Early Hearing Detection And Intervention Research Articles

An Early Hearing Detection and Intervention Program in Songklanagarind Hospital

Objective: To compare the results of the universal newborn hearing screening program in Songklanagarind Hospital with the Joint Committee of Infant Hearing (JCIH) recommendations in regards to early hearing detection and intervention.Material and Methods: We retrospectively reviewed the Early Hearing Detection and Intervention (EHDI) program results between January 2017 and June 2017. Furthermore, we calculated and compared the percentages of hearing screening, diagnostic evaluation, and rehabilitation at 1, 3, and 6 months of age.Results: A total of 1,579 (93.1%) newborns were screened for otoacoustic emissions (OAEs). One hundred and eight (6.8%) newborns showed abnormal OAE in the first phase, and 11 (0.7%) newborns failed the OAE retest before discharge and within 1 month of age. Ten newborns (90.9%) had a hearing loss diagnosis confirmed due to a complete audiologic evaluation before 3 months of age, and 100.0% of newborns with abnormal hearing were enrolled for intervention within 6 months of age. Among the 4 newborns with abnormal hearing, 3 of them had conductive hearing loss, and one had profound sensorineural hearing loss, receiving an intervention via cochlear implant. Following intervention, all newborns with hearing loss had improved their hearing ability, speech and language development.Conclusion: The universal newborn hearing-screening program is the first step in identifying a child with hearing problems, which leads into early intervention. The key to achieve best outcomes for the newborns is to ensure family support and the involvement of an interdisciplinary team.

Analysis of barriers and facilitators to early hearing detection and intervention in KwaZulu-Natal, South Africa.

BackgroundThere is slow progress in early hearing detection and intervention (EHDI) services within South Africa. Audiologists are EHDI gatekeepers and can provide valuable insights into the barriers and facilitators that can progressively move EHDI towards best practice in South Africa.ObjectivesThe study aimed to determine the barriers and facilitators to EHDI in KwaZulu-Natal as reported by audiologists/speech therapists and audiologists (A/STAs).MethodA descriptive qualitative approach was used. Telephonic interviews were conducted with 12 A/STAs working in public and private healthcare facilities, using the strengths, weaknesses, opportunities, threats (SWOT) conceptual framework. Data was analysed using thematic analysis in conjunction with NVivo software.ResultsOne of the main barriers perceived by A/STAs, affecting EHDI was the lack of resources in healthcare facilities. The participants indicated that although there was a guideline in place to guide practice, it may be more suited to an urban area versus a rural area. Poor knowledge and awareness of EHDI was also identified as a barrier. Information provided from A/STAs at grassroots level, in the various provinces, may benefit in developing a more contextually relevant and practical guideline. Facilitators included; development of task teams specifically for EHDI programmes, creation of improved communication networks for collaboration and communication, training of healthcare professionals and improving data management systems.ConclusionStrategies such as an increase in resources, further education and training, development of contextually relevant, culturally, and linguistically diverse practices and protocols need to be in place to improve EHDI implementation. Further research, clinical implications and limitations are provided emanating from the study.

Assessing Impact of COVID-19 Pandemic on Receipt and Timeliness of Newborn Hearing Screening and Diagnostic Services Among Infants Born in Four States.

The study compares receipt and timeliness of newborn hearing screening and follow-up diagnostic services between the pre-pandemic birth cohort and the pandemic birth cohort in four participating states. Findings from this study will help inform state Early Hearing Detection and Intervention (EHDI) programs in the future should a major public health event occur again.

Likely Impact of the COVID-19 Pandemic on Newborn Hearing Screening and Follow-up Services in the United States in 2020.

This perspective aims to highlight aspects of the Early Hearing Detection and Intervention (EHDI) newborn hearing screening and follow-up processes that were impacted by the COVID-19 pandemic and considers factors that likely impacted follow-up after failing newborn hearing screening among infants born in the United States during 2020. Efforts to minimize the potential impact of missed or delayed identification of hearing loss in infants and young children will also be discussed to help guide future program improvement activities.

