Early Hearing Detection & Intervention (EHDI) Recommendations
- The Joint Committee on Infant Hearing1 and U.S. Public Health Service’s Healthy People 2010 health objectives2 recommend that all newborns be screened for hearing loss by 1 month of age, have diagnostic follow-up by 3 months, and receive appropriate intervention services by 6 months of age.
- A National Institutes of Health (NIH) Consensus Panel in 1993 recommended hearing screening of all newborns. The consensus report concluded that the best opportunity for achieving this goal is provided by the development of hearing screening programs for newborns in hospital nurseries or in birthing centers, prior to discharge.3
- The U.S. Preventive Services Task Force in 2001 concluded that universal newborn hearing screening does lead to earlier identification and treatment. However, there were not enough clinical studies of sufficient size and strength to evaluate long-term outcomes. While the preponderance of anecdotal evidence and clinical research indicates that EHDI provides substantial benefit, additional clinical outcome studies and clinical trials are needed.4
Methods and Costs for Newborn Hearing Screening
- Advances in technology for newborn hearing screening at most birthing hospitals have allowed for cost containment, with current charges ranging from $25 to $60. The cost of identifying a newborn with hearing loss is less than one-tenth the cost of identifying newborns with PKU, hypothyroidism, or sickle cell anemia, which are screened for in nearly every state.5
- Currently, two types of electrophysiologic procedures are used to screen newborns singly or in combination:
Auditory brainstem responses (ABR) are measured by placing sensors on the baby’s head. Sound is then introduced to the baby’s ears through tiny earphones while the child sleeps. A computer allows brainwave activity to be recorded to indicate whether the ear and auditory brainstem pathway are responding to sound. This test is painless and takes only about 5 minutes.
Otoacoustic emissions (OAE) are faint sounds produced by most normal inner ears. The sounds cannot be heard by people, but can be detected by very sensitive microphones that are placed in the ear canal. During testing, a tiny flexible plug is inserted into the baby’s ear and sound is then projected into the ear through the plug. A microphone inside the plug records the otoacoustic emissions that the normal ear produces in response to the incoming sound. Testing is also painless, takes about 5 minutes to complete, and can be done while the baby sleeps.
These measures are changing and advancing with new technologies.
Benefits of Early Hearing Detection and Intervention (EHDI)
- Infants identified with hearing loss can be fit with amplification by as young as 4 weeks of age. With appropriate early intervention, children with hearing loss can be mainstreamed in regular elementary and secondary education classrooms.6 Recent research has concluded that children born with a hearing loss who are identified and given appropriate intervention before 6 months of age demonstrated significantly better speech and reading comprehension than children identified after 6 months of age.7 8
- Even mild hearing loss can significantly interfere with the reception of spoken language and education performance. Research indicates that children with unilateral hearing loss (in one ear) are ten times as likely to be held back at least one grade compared to children with normal hearing.9 10 11 Similar academic achievement lags have been reported for children with even slight hearing loss.12 Children with mild hearing loss miss 25-50% of speech in the classroom and may be inappropriately labeled as having a behavior problem.13
- Recent clinical studies indicate that early detection of hearing loss followed with appropriate intervention minimizes the need for extensive habilitation during the school years and therefore reduces the burden on the IDEA Part B program.14 15 In contrast, a 30-year Gallaudet study revealed that half of the children with hearing loss graduate from high school with a 4th grade reading level or less.16
- 1Joint Committee on Infant Hearing. Year 2000 position statement: principles and guidelines for early hearing detection and intervention programs. American Journal of Audiology. 2000; 9:9-29. http://professional.asha.org/resources/legislative/ih_index.cfm.
- 2Healthy People 2010: Volume II (second edition), http://www.health.gov/healthypeople/document/html/objectives/28-11.htm
- 3National Institutes of Health. Early identification of hearing impairment in infants and younger children. National Institutes of Health, Rockville, MD 1993.
- 4Newborn Hearing Screening: Recommendations and Rationale. U.S. Preventive Services Task Force, Agency for Healthcare Research and Quality, Rockville, MD; 2001 http://www.ahrq.gov/clinic/3rduspstf/newhearrr.htm.
- 5Grosse S. Cost comparison of screening newborns for hearing impairment and biochemical disorders. Centers for Disease Control and Prevention. Paper presented at the Newborn Screening and Genetics Conference, May 2001.
- 6Joint Committee on Infant Hearing. Year 2000 position statement: principles and guidelines for early hearing detection and intervention programs. American Journal of Audiology. 2000; 9:9-29. http://professional.asha.org/resources/legislative/ih_index.cfm.
- 7Yoshinaga-Itano C, Apuzzo ML. Identification of hearing loss after 18 months of age is not early enough. American Annuals of the Deaf. 1998;143(5):380-387.
- 8Yoshinaga-Itano C, Sedey AL, Coulter BA, Mehl AL. Language of early and later-identified children with hearing loss. Pediatrics. 1998;102:1168-1171.
- 9Bess F. The minimally hearing-impaired child. Ear and Hearing, 1985; 6:43-47.
- 10Bess, F., Dodd-Murphy, J. & Parker, R. Children with minimal sensorineural hearing loss: Prevalence, educational performance, and functional status. Ear and Hearing, 1998; 19(5) 339-354.
- 11Oyler R, Oyler A, and Matkin N. Unilateral hearing loss: Demographics and educational impact. Language, Speech and Hearing Services in Schools; 1988; 19: 201-209.
- 12Quigley S. Effect of hearing impairment in normal language development. Pediatric Audiology, Englewood Cliffs, NJ: Prentice-Hall; 1978.
- 13Flexer, C. Facilitating hearing and listening in young children. San Diego, CA: Singular; 1994.
- 14Centers for Disease Control and Prevention. National Center for Birth Defects and Developmental Disabilities, Early Hearing Detection and Intervention Program. What is EHDI? http://www.cdc.gov/ncbddd/ehdi/ehdi.htm.
- 15Ross, M. Performance of Hard of Hearing Children – Academic Achievement. Our Forgotten Children – Hard of Hearing Pupils in the Schools, Third edition; Bethesda, MD, Self Help for Hard of Hearing People; 2001; 28-30.
- 16Gallaudet Research Institute. Stanford Achievement Test, 9th Edition, Form S, Norms Booklet for Deaf and Hard of Hearing Students; Washington, DC: Gallaudet University; 1996 http://gri.gallaudet.edu/Literacy.