Universal newborn hearing screening (UNHS) has become the standard of care in a growing number of states. Currently, 37 states have adopted legislation mandating universal screening. Our institution initiated UNHS in June 1995, initially as a participant in the New York State Demonstration Project and continuing thereafter. To date, we have screened 20,000 babies.Figure. BradleyFigure. BarberaAlthough the introduction and maintenance of a successful program require considerable effort, the true challenge lies in the follow-up and management of infants with hearing loss. The Joint Committee on Infant Hearing recommends that hearing loss be confirmed by 3 months of age and intervention initiated by 6 months. Yoshinaga-Itano et al. demonstrated that children who were identified by 6 months showed significantly better expressive and receptive language than did later-identified children.1 Despite significant strides in earlier identification, we are not yet seeing a parallel reduction in the age of hearing aid fitting. What are the reasons for these delays? How can we reduce the time between screening, diagnosis, and hearing aid fit? INCREASED DEMANDS ON THE AUDIOLOGIST Audiologists are now faced with the new challenge of diagnosing and managing these very little people. Some of us may feel ill-equipped to perform these services, but are now forced to become the primary providers. Unfortunately, there are no clear standards identifying the minimal audiologic information required prior to hearing aid fitting. The protocol that we have adopted at our institution requires otoacoustic emissions (OAE) and auditory brainstem response (ABR), including click, 500-Hz, and, preferably, 2000-Hz tonebursts in each ear. The inability to obtain bone-conduction information will not delay an early intervention referral or amplification. A normal ENT exam and high-frequency tympanometry are sufficient to rule out transient conductive hearing loss. Despite its limitations, behavioral observation audiometry is utilized as part of a comprehensive diagnostic work-up. Children are monitored carefully—before, during, and after hearing aid fitting. ACCEPTANCE BY PARENTS, MDs We know that parents want to do what is best for their child. Why, then, do so many parents not show for appointments or refuse follow-up testing? It is important to remember that hearing loss is invisible, especially to parents who see their child responding to sound. Watkin and Baldwin found that only 7% of parents whose baby had moderate hearing loss expressed concerns about the infant's hearing.2 The audiologist must counsel the parents and allow them time to accept their child's hearing loss. This can be frustrating as we hear the clock tick. In some cases, parents may report that their pediatrician doesn't think the child needs the testing. We, however, have found our community physicians extremely helpful in encouraging follow-up and contacting families. It is essential to keep the pediatrician “in the loop” from the outset. The physician should be familiar with your screening program and receive copies of all findings. FINANCIAL ASSISTANCE Parents may receive financial assistance from early intervention or other state-funded agencies. However, the approval process can be lengthy. We encourage our dispensing colleagues to provide loaner aids. Our policy is to be patient yet diligent in working with the families and early intervention coordinators to expedite the process. Other issues that confound follow-up include transportation problems, language barriers, and time constraints on the families. Our coordinator maintains personal contact with each family, involving public health nurses when necessary. Family members need to feel that they are active participants in the diagnosis and decision-making process. This partnership is essential for effective management.
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Dec 6, 2023
Y. Lill + 7
Open Access