School readiness and academic achievement of children with hearing impairment: A South African exploratory study

Background: Children with hearing impairment may be at risk of not achieving the necessary school readiness because of the link between hearing impairment and academic achievement. However, early hearing detection and intervention (EHDI) can improve potential outcomes for these children.Aim: As part of a bigger study titled ‘Communication and school readiness abilities of hearing-impaired preschool graduates: Exploring outcomes of early intervention preschool programs in Gauteng’, the aim of this study was to describe the school readiness and academic achievement of children with hearing impairment through retrospective record reviews of EHDI preschool records and Grade 3 teachers’ survey.Setting: The study was conducted in Gauteng, South Africa, where two EHDI preschool centres participated in the study.Methods: Eight children identified with hearing impairment and enrolled in EHDI preschools were included in the study, along with their Grade 3 teachers. Data collection was conducted through a self-developed teacher questionnaire and record reviews of the children’s preschool files. Data were analysed using descriptive statistics.Results: Three children (n = 8) obtained age-appropriate school readiness results and were subsequently enrolled in mainstream schools. Five children (n = 8) did not exhibit age-appropriate school readiness and were subsequently enrolled in remedial schools and schools for Learners with Special Education Needs (LSEN).Conclusion: These preliminary findings demonstrate that through EHDI, children with hearing impairment are allowed to develop the school readiness required to experience academic success. Factors influencing outcomes within the South African context need to be explored in order for South Africa to benefit maximally from EHDI initiatives.

Early Hearing Detection and Intervention for Children with Craniofacial Anomalies

Early Hearing Detection and Intervention for Children with Craniofacial Anomalies

Knowledge, attitude and management of hearing screening in children among family physicians in the Kingdom of Saudi Arabia.

Early detection and management of hearing loss are important to develop ordinary speaking language and academic skills during childhood. Lack of knowledge by either parents or health care providers could hinder the process of hearing loss diagnosis, such that the intervention will be less effective. There is little evidence about the knowledge and practice of family physicians regarding hearing screening in Saudi Arabia and worldwide. This study aimed to assess family physicians' knowledge, attitudes, and practices related to hearing loss in children. This in turn will help policy makers and educational institutions to establish and promote a program concerned with screening, diagnosis and intervention of paediatric hearing loss. A cross-sectional descriptive study enrolled 133 family physicians working at primary health centres in Saudi Arabia from March 2020 to September 2020. A self-reported questionnaire was used to assess the knowledge, attitudes, and practices of family physicians concerning hearing loss in children. The majority of the participants were working under the umbrella of the Ministry of Health and around half of them did not screen any child for hearing loss. Despite that, 91.7% indicated the importance of neonatal hearing screening, 70.7% indicate infant candidacy for cochlear implant and only 33.1% know about the existence of the early hearing detection and intervention (EHDI) governmental program in kingdom of Saudi Arabia (KSA). Participants were able to identify factors associated with hearing loss such as a family history of hearing loss (85.6%), meningitis (75%) and craniofacial anomalies (51.5%). The most frequent specialists for patient referrals were ear nose and throat ENT (75.2%) and audiologists (67.7%). This study shows that family physicians have good general background about the benefits of EHDI programs and the management of hearing loss in the paediatric population. However, it also indicated insufficient knowledge in other domains of hearing loss, including assessments and the presence of the EHDI governmental program in KSA. Further actions on the involvement of family physicians in the process of neonatal hearing screening, diagnosis and intervention for hearing impairment are needed.

Expanding the Role of Educational Audiologists After a Failed Newborn Hearing Screening: A Quality Improvement Study.

