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The identification, assessment, and management of hearing impairment in the pediatric population can be a challenging endeavor. Nevertheless, newer technology, improved techniques, and the cooperative efforts of various professional organizations and their constituencies have made significant strides toward achieving this goal. As more precise objective technologies are introduced, there will be a tendency to rely more heavily on their application. Both IA and OAEs have already made significant impact in pediatric practices because of their ease and simplicity. Within a short period of time, trained technical staff can become proficient in their usage and test interpretation. Their application in conjunction with basic audiometry can provide a global picture of auditory status (Table 2). However, it is critical to recall that the basic building block of auditory assessment is the audiogram, a true measure of behavioral threshold sensitivity. Therefore, when test results suggest hearing impairment, appropriate audiological referral to the will ensure continuity of services and provision of rehabilitative measures. It is equally essential for primary care providers to understand the therapeutic needs of their patients and to manage and coordinate the medical aspects of the infant or child when hearing loss is suspected.

When sedation, prematurity or other disease processes mask symptoms in the clinically ill newborn, serum bilirubin concentration is monitored as the sole indicator of kernicterus risk. This case emphasizes the value of auditory brainstem responses for the management of indirect hyperbilirubinemia complicated by prematurity, hemolytic anemia, asphyxia, and direct hyperbilirubinemia.

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