Early Identification Of Hearing Impairment Research Articles

Newborn hearing screening program

The primary justification for early identification of hearing impairment in infants relates to the impact of hearing impairment on speech and language acquisition, academic achievement, and social and emotional development [1-3]. The first three years of life are most important for speech and language acquisition. Animal studies have shown that early auditory deprivation interferes with the development of neural structures necessary for hearing. The goal of early identification and intervention is to minimize the adverse effects. Neonatal and infant screening programs using test procedure like otoacoustic (OAE) emission and auditory brain stem response (ABR) have been established worldwide for this purpose.

Using Benefit-Cost Ratio to Select Universal Newborn Hearing Screening Test Criteria

Current protocols presumably use criteria that are chosen on the basis of the sensitivity and specificity rates they produce. Such an approach emphasizes test performance but does not include societal implications of the benefit of early identification. The purpose of the present analysis was to evaluate an approach to selecting criteria for use in Universal Newborn Hearing Screening (UNHS) programs that uses benefit-cost ratio (BCR) to demonstrate an alternative method to audiologists, administrators, and others involved in UNHS protocol decisions. Existing data from more than 1200 ears were used to analyze BCR as a function of Distortion Product Otoacoustic Emission (DPOAE) level. These data were selected because both audiometric and DPOAE data were available on every ear. Although these data were not obtained in newborns, this compromise was necessary because audiometric outcomes (especially in infants with congenital hearing loss) in neonates are either lacking or limited in number. As such, it is important to note that the characteristics of responses from the group of subjects that formed the bases of the present analyses are different from those for neonates. This limits the extent to which actual criterion levels can be selected but should not affect the general approach of using BCR as a framework for considering UNHS criteria. Estimates of the prevalence of congenital hearing loss identified through UNHS in 37 states and U.S. territories in 2004 were used to calculate BCR. A range of estimates for the lifetime monetary benefits and yearly costs for UNHS were used, based on data available in the literature. Still, exact benefits and costs are difficult to know. Both one-step (DPOAE alone) and two-step (DPOAE followed by automated auditory brainstem response, AABR) screening paradigms were considered in the calculation of BCR. The influence of middle ear effusion was simulated by incorporating a range of expected DPOAE level reductions into an additional BCR analyses Our calculations indicate that for a range of proposed benefit and cost estimates, the monetary benefits of both one-step (DPOAE alone) and two-step (DPOAE followed by AABR) NHS programs outweigh programmatic costs. Our calculations indicate that BCR is robust in that it can be applied regardless of the values that are assigned to benefit and cost. Maximum BCR was identified and remained stable regardless of these values; however, it was recognized that the use of maximum BCR could result in reduced test sensitivity and may not be optimal for use in UNHS programs. The inclusion of secondary AABR screening increases BCR but does not alter the DPOAE criterion level at which maximum BCR occurs. The model of middle ear effusion reduces overall DPOAE level, subsequently lowering the DPOAE criterion level at which maximum BCR was obtained BCR is one of several alternative methods for choosing UNHS criteria, in which the evaluation of costs and benefits allows clinical and societal considerations to be incorporated into the pass/refer decision in a meaningful way. Although some of the benefits of early identification of hearing impairment cannot be estimated through a monetary analysis, such as improved psychosocial development and quality of life, this article provides an alternative to audiologists and administrators for selecting UNHS protocols that includes consideration of societal implications of UNHS screening criteria. BCR suggests that UNHS is a worthwhile investment for society as benefits always outweigh costs, at least for the estimations included in this article. Although the use of screening criteria that maximize BCR results in lower test sensitivity compared with other criteria, BCR may be used to select criteria that result in increased test sensitivity and still provide a high, although not maximal, BCR. Using BCR analysis provides a framework in which the societal implications of NHS protocols are considered and emphasizes the value of UNHS.