Purpose Lack of timely and proximal access to diagnostic hearing evaluation using auditory brainstem response (ABR) testing hampers the effectiveness of Early Hearing Detection and Intervention (EHDI) programs in the United States. This study measured the impact of a state-based quality-improvement (QI) project that provided diagnostic ABR equipment and training to educational audiologists distributed throughout Iowa in regional special education centers. Method We used de-identified administrative data generated by the state EHDI program to analyze markers of access to early hearing health care for infants in a preproject condition ("Baseline") compared to the implementation of diagnostic ABRs at the regional special education centers ("QI Project"). Results Our findings revealed that the QI Project was associated with improvements in timeliness of first hearing evaluation, distance traveled for first hearing evaluation, and likelihood of receiving on-guideline audiology care during the first hearing evaluation. Conclusions Following the onset of the QI Project, infants and their families had greater access to initial hearing evaluation after failed newborn hearing screening. This improvement could have cascading effects on timeliness of later intervention among those with confirmed permanent childhood hearing loss.

Caregiver Navigation Through Early Hearing Detection and Intervention Programs in South Africa

This research study aimed to explore the experiences of caregivers of children through the early hearing detection and intervention (EHDI) process in the public health care sector in South Africa. A qualitative research design was employed. Semistructured interviews were conducted with 8 caregivers from 3 different levels of service delivery in the public health care sector who had children aged 5 months and 3 years. Data were analyzed using inductive thematic analysis, which resulted in 6 interrelated themes. Most participants reported a positive experience in terms of service provision with professionals. Accessibility to services and long waiting periods, however, remain challenges within the EHDI process. Continuity of care and care coordination was found to need attention in South Africa, particularly for high-risk infants who require ongoing follow-up.

Impact of Meeting Early Hearing Detection and Intervention Benchmarks on Spoken Language.

This study compared preschool spoken language outcomes for children with hearing loss who met Early Hearing Detection and Intervention (EHDI) guidelines to those who did not, as well as to compare outcomes for those who met current EHDI guidelines to those who met earlier benchmarks. Finally, the predictive role of meeting each component of the guidelines was evaluated relative to language outcomes. Children who met the EHDI guidelines had higher language scores than those who did not; however, there was no difference between children who met the current guidelines and those who met the earlier benchmarks. Entering early intervention by six months of age was the only unique predictor of spoken language outcomes. The findings suggest that EHDI programs should target increasing the number of children with hearing loss who meet the current 1-3-6 benchmarks with a particular focus on enrollment in early intervention by six months.

Applying Next Generation Sequencing to an Early Detection of Hearing Loss Program 1 Clínica Universidad de Navarra 2 Unidad de Tumores Sólidos y Enfermedades Hereditarias CIMALAB, Diagnostics – Universidad de Navarra Diagnostics – Universidad de Navarra Manrique M1 , Patiño-García A1,2, Prieto-Matos C1 , Manrique-Huarte R1 , Calavi

Current early hearing detection and intervention (EHDI) programs for children indicate that the diagnosis and treatment must be carried out within the first six months of life. Genetic testing can identify the causal variant of the hereditary hearing loss and is very useful for that. Implementing this testing would enable personalized medicine, avoiding other more costly and time consuming tests, and the negative effect of treating a child outside of the period of greatest hearing sensitivity. Genetic tools are not part of EHDI programs. These programs are based on testing hearing. If genetic tools are used, the most likely gene is selected and analyzed via Sanger sequencing. The latest next-generation sequencing (NGS) can be applied to EHDI programs. From 100 to 200 genes associated to hearing loss can be analyzed through NGS in one blood sample or saliva set, bringing down the cost of analysis and enabling the causal diagnosis of hearing loss in a short time span. This paper reviews the current state of early hearing detection and intervention programs in children, discusses the next generation gene sequencing tools applied to hearing loss in children, presents potential approaches to the EHDI programs and analyzes the key issues to personalize the treatment of hearing loss

Performance and characteristics of the Newborn Hearing Screening Program in Campania region (Italy) between 2013 and 2019

