Coexisting Hearing Impairment in Children Presenting With Speech and Language Delay: A Case Series Highlighting the Importance of Routine Audiological Assessment.

Background: Speech and language delay is a common reason for referral to developmental pediatric services. Hearing impairment is an important and potentially manageable cause but may be overlooked because its clinical presentation often overlaps with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and other neurodevelopmental disorders. In Myanmar, where universal newborn hearing screening has not yet been routinely implemented, delayed recognition of hearing impairment remains an important clinical challenge. Case Presentation: We describe four children aged 5-7 years who were assessed at the Developmental Paediatrics Service of CLL HEALTH Community Paediatric Clinics, Yangon, Myanmar, after referral for speech delay, behavioral concerns, suspected ASD, attention difficulties, or school readiness assessment. Comprehensive developmental assessment together with formal audiological evaluation identified bilateral moderate sensorineural hearing loss in one child with language disorder, bilateral sensorineural hearing loss in a child with developmental coordination disorder and executive dysfunction, bilateral severe-to-profound hearing loss in a child initially suspected of having ADHD, and unilateral mild-to-moderate hearing loss in a child with ASD. None of the children had undergone newborn hearing screening. Hearing impairment either explained the presenting concerns or coexisted with neurodevelopmental disorders, contributing to communication, behavioral, and educational difficulties. Conclusion: This case series highlights the diagnostic challenges of recognizing hearing impairment in children presenting with developmental concerns in Myanmar, particularly in the absence of routine newborn hearing screening. Hearing impairment may mimic neurodevelopmental disorders, coexist with them, or contribute substantially to developmental difficulties. Routine audiological assessment should, therefore, be incorporated into the evaluation of all children presenting with speech and language delay or broader developmental concerns to facilitate timely diagnosis and appropriate multidisciplinary intervention.