Effects of Early Auditory Experience on the Spoken Language of Deaf Children at 3 Years of Age

By age 3, typically developing children have achieved extensive vocabulary and syntax skills that facilitate both cognitive and social development. Substantial delays in spoken language acquisition have been documented for children with severe to profound deafness, even those with auditory oral training and early hearing aid use. This study documents the spoken language skills achieved by orally educated 3-yr-olds whose profound hearing loss was identified and hearing aids fitted between 1 and 30 mo of age and who received a cochlear implant between 12 and 38 mo of age. The purpose of the analysis was to examine the effects of age, duration, and type of early auditory experience on spoken language competence at age 3.5 yr. The spoken language skills of 76 children who had used a cochlear implant for at least 7 mo were evaluated via standardized 30-minute language sample analysis, a parent-completed vocabulary checklist, and a teacher language-rating scale. The children were recruited from and enrolled in oral education programs or therapy practices across the United States. Inclusion criteria included presumed deaf since birth, English the primary language of the home, no other known conditions that interfere with speech/language development, enrolled in programs using oral education methods, and no known problems with the cochlear implant lasting more than 30 days. Strong correlations were obtained among all language measures. Therefore, principal components analysis was used to derive a single Language Factor score for each child. A number of possible predictors of language outcome were examined, including age at identification and intervention with a hearing aid, duration of use of a hearing aid, pre-implant pure-tone average (PTA) threshold with a hearing aid, PTA threshold with a cochlear implant, and duration of use of a cochlear implant/age at implantation (the last two variables were practically identical because all children were tested between 40 and 44 mo of age). Examination of the independent influence of these predictors through multiple regression analysis revealed that pre-implant-aided PTA threshold and duration of cochlear implant use (i.e., age at implant) accounted for 58% of the variance in Language Factor scores. A significant negative coefficient associated with pre-implant-aided threshold indicated that children with poorer hearing before implantation exhibited poorer language skills at age 3.5 yr. Likewise, a strong positive coefficient associated with duration of implant use indicated that children who had used their implant for a longer period of time (i.e., who were implanted at an earlier age) exhibited better language at age 3.5 yr. Age at identification and amplification was unrelated to language outcome, as was aided threshold with the cochlear implant. A significant quadratic trend in the relation between duration of implant use and language score revealed a steady increase in language skill (at age 3.5 yr) for each additional month of use of a cochlear implant after the first 12 mo of implant use. The advantage to language of longer implant use became more pronounced over time. Longer use of a cochlear implant in infancy and very early childhood dramatically affects the amount of spoken language exhibited by 3-yr-old, profoundly deaf children. In this sample, the amount of pre-implant intervention with a hearing aid was not related to language outcome at 3.5 yr of age. Rather, it was cochlear implantation at a younger age that served to promote spoken language competence. The previously identified language-facilitating factors of early identification of hearing impairment and early educational intervention may not be sufficient for optimizing spoken language of profoundly deaf children unless it leads to early cochlear implantation.

Auditory-Verbal Therapy for Children with Hearing Impairment

The new millennium has brought about great innovation and advancement in hearing technology, early detection and intervention. This in turn has altered expectations of what children with hearing impairment are really capable of in terms of listening, developing spoken language, and academic and social performance. In Singapore, with Universal Newborn Hearing Screening in place, babies with hearing impairment can be detected early and early intervention implemented by 6 months of age. To benefit from the “critical periods” of acoustic neurological and linguistic development, early identification of hearing impairment, medical intervention, use of appropriate amplification technology and effective habilitation are vital. Auditory-Verbal practice emphasises listening to access auditory information, so that these children have the opportunity to develop intelligible speech and spoken language. Auditory-Verbal practice supports ongoing individualised diagnostic therapy with parent participation, guidance, education and support by an Auditory-Verbal specialist. The goal of Auditory-Verbal therapy is to enable children with hearing loss to grow up in regular learning and living environments so that they can become independent, participating and contributing citizens in mainstream society

Characteristics of Children with Permanent Mild Hearing Impairment

The report was intended to provide up-to-date information about permanent mild hearing impairment (HI) in early childhood. Altogether 33/250 children with a permanent mild HI in the better ear (average at frequencies of 0.5, 1, 2, 4 kHz ≧25–39 dB HL) were found during the 7-year period from 1994 to 2001 in the Outpatient Clinic of the Department Phoniatrics/Pedaudiology, University of Göttingen. Twenty-two of 33 children had a mild HI in one or both ears. The loss was sensorineural in 73% of the children (88% bilateral, 12% unilateral), and conductive in 27% (67% bilaterally, 33% unilaterally) because of ear malformations or a suspicion of middle ear anomalies. Clinical data and test performances were presented for these four types of mild HI. Altogether, standardized language assessment demonstrated no delays in receptive and expressive vocabulary ability development on average, although the acquisition of two-word phrases in infancy was in mean delayed. Nonverbal intelligence was within the normal range, and on average the children did not perform less well in central auditory processing than normal children. Provided that no additional handicaps were present, mild HI did not adversely affect speech/language development if the children were fitted with hearing aids after early identification of HI.