PurposeUniversal newborn hearing screening (UNHS) in the first month of life is crucial for facilitating both early hearing detection and intervention (EHDI) of significant permanent hearing impairment (PHI). In Campania region, UNHS has been introduced in 2003 by the Regional Council Resolution and started on January 2007. The aim of this paper is to update a previous article describing the performance of the program since its implementation in the period between 2013 and 2019.MethodsA longitudinal retrospective study was carried at the Regional Reference Center III on 350,178 babies born in the analysis period. The paper reports the main results of overall coverage, referral rate, lost-to-follow-up rate,yield for PHI and shall determine various risk factor associations with hearing impairmentResultsIn Campania region, 318,878 newborns were enrolled at I level, with a coverage rate of 91.06%, 301,818 (86.18%) Well Infant Nurseries (WIN) and 17,060 (5.35%) Neonatal Intensive Care Unit (NICU) babies. PHI was identified in 413 children, 288 (69.73%) bilaterally and 125 (30.26%) unilaterally. The overall cumulative incidence rate of PHI was 1.29 per 1000 live-born infants (95% CI 1.17–1.42) with a quite steady tendency during the whole study period.ConclusionsThis study confirms the feasibility and effectiveness of UNHS in Campania region also in a setting with major socioeconomic and health organization restrictions.The program meets quality benchmarks to evaluate the progress of UNHS. Nowadays, it is possible to achieve an early diagnosis of all types of HL avoiding the consequences of hearing deprivation.

Audiologist Perception on Reporting Hearing Assessment Results to State Early Hearing Detection and Intervention Programs.

To describe an evaluation conducted by 39 state Early Hearing Detection and Intervention (EHDI) programs on the reporting process and system usability for audiologists when reporting the hearing test results to the EHDI program and the barriers encountered during reporting. Each author independently extracted numbers, percentages, and texts from the evaluation reports into an Excel spreadsheet, which then became the dataset. Authors then compared and cross-checked the datasets before coding. Texts conveying similar concepts were coded with the same name and organized into categories. Finally, thematic identification and analysis were performed when a theme(s) or concept(s) that pertained to similar challenges encountered by audiologists was identified and organized under a higher-order domain. Some audiologists reported no barriers when reporting hearing test results to the state EHDI programs. Among those audiologists who reported barriers, the most recurrent barrier was a non-user-friendly data system design. The second most recurrent barrier was not having adequate administrative time to report data as a busy clinician. The third most recurrent barrier was an incomplete understanding of the state EHDI reporting requirements. Finally, the method audiologists were required to use when reporting results also posed some challenges, such as no internet connection in rural areas when required to report via an internet portal. Because of the wide variety of barriers faced by audiologists, multiple strategies to improve the reporting process would likely be beneficial.

What are the current practices employed by audiologists in early hearing detection and intervention in the South African healthcare context?

BackgroundUniversal access to early hearing detection and intervention (EHDI) forms part of the audiology community's goal. Evidence on current practices employed by South African audiologists in EHDI in order to ensure this universal access and success for children with hearing impairment is therefore required, hence this study. MethodsA quantitative survey research methodology with a cross-sectional design was employed. An online survey was completed by 49 qualified audiologists and dually qualified speech therapists and audiologists. Data were analysed using descriptive statistics. ResultsResults identified gaps in the implementation of EHDI within the South African context. A total of 83.7% of the participants were involved in newborn hearing screening (NHS), with over half adopting the targeted screening approach instead of universal NHS services (UNHS). Capacity versus Demand challenges play a significant role in the lack of successful implementation of NHS with over 60% of the audiologists in the sample reporting that NHS is and should only be conducted by audiologists only; with minimal evidence of task shifting found. No standardised screening protocol was found, with challenges around budget allocation for EHDI revealed. ConclusionsAlthough progress has been noted, a) gaps between public and private healthcare sector resources allocations and availability, b) limited contextually responsive strategic planning, as well as c) lack of translation of knowledge, policies and guidelines into practice, are glaring areas that require attention by the South African audiology community.

