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October 31, 2000, Tuesday, Late Edition -
Final
SECTION: Section F; Page 8; Column
1; Health & Fitness
LENGTH: 1123 words
HEADLINE: PERSONAL HEALTH;
Early Detection of
Infant Deafness Is Vital
BYLINE: By JANE E.
BRODY
BODY:
Deafness is the most common
disability present at birth. Every year, 12,000 American babies are born with
moderate to severe hearing impairment and another 12,000 are born with lesser
degrees of hearing loss.
"A deaf newborn looks and acts like any other
baby," said Dr. Andrew J. Schuman, adjunct professor of pediatrics at Dartmouth
Medical School. There are rarely outward clues and, unless newborns are tested
for hearing loss, it is often not detected until the child is 2 or 3 and fails
to start talking.
Such delays can permanently impair a child's ability
to learn to speak intelligibly and can result in long-lasting social, emotional
and academic difficulties.
If a congenital hearing loss is not detected
and corrected in the first months of life, the part of the brain that processes
auditory signals fails to receive adequate stimulation and its development is
likely to be permanently compromised. A delay of only six months can impede a
child's language development, even with extensive rehabilitation.
Yet,
despite the existence of a patchwork of legislation in 32 states mandating
screening of newborns for hearing loss, fewer than half the newborns in this
country have their hearing checked before they leave the hospital.
Each
day, 18 American newborns go home with a hearing impairment or profound deafness
that neither their parents nor their doctors are aware of.
Adding to the
poignancy of the problem is that relatively inexpensive, easy-to-use and highly
accurate devices for detecting hearing loss are available, as are treatments
like hearing aids and cochlear implants that can restore hearing to near normal.
Hearing Loss in Perspective
In contrast to the 24,000
American babies born each year with significant hearing impairment, only 2,000
are born with cystic fibrosis, 800 are born with sickle cell disease, 800 are
born with thyroid deficiency and 400 are born with phenylketonuria (PKU). Yet,
standardized newborn screening programs exist throughout the country for all
these disorders except hearing loss.
Further, as noted by Dr. Schuman,
who directs the screening at Elliot Hospital in Manchester, N.H., "once the
hospital buys the equipment, administering the test is not very costly -- about
$30 a test, which is comparable to these other tests."
The estimated
total cost involved in screening to detect each case of a hearing impaired
newborn -- $9,600 -- is also well within the ballpark of these other disorders,
he said. For example, it costs $6,000 to diagnose a single case of cystic
fibrosis, $10,800 for thyroid deficiency, $23,000 for sickle cell anemia and
$40,000 for PKU. And because it is much cheaper to rehabilitate a child whose
hearing impairment is detected in infancy, screening programs for newborn
hearing loss end up paying for themselves within a few