Updating Hearing Screening Practices in Early Childhood Settings

Abstract

Each day in the life of a young child with an undetected hearing loss is a day without full access to language. When hearing loss goes undetected, the resulting language deficits can become overwhelming obstacles to literacy, educational achievement, socialization, and school readiness. Several national programs such as Head Start, Early and Periodic Screening, Diagnostic and Treatment (EPSDT), and Part C of the Individuals with Disabilities Education Act have demonstrated a commitment to providing hearing screening for young children. These programs have typically had to rely on subjective hearing screening methods. Otoacoustic emissions (OAE) technology, used widely in hospital-based newborn screening programs, is beginning to be recognized as a more practical and effective alternative when screening children birth to three years of age. Effective use of OAE screening technology in early childhood settings is contingent upon consultation from an experienced pediatric audiologist, the selection of OAE equipment demonstrated to be effective for screening children between birth and three years of age, adherence to an appropriate screening and follow-up protocol, and access to training and followup technical assistance. When these elements are present, children with a wide range of hearing health conditions can be identified in a timely manner. Several national programs such as Head Start, Early and Periodic Screening, Diagnostic and Treatment (EPSDT), and Part C of the Individuals with Disabilities Education Act have demonstrated a commitment to providing hearing screening for young children. These programs have typically had to rely on subjective hearing screening methods including health-care provider reports indicating that ears were “checked,” observations of the child’s behavioral response to sound (such as hand clapping or bell ringing), parent perceptions of the child’s behavior, or prior documentation of newborn hearing screening outcomes (Munoz, 2003). Otoacoustic emissions (OAE) technology, used widely in hospital-based newborn screening programs and validated by professional organizations as an objective and reliable screening method (Joint Committee on Infant Hearing, 2000), is beginning to be recognized as a more practical and effective alternative when screening children birth to three years of age. How many infants and young children have a hearing loss? In the United States, approximately 1 out of every 300 children is born with a permanent hearing loss, making it the most common birth defect in the country (White, 1996). Advances in technology have now made it possible to screen newborns for hearing loss and over the past 10 years, the percentage of infants screened at birth has increased from 3% to over 90% (White, 2004). While universal in concept, however, approximately 10% of newborns do not receive a hearing screening and in some states 50% or more of the infants who do not pass newborn hearing screening are lost to follow-up before receiving the additional screening, diagnostic assessment, or early intervention services they need (Centers for Disease Control, 2005). In addition, not all hearing loss can be identified at birth because a child can lose his or her hearing at any point in early childhood. It is estimated that by school age, approximately 3 out of every 300 students have a permanent hearing loss (American Speech-Language-Hearing Association, 1993). Finally, it is estimated that 35% of preschoolers will have repeated episodes of ear infections, usually accompanied by a temporary hearing loss, that can also disrupt the language learning process (American Speech-Language-Hearing Association, 2004). Hence, early childhood hearing screening programs are critical for identifying a range of hearing-health conditions that can impede development for many children.