Healthcare practitioners’ views about early hearing detection and intervention practices in KwaZulu‑Natal, South Africa

Background. Healthcare practitioners’ views, understanding of and support for early hearing detection and intervention (EHDI) is essential for its effective implementation Objectives. To determine public healthcare practitioners’ views about EHDI at primary healthcare level based on primary-care nurse’s awareness and referral practices related to high-risk factors for hearing loss and the challenges with EHDI implementation. Methods. A customised questionnaire ( α =0.71) was used to survey a sample ( N =38) of relevant healthcare practitioners, including audiologists, speech therapists and ear, nose and throat (ENT) specialists from 11 purposively selected hospitals in KwaZulu-Natal, South Africa (SA). Results. Practitioners had a positive view towards hearing screening being mandatory and that it should form part of the birth package offered to mothers. Approximately 58% of participants agreed that the list of high-risk factors issued by the Joint Committee on Infant Hearing (JCIH) is relevant in the SA context and 50% agreed that infants with hearing loss globally present with similar high-risk factors. Approximately 21% of the participants disagreed with this, suggesting that the risk factors differ among populations. Only 45% of participants considered primary-care nurses to be aware of high-risk factors for hearing loss. Most were thus unlikely to refer infants for further hearing testing. Conclusion. Poor awareness, lack of infrastructure for screening and limited resources necessitate further education and training for nurses on risk factors and resource availability at the primary healthcare level is crucial, considering that the majority of South Africans access services at this level of care.

The effect of simulation learning on audiology and speech-language pathology students’ self-confidence related to early hearing detection and intervention: a randomized experiment

ABSTRACT The use of simulation in audiology (AUD) and speech-language pathology (SLP) fields is less than its use in other health professions. This study aimed to examine the effect of the use of simulation training sessions versus video simulation case scenarios on AUD and SLP undergraduate students’ confidence in knowledge and professional competencies of the 1–3–6 early hearing detection and intervention (EHDI) timeline. A randomized pretest-posttest control group study design was used to assess self-ratings of confidence for specific knowledge and professional competencies. Thirty-four undergraduate students (AUD = 24; SLP = 10) participated in this study. The mean age of the participants was 20.09 years (SD = ±0.79, range: 19–21 years). All AUD and SLP participants attended a lecture and then were divided into two groups: the experimental group had simulation activities, while the control group watched video-recorded scenarios followed by a discussion session. Statistically significant differences (improvements) of students’ confidence in knowledge and professional competencies were detected in both groups. The mean difference between pre- and post-test scores for the experimental group was 0.59 (p < 0.001), and it was 0.91 (p < 0.001) for the control group. The use of simulation training sessions or video simulation case sceneries can facilitate student learning. Video simulation case scenarios are feasible for teaching the 1–3–6 EHDI timeline and offer similar situations to simulation training sessions. AUD and SLP programs are encouraged to use both teaching methods.

Receipt and Timeliness of Newborn Hearing Screening and Diagnostic Services Among Babies Born in 2017 in 9 States.

By providing timely services at all steps along the continuum of the early hearing detection and intervention (EHDI) process, providers may be able to lessen potential adverse effects of late identification of hearing loss on children's language development. To examine the timeliness of key events in the EHDI process from birth through diagnosis of hearing loss among different populations. Retrospective, cross-sectional. Data pooled from 9 states' EHDI information systems were used to determine the extent to which timely screening and diagnosis were achieved by 754 613 infants born in calendar year 2017. Enrollment into early intervention for children diagnosed is not examined here due to incomplete data. Nine state EHDI programs were selected to participate in this study for their successful experience in using EHDI-IS to collect detailed child-level data. Age of service, rate of service receipt. Median age of newborn hearing screening was 1 day, and median age of hearing loss diagnosis was 68 days. Early completion of newborn hearing screening was associated with maternal education, maternal race/ethnicity, and admission into a neonatal intensive care unit (NICU). Receiving and completing follow-up diagnostic services were associated with maternal education, maternal race/ethnicity, age of screening, and enrollment into the Women, Infants, and Children program. Timely completion of the newborn hearing screening is achieved by most of the population among the participating states. Increased efforts may be considered by state EHDI programs to provide additional follow-up and education to underrepresented racial/ethnic groups, mothers with less education, and NICU infants and their families as these groups appear to be at an increased risk for delayed diagnostic testing for hearing loss.