Projected cost-effectiveness of statewide universal newborn hearing screening.

Early identification of hearing impairment may improve language outcomes and subsequent school and occupational performance of the deaf. Universal newborn hearing screening (UNHS), currently mandated by 32 states, can reduce the median age of identification of hearing impairment from 12 to 18 months to 6 months or less. However, because false-negative tests must be minimized, the prevalence of congenital deafness is low, and screening tests are imperfect, UNHS results in many false-positive results and has a low positive predictive value (PPV). The objective of this study was to evaluate UNHS and selective screening in terms of both short- and long-term benefits, harms, and financial costs and to identify steps in the screening process that could be improved to increase cost-effectiveness. The cost-effectiveness analysis, conducted from the societal perspective, compared the projected outcomes of 1) no newborn hearing screening, 2) selective newborn hearing screening, and 3) UNHS for a hypothetical state birth cohort of 80 000 infants. Probability and cost estimates for the decision model were obtained from published studies, expert opinion, and national and state sources. The main outcomes were incremental cost per infant whose deafness was diagnosed by 6 months, which included only the cost of screening and diagnostic evaluation; and incremental cost per deaf child with normal language, which also included the costs of medical care, education and assistive devices, and lost productivity over the lifetime of the deaf individual. Selective screening identified 62 of the 128 deaf infants in the birth cohort, referred 0.18% of all infants for diagnostic evaluation, and had a PPV of 43%. UNHS identified 116 of the 128 deaf infants, referred 1.6% of all infants, and had a PPV of 8.8%. Our model simulated real-world conditions in which some infants whose deafness is identified at screening do not receive a definitive diagnosis of being deaf before 6 months; and a portion of deaf and hard-of-hearing infants who 1) have false-negative screening test results, 2) are not screened, or 3) fail the hearing screen but are not immediately followed up with diagnostic evaluation nonetheless receive a diagnosis by 6 months of age. In the absence of newborn hearing screening, approximately 30 deaf infants were identified by 6 months of age by passive detection alone at a cost of $69 000. The selective screening protocol, when compared with no newborn hearing screening, resulted in an additional 36 infants whose deafness was diagnosed by 6 months at an additional cost of approximately $600 000, yielding an incremental cost-effectiveness of approximately $16 000 per additional infant whose deafness was diagnosed by 6 months. Compared with selective screening, the UNHS protocol resulted in 33 additional infants whose deafness was diagnosed by 6 months of age at an additional cost of approximately $1.5 million, yielding an incremental cost-effectiveness of approximately $44 000 per additional infant whose deafness was diagnosed by 6 months of age. Increasing the rate of follow-up to diagnostic evaluation from the base-case estimate of 77% to 100% decreased the incremental cost of UNHS to $38 000 per additional infant whose deafness was diagnosed by 6 months. Under the base-case assumptions about lifetime savings that result from normal language with early intervention, UNHS resulted in normal language achievement for more deaf children and was cost saving in the long term compared with both selective screening and no screening. The short-term cost-effectiveness of UNHS is comparable to the cost per case diagnosed of other newborn screening programs and could be improved by increasing the rate of follow-up to diagnostic evaluation after positive screening test results. If early identification results in improved language abilities, lower educational and vocational costs, and increased lifetime productivity, then UNHS has the potential for long-term cost savings compared with selective hearing screening and no screening. To understand the actual long-term economic effects of UNHS, better evidence is needed regarding the impact of early intervention on language outcomes and subsequent changes in educational costs and lifetime productivity.

