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Detecting Hearing Loss in Infants and Young Children
Detecting Hearing Loss in Infants and Young Children
During the first 3 years of life, powerful developments in language and social skills begin to form the foundations of a child's interaction with the world. Undiscovered deafness or hearing loss can affect a child's development during this period and have lasting consequences. Unfortunately, hearing loss is not identified in many babies until years of crucial development have passed. These undiagnosed children underlie the call for universal hearing screening of newborns.
Congenital hearing loss affects 1 out of every 1,000 infants born in the United States each year. The new national health agenda, Healthy People 2010, however, notes recent research suggesting that the figure could be as high as 2 to 3 per 1,000. Estimates for the average age of diagnosis range between 14 months and 3 years. Since hearing loss of any kind can slow a child's development, detecting hearing impairment in the nursery is a necessity. Newborns with unidentified hearing loss miss the chance to receive early help that can minimize the effects of hearing loss on their linguistic and social development and later academic performance. The burdens of undetected hearing loss are not only difficult for the individual and the family, but also likely to be expensive. Considering this urgency, it is surprising to many people that 85 percent of all newborns are still not screened for hearing loss while in the hospital.
In 1993, the National Institutes of Health (NIH) held a consensus conference, sponsored by the National Institute on Deafness and Other Communication Disorders (NIDCD), on identifying hearing loss in infants and young children. In its consensus statement, the expert panel strongly recommended that all newborns be tested for hearing loss at birth or within the first 3 months of life. The report noted that the high cost of screening accounts for the limited availability of hearing tests. Previously, hospitals dealt with this issue by using high-risk criteria--such as low birth weight or known genetic risk--to assess and select newborns for screening. Testing every newborn who fell into the high-risk category, however, resulted in the early detection of hearing loss in only half of deaf children.
Two common screening techniques are used to test newborns. For the past 15 years, auditory brain response (ABR) testing, which examines the brain's electrical response to sound to determine whether the ear is functioning properly, was most often used. Technicians with a fairly high level of skill are needed to perform ABR testing.
Evoked otoacoustic emissions (EOAE) testing is also used. EOAE is based on monitoring sounds produced by the inner ear in response to stimulation. One advantage to EOAE testing is that it is quicker and easier for technicians to perform than ABR. States are effectively using one or both of these methods in newborn hearing screening programs.
Researchers continue to pursue enhanced testing options, since a hearing deficit can have a major impact on a child's life. More information is also needed about interventions for all levels of hearing loss: mild, moderate, and severe, as well as for late-onset hearing loss.
Recent research suggests that children who receive language intervention before they are 6 months old develop significantly better language skills than those for whom help is delayed. In light of these findings, the call for universal hearing screening for newborns continues to grow. Findings of the NIH consensus panel, as well as those from more recent studies, have sparked new efforts by some States to screen more infants. Recently, Representative James T. Walsh (R-NY) introduced language on hearing screening and intervention in newborns and infants that was incorporated into the conference report accompanying the Fiscal Year 2000 Labor, Health and Human Services, and Education Appropriations Bill. The legislation provides new funding to screen newborns and infants and authorizes grants to States to establish screening programs.
This legislation also encourages NIDCD to continue to study the efficacy of new screening techniques and technology, as well as the efficacy of intervention and related basic and applied research; the Health Resources and Services Administration (HRSA) to develop statewide early detection, diagnosis, and intervention programs and services; and the Centers for Disease Control and Prevention (CDC) to provide technical assistance to State agencies to complement an intramural program and to conduct applied research related to newborn and infant hearing detection, diagnosis, and intervention.
As awareness and community efforts continue, Healthy People 2010's goal of universal screening may yet be realized. Reaching that goal will ultimately mean that early intervention in children with all degrees of hearing loss will become more prevalent. As the average age of diagnosis drops, fewer families will miss the chance to make language-learning choices that can maximize their baby's crucial early years of development and future opportunities.
For more information on this important topic, contact the NIDCD Information Clearinghouse for free publications on the early identification of hearing loss in children.