| (1) Caregiver concern regarding hearing, speech, language, or developmental delay. |
| (2) Family history of permanent childhood hearing loss. |
| (3) Neonatal intensive care of more than 5 days or any of |
| the following regardless of length of stay: ECMO, assisted ventilation, |
| exposure to ototoxic medications (gentimycin and tobramycin) or loop |
| diuretics (furo-semide/Lasix), and hyperbilirubinemia that requires exchange |
| transfusion. |
| (4) In utero infections, such as CMV, herpes, rubella, syphilis, and |
| toxoplasmosis. |
| (5) Craniofacial anomalies, including those that involve the pinna, ear canal, |
| ear tags, ear pits, and temporal bone anomalies. |
| (6) Physical findings, such as white forelock, that are associated with a |
| syndrome known to include a sensorineural or permanent conductive hearing |
| loss. |
| (7) Syndromes associated with hearing loss or progressive or late-onset |
| hearing loss, such as neurofibro-matosis, osteopetrosis, and Usher syndrome; |
| other frequently identified syndromes include Waarden-burg, Alport, Pendred, |
| and Jervell and Lange-Nielson. |
| (8) Neurodegenerative disorders, such as Hunter syndrome, or sensory motor |
| neuropathies, such as Friedreich ataxia and Charcot-Marie-Tooth syndrome. |
| (9) Culture-positive postnatal infections associated with sensorineural hearing |
| loss, including confirmed bacterial and viral (especially herpes viruses and |
| varicella) meningitis. |
| (10) Head trauma, especially basal skull/temporal bone fracture that requires |
| hospitalization. |
| (11) Chemotherapy. |