The impact of molecular genetics on the clinical management of pediatric sensorineural hearing loss

In this issue of The Journal, Wolf et al1 raise several points relevant to hereditary hearing impairment, early identification of hearing impairment in infants, and the (potential) effect that novel molecular biologic and molecular genetic information can have on patient management. See related article, p 242.

Early identification of hearing loss in high-risk newborns and young children in Thailand by using transient otoacoustic emissions (TEOAEs)

Hearing impairment in prelingual children affects their speech and language development leading to poor educational outcome and results in more effort in habilitation from all levels of related professionals. Many known risk factors have been reported as a possible cause of hearing impairment in newborn and young children. High-risk registration that aimed to search early for newborns at risk of hearing loss was introduced in 1970 in the USA. In the 1980s, ABR became a standard test for hearing screening in young children and TEOAEs screening has - become a standard test since 1990. In Thailand, only ABR was used as a standard test in hearing evaluation in newborn and young children; however, the TEOAEs test has not been tested for its sensitivity and specificity nor for its use in hearing screening in our clinic. This study tried to establish the sensitivity and specificity of TEOAEs for early identification of hearing impairment in newborn and young children compared with conventional ABR. During January 1997 to December 1998, all infants and young children with a high-risk history were included. TEOAEs and conventional ABR were examined in 23 females and 58 males, whose ages ranged from 6 days to 7 years, using the standard protocol for hearing screening. All subjects were tested twice at 3 to 12 months' interval. All medical and family histories were reviewed. Subjects who failed the first screening should be tested by tympanometry to rule out coexisting middle-ear disorders. Of all 81 newborns and young children tested, 28 failed TEOAEs screening (34.5%). Twenty-seven children showed cochlear hearing loss; 20 had bilateral impairment (25%). One had bilateral conductive hearing loss (CHL) due to serous otitis media. Only one who passed the TEOAEs but failed the ABR test was suspected of having retrocochlear hearing impairment in both ears. Twenty of 81 subjects had been diagnosed before the age of 6 months. Five children (25%) had severe SNHL; one (5%) was bilateral. Overall very high sensitivity (>96%) and specificity (>98%) of TEOAEs when compared with ABR were found in this hearing screening. It is recommended that a TEOAEs test should be performed as screening for hearing impairment in newborns and young children at risk of having hearing loss. In complement with a tympanogram and ABR, a diagnosis of CHL and retrocochlear hearing impairment could be disclosed.

Early Identification of Hearing Impairment in Patients With Type 1 Diabetes Mellitus

The aim of this study was to evaluate the cochlear micromechanics and central auditory function in patients with type I diabetes mellitus and to identify the site of possible dysfunction. Cochlear activity was evaluated by recording distortion product otoacoustic emissions (DPOAEs). DPOAEs were performed using an ILO 92 Otodynamics Analyser. Functional changes in the retrocochlear auditory pathway were evaluated by auditory brainstem responses (ABRs). DPOAEs and ABRs were measured in 42 normally hearing patients with type 1 diabetes mellitus aged 21 to 42 years, and 33 age- and sex-matched nondiabetic control subjects. Both of the groups (diabetic and control) had normal and undifferentiated results in tonal and impedance audiometry. ABR peripheral transmission time (wave I) and central transmission time (interpeak latencies I-V) were significantly delayed in the diabetic compared with normal subjects, and the mean amplitudes of various DPOAEs were significantly reduced in the diabetic patients compared with the control subjects. Combined use of different procedures for monitoring central and peripheral portions of the auditory pathway in diabetic patients showed alterations in cochlear micromechanics and the retrocochlear auditory pathway. Hearing impairment in diabetic patients is usually mild and subclinical, and can be detected early by accurate and objective audiometric methods.

Audiology in Latin America: hearing impairment, resources and services.

Evidence is presented about the limitation of information available on prevalence/incidence of deafness and hearing impairment in the developing world; particularly in Latin America. Two questionnaires on audiological resources and services were mailed to Latin American and Caribbean countries in general and to Central American nations in particular. The information returned by Argentina, Chile, Colombia, Costa Rica, Cuba, Belize, El Salvador, Grenada, Guatemala, Honduras, Mexico, Nicaragua, Panama, Puerto Rico and Uruguay was analysed. Data was gathered about epidemiological studies on hearing impairment, about specific programmes, such as early identification of hearing impairment, national registers on deafness and programmes on hearing screening. Training programmes and availability of professionals in the field of hearing and deafness is also shown. Hearing services, hearing aids provision, hearing testing equipment, professional organization and legislation in audiology is also documented. It is our conclusion that hearing impairment is a low priority for health systems in the developing world, technology continues to be excessively costly and material and human resources are limited, and services are poor and restricted.

