Copyright 1999 Newsday, Inc.
Newsday (New York, NY)
November 23, 1999, Tuesday ALL EDITIONS
SECTION: HEALTH & DISCOVERY; Page C05
LENGTH: 1032 words
HEADLINE:
EASING FEARS FOR LITTLE EARS / HEARING TEST DOESN'T RELY ON RESPONSE FROM
INFANTS
BYLINE: By Donna Kutt Nahas. Donna Kutt Nahas
is a freelance writer.
BODY:
By Donna
Kutt Nahas IN THE FIRST HOURS and days of life, doctors poke, prod and probe
newborns, testing them for life-threatening genetic diseases and blood
disorders. Until recently, doctors in some hospital nurseries tested the hearing
of healthy infants merely by observing their response to a loud clap or ringing
bell.
Although a more sophisticated and sensitive method of screening
for signs of hearing loss - a method called oto-acoustic emissions technology -
has been available for several years, it has only recently been automated and
packaged into a simple-to-use hand-held device.
Several companies have
developed automated units. Welch Allyn Inc., headquartered in Skaneateles Falls,
N.Y., introduced the AudioPath in July.
Etymologic Research of Elk Grove
Village, Ill., introduced Eroscan in March and Bio-logic Systems Corp. of
Mundelein, Ill., launched AuDX Basic in mid-1997.
Another manufacturer
is the Danish company Madsen, based in Copenhagen, which manufactures the
Echocheck.
The lightweight units do not require a patient response, as
in traditional audiometry testing, and consist of a miniature rubber-tipped
probe, which contains tiny speakers and a microphone, a printer / charger module
and pod.
All the devices essentially test cochlear function. The
cochlea, which resembles a snail's shell, is the hearing organ housed in the
inner ear. Once the probe is placed into the baby's ear and a button is pressed,
two tones are sent through the ear to stimulate hair cells to move in the
cochlea. The undulating movement of the hair cells, like seaweed in the ocean,
generates and emits a response that travels in a reverse direction from the
cochlea back to the ear canal, where it is detected by the probe microphone.
Within about 10 seconds the liquid crystal display (LCD) screen
registers a "pass" or "refer." In the case of the latter, the patient is usually
rescreened by the device in about four weeks. Following a second failure,
another test, usually the diagnostic auditory brainstem response, evaluates
brain waves responsive to sounds the baby hears via ear phones.
"It EOAE
TESTING will not tell us if there is a mild or profound hearing loss and the
part of the ear affected, but it will tell us this is a child who is normal or
this is a child we have to do more testing on," said Dr. Lynn Spivak, director
of the hearing and speech center at the North Shore-Long Island Jewish Health
System.
Although the product's manufacturers say the test is highly
reliable, the portable device cannot detect hearing impairment in 100 percent of
people tested. Welch Allyn said its Audiopath has a 5 percent fail rate, which
means results are normal when hearing loss is present (false-negative) or
results are abnormal when hearing loss is not present (false-positive).
Bio-logic Systems says its fail rate for AudX Basic is between 4 and 6 percent.
Hearing loss affects about one to three per 1,000 healthy newborns and
about two to four per 100 sick newborns in the country. Speech and hearing
experts said the average age for detecting hearing loss is between 18 months and
two-and-a-half years, when the brain is primed for learning language.
Undetected hearing loss can seriously impair speech, cognitive and
emotional development.
"The parent would sometimes present the child to
a pediatrician at two-and-a-half years old when their disability has been
discovered but, by then, their brains have been developed largely without the
influence of words," said Kim McNeilly, product manager at Welch Allyn. "At that
point, the child would be behind the developmental and learning curve." A number
of Long Island hospitals have introduced or are planning to unveil automated
units as part of an infant hearing screening program.
Since the hearing and speech center at Long Island Jewish Medical Center
began screening with the manual device in 1995, 55 newborns were diagnosed with
significant hearing loss, half of whom did not present risk factors for the
disorder. Prior to 1995, most hospitals performed the screening only on infants
suspected of having a hearing problem.
"It is becoming the standard of
care to screen all infants for hearing loss," said Mary Bradley, director of
speech and hearing at University Medical Center at Stony Brook. She said the
medical center began universal hearing screening on newborns in 1995. Prior to
that, the hospital screened only high-risk infants with an auditory brainstem
response test.
The impetus to provide routine newborn hearing screening
is in part due to federal legislation that would provide funding to help states
design and implement programs to screen newborns for hearing loss.
According to Charles Diggs, director of state and consumer advocacy at
the American Speech-Language-Hearing Association in Rockville, Md., 22 states,
including New York, have adopted hearing screening legislation. In New York, a
bill to establish newborn and infant hearing screening programs
was signed by Gov. George Pataki on Nov. 1. The legislation mandates that state
"institutions caring for newborns" provide newborns with a hearing screening
referral or testing before leaving the hospital.The law takes effect April 1.
Hearing loss in newborns is usually caused by a prenatal infection,
degeneration of the auditory nerve or birth trauma. Chronic middle ear
infections or otitis media is prevalent in the preschool set and can commonly
affect newborns.
If identified and treated before age six months, babies
with hearing loss can learn and develop with a minimum of intervention.
Treatment would include hearing aids, and speech and hearing therapies.
For Dr. Robert A. Dracker, a pediatrician with a practice in Syracuse,
N.Y., the portable device has enabled him to reassure anxious parents that their
children are developing normally.
"The bulk of what we do in pediatrics
is preventive health care and assessing development, physical functioning and
nutrition," Dracker said. "If I can tell parents I can screen their child and
tell them his hearing is intact, I can offer them another level of reassurance."
Donna Kutt Nahas is a freelance writer.
GRAPHIC:
Newsday Photo Dick Kraus Carol Casey inserts a probe into the ear of newborn
Lindsey Jayne Brenner, who is held by Drr. Martin B. Cohen.
LOAD-DATE: November 23, 1999 