Maternal knowledge and views regarding early hearing detection and intervention in children aged 0-5 years at a semi-urban primary care clinic in South Africa.

BackgroundSouth Africans have an increasing burden of hearing loss, especially in low-income rural areas. Limited information is available regarding caregivers’ knowledge and views regarding infant hearing loss, which is essential for the successful implementation of early hearing detection and intervention (EHDI) programmes.ObjectivesThe main aim of the study was to describe the knowledge and views of mothers with children aged between 0 and 5 years old regarding hearing screening, risk factors, symptoms of hearing loss, and intervention options for hearing loss.MethodA survey was employed at a primary care clinic to gain insight into the maternal views on hearing loss and early intervention services for children aged 0–5 years old.ResultsThe majority (83.2%) of the mothers believed that hearing can be tested at birth, 90.7% believed in the biomedical model of intervention which is based on cure, prevention, and pathology as opposed to traditional or alternative medicinal beliefs, and 95.3% indicated that they would seek medical attention if they noticed symptoms of hearing loss. Consequences of hearing loss, such as academic, communication and social problems, were indicated by 65.4% of mothers.ConclusionThe findings demonstrated that although cultural beliefs regarding superstitious causes of hearing loss and use of traditional medicine exist, satisfactory maternal knowledge regarding detection and intervention for hearing loss is present. Maternal views are favourable and a general willingness to participate in EHDI programmes was present. This study advocates for the implementation of EHDI programmes at all primary healthcare clinics across South Africa.

Early Hearing Detection and Intervention (EHDI) Within the Medical Home

The pediatric medical home is a model to provide quality health care to a child that is coordinated and overseen by a team of professionals who are grounded in family-centered practice (Cleveland Clinic, 2012 ; Munoz, Nelson, Bradham, Hoffman, &amp; Houston, 2011). The medical home can be a centralized, consolidated, and comprehensive approach to address concerns for a child and can bolster the early intervention goals of Early Hearing Detection and Intervention ([EHDI]; Buchino et al., 2019 ; Munoz, Shisler, Moeller, &amp; White, 2009 ; Munoz et al., 2011). With early access to screening information for children who are D/deaf or hard of hearing, the medical home plays a role in early diagnostic services and follow-up care that are critical to EHDI. This connection allows for discussion of how the medical home can exist and be supported within the context of existing service provision systems as a potential preemptive intervention to address the needs of children and families. By reviewing publicly accessible materials, the state of Connecticut can be used as a case study to look at various methods of medical home engagement with the outcome of supporting EHDI-based benchmarks (Connecticut Department of Public Health, 2014 , 2018). At the same time, a novel means of data collection through the medical home is proposed.

Delayed Identification of Infants Who Are Deaf or Hard of Hearing - Minnesota, 2012-2016.

Few studies have examined factors associated with the timing of identification of hearing loss within a cohort of infants identified as deaf or hard of hearing (DHH) and what factors are associated with delayed identification. Minnesota Early Hearing Detection and Intervention (EHDI) personnel studied deidentified data from 729 infants with confirmed congenital hearing loss (i.e., hearing loss identification after not passing newborn hearing screening) born in Minnesota during 2012-2016. Differences in likelihood of delayed identification of congenital hearing loss (defined as not passing newborn hearing screening and age >3 months at the time of identification as DHH) based on multiple variables were analyzed. Overall, 222 (30.4%) infants identified as DHH had delayed identification. Multivariate regression showed that infants identified as DHH were significantly more likely to have delayed identification if they had 1) low birthweight, 2) public insurance, 3) a residence outside the metropolitan area, 4) a mother with a lower level of education, 5) a mother aged <25 years, or 6) a mother who was Hmong. Despite achievements of EHDI programs, disparities exist in timely identification of hearing loss. Using this information to develop public health initiatives that target certain populations could improve timely identification, reduce the risk for language delay, and enhance outcomes in children who are DHH.