Year 2000 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs.

Year 2000 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs.

Identifying hearing loss: parents' needs.

Universal neonatal hearing screening programs are being established across the country at a rapidly accelerating rate, prompted by professional endorsement, legislated mandates, and available technology. The subsequent early identification of hearing impairment in infants will have significant impact on families as well as the audiologists who serve them. However, there have been no studies that surveyed parents of children who are deaf and or have hearing loss as to their opinions about early detection of hearing loss and the process that ensues after its detection. Here, we present the results of a retrospective survey of 75 parents whose children have known hearing loss. Their responses to a five-item questionnaire reflect parents' perspectives and identify key elements of a comprehensive management program: parent contact, unbiased information, sufficient time to process complex information, and counseling from a skilled, empathic audiologist. Implications for counseling issues and professional training are also discussed.

Consensus on Early Identification of Hearing Loss?

The National Institutes of Health Consensus Development Conference on Early Identification of Hearing Impairment was convened to address the advantages of early identification of hearing impairment and the consequences of late identification of hearing impairment, the issue of which children should be screened for hearing impairment and when, the advantages and disadvantages of current screening methods, the question of which model for hearing screening and follow-up is preferred, and future directions for research in diagnosis and management of hearing impairment in infants and young children. Among their findings, the panel concluded that (1) all infants admitted to the neonatal intensive care unit be screened for hearing loss prior to discharge, (2) universal screening be implemented for all infants within the first 3 months of life, (3) the preferred model for screening should begin with an evoked otoacoustic emissions test and should he followed by an auditory brainstem response test for all infants who fail the evoked otoacoustic emissions test, (4) comprehensive intervention and management programs must be an integral part of a universal screening program, (5) universal neonatal screening should not be a replacement for ongoing surveillance throughout infancy and early childhood, and (6) education of primary caregivers and primary health care providers on the early signs of hearing impairment is essential.

The Colorado Newborn Hearing Screening Project

No AccessAmerican Journal of AudiologyResearch Article1 Nov 1997The Colorado Newborn Hearing Screening Project Vickie ThomsonMA Vickie Thomson Colorado Newborn Hearing Screening Project, State Coordinator, Colorado Newborn Hearing Screening Project, 4300 Cherry Creek Drive, South Denver, CO 80222-1530 Google Scholar More articles by this author https://doi.org/10.1044/1059-0889.0603.74 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationTrack Citations ShareFacebookTwitterLinked In References Abdala de Uzcategui, C. (1997). Parents’ reaction to newborn hearing screening.Audiology Today( 9(1), 24–27. Google Scholar American Speech-Language-Hearing Association. (1994). Joint Committee on Infant Hearing position paper.Asha, 36, 38–41. Google Scholar Barringer, D. G., Mauk, G. W., Jensen, S., & Woods, N. (1997). Survey of parents’ perception regarding hospital-based newborn hearing screening.Audiology Today, 9(1), 18–19. Google Scholar Bess, F. H., & Paradise, J. L. (1994). Universal screening for infant hearing: Not simple, not risk-free, not necessarily beneficial, and not presently justified.Pediatrics, 98(2), 330–334. Google Scholar Cowley, G. (Spring, 1997). The language explosion.Newsweek Special Edition, 16–22. Google Scholar Downs, M. P., & Sterritt, G. M. (1967). Guide to newborn and infant screening programs.Archives of Otolaryngology, 85, 15–22. Google Scholar Healthy People 2000. (1990). U.S. Department of Health and Human Services, Public Health Service, DHHS Publication (PHS) 91-50213. Washington, DC: U.S. Government Printing Office. Google Scholar National Institutes of Health. (March, 1993). Consensus Statement. Early identification of hearing impairment in infants and young children. Google Scholar Yoshinaga-Itano, C., & Apuzzo, M. L.Early identification of infants with significant hearing loss and the Minnesota child development inventory.Seminars in Hearing, 16(2), 124–139. Google Scholar Additional Resources FiguresReferencesRelatedDetailsCited byPerspectives on Hearing and Hearing Disorders in Childhood20:1 (3-11)1 Mar 2010The Colorado Journey Towards Optimal Outcomes for Children With Hearing LossChristine Yoshinaga-Itano Volume 6Issue 3November 1997Pages: 74-77 Get Permissions Add to your Mendeley library History Published in issue: Nov 1, 1997 Metrics Topicsasha-topicsasha-article-typeskeywordsimplementationuniversal newborn hearing screeningadvisory boardlegislationdata managementCopyright & PermissionsCopyright © 1997 American Speech-Language-Hearing AssociationPDF downloadLoading ...

