP risk factors (PDF)

Specialized audiological monitoring

This care path addresses the audiological follow-up for children with congenital cytomegalovirus (cCMV) in BC.

• Congenital CMV care path (PDF)

This care path addresses the audiological follow-up for children with meningitis in BC.

• Meningitis care path (PDF)

This care path addresses the audiological follow-up for children identified as having auditory neuropathy spectrum disorder (ANSD).

• Auditory neuropathy spectrum disorder (ANSD) care path (PDF)

Specialized BC Children's Hospital teams

BC Children's Hospital neonatal follow-up

The BC Children's Hospital Neonatal Follow-up (NFU) Program is a multidisciplinary team program that enrols families to participate in regular interdisciplinary team review and assessment. The program offers enrolment to families whose infants have certain perinatal/risk factors that place them at high risk of additional/complex needs or for whom little is known about potential outcomes. Patient recruitment criteria are available on their website.

• BC Children's Hospital Neonatal Follow-up Enrolment Information for PHA (PDF)

This care path addresses the typical audiological schedule for children followed by this program for which hearing assessment is recommended:

• BC Children's Hospital Neonatal Follow-up Care Path (PDF)

This care path addresses the typical audiological schedule for children followed by this program with a history of congenital diaphragmatic hernia (CDH) or those that have received extracorporeal membrane oxygenation (ECMO):

• BC Children's Hospital Neonatal Follow-up CDH/ECMO Care Path (PDF)

Cleft palate and craniofacial

There are many exceptions to this guideline. We review each child's case with the information we have at the time. If we have not ruled out hearing loss by the time of their team visit, we will book audiology as part of their visit.

We refer patients with cleft lip and/or cleft palate and some craniofacial anomalies to the team.

Many infants with cleft lip and/or palate receive nursing support early in life for feeding and other consultations.

Generally, babies with cleft palate receive a hearing screening through the BC Early Hearing Program, as well as a diagnostic hearing test prior to 3 months of age and again at around 9 months of age, prior to their cleft repair surgery.  

Many children with cleft palates have more episodes of middle ear fluid than children without clefts. For this reason many get ear tubes (myringotomy tubes) at the time of their palate repair and ENT follows them closely. 

The audiologist on the team works closely with public health audiology in the community to ensure we provide appropriate follow-up hearing testing in the early years.  

For more information, contact the cleft palate program nurse at 604-875-2345  local 7057 or visit the Cleft Palate Craniofacial Disorders Clinical Resources web page.

Care paths

This clinical guideline addresses audiology follow-up for children with cleft palate, craniofacial anomalies and syndromes associated with hearing loss.

• Cleft palate, craniofacial syndromic clinical practice guideline (PDF)

We have developed several specific care paths for various groups of children covered in this guideline.

• Cleft palate craniofacial syndromic abbreviated care path summary (PDF)
• Children with cleft palate care path (PDF)
• Children with Down syndrome care path (PDF)
• Children with syndromes and hearing loss - which care path to use? (PDF)

We have developed care paths for three groups of children with syndromes with varying degrees of known risk of late-onset permanent hearing loss.

• No risk care path (PDF)
• Lower risk care path (PDF)
• High risk care path (PDF)

Patient brochure

This brochure is for audiologists to provide to, and review with, families of children with a cleft palate. We suggest that they provide the brochure at the early diagnostic ABR visit and/or around the first behavioural assessment, not at the time of screening.

• Cleft palate and hearing patient handout (PDF)