Universal newborn screening for hearing loss: Ideal vs. reality and the role of otolaryngologists

In 1993 the National Institutes of Health Consensus Statement, Early Identification of Hearing Impairment in Infants and Young Children, recommended “universal screening for hearing impairment prior to three months of age.” However, the decision to invoke screening programs that include all newborns remains highly controversial, even though such programs now exist in at least 60 hospitals in 18 states. Unfortunately, otolaryngologists in the United States have not been actively involved in this ongoing debate, despite the role of those in our specialty as “gatekeepers” of hearing loss in patients of all ages. In relation to identification of hearing loss in the neonatal period, we have abrogated our responsibility to other health care professionals. Otolaryngologists, this is your ”wake up call.” (Otolaryngol Head Neck Surg 1996;115:89-93.)

Letter to the Editor

In their recent Pediatrics artide entitled "Universal Screening for Infant Hearing Impairment: Not Simple, Not Risk-Free, Not Necessarily Beneficial, and Not Presently Justified," Bess and Paradise comment on the performance of the auditory brainstem response (ABR) as a screening procedure, and quote an estimate from the 1993 National Institutes of Health Conference Statement on Early Identification of Hearing Impairment that "for every child with significant hearing impairment, more than 100 babies are referred." Bess and Paradise then comment that "the same concerns necessarily apply to a recently devised, automated ABR instrument," and reference my Handbook of Auditory Evoked Responses in support of their contention.

Letter to the Editor

In March 1993, the Consensus Panel of the National Institutes of Health (NIH) Consensus Development Conference on Early Identification of Hearing Impairment in Infants and Young Children recommended universal infant hearing screening and reinforced the goal of early intervention for infants with hearing loss. In an editorial commentary, Bess and Paradise opposed the recommendation for universal infant hearing screening and disparaged the benefit and effectiveness of early intervention.1 I am concerned that pediatricians will underestimate the importance of childhood hearing loss and the effectiveness of early intervention.

Letter to the Editor

In their recent commentary Bess and Paradise1 impugn the recommendations of the National Institutes of Health (NIH) Consensus Development Conference on Early Identification of Hearing Impairment in Infants and Young Children (March 1-3, 1993) for universal infant hearing screening. Bess and Paradise challenge the validity and predictive value of the recommended two-sequence screening procedure, evoked otoacoustic emissions (EOAE), and auditory brainstem response (ABR). Although they confirm that EOAE and ABR testing is highly sensitive, they contend that the specificity and positive predictive value of these procedures are problematic.

Letter to the Editor

In their recent Pediatrics commentary entitled "Universal Screening for Infant Hearing Impairment: Not Simple, Not Risk-Free, Not Necessarily Beneficial, and Not Presently Justified," Bess and Paradise argue that "universal screening is ill-considered and at this time ill-advised." Bess and Paradise state their general objections to the National Institutes of Health (NIH) Consensus Statement on Early Identification of Hearing Impairment, and then express their concerns about the rationale for early intervention for infant hearing impairment and about current infant screening tests.

Screening for hearing loss

EDITOR, - The National Deaf Children's Society launched its document Quality Standards in Paediatric Audiology at a one day conference on the early identification of hearing impairment in children.1 The conference was a tribute to the determination of this voluntary society to raise standards in screening of hearing but did not make clear that the standards cover only sensorineural hearing impairment. (Sensorineural hearing loss affects about 1-5/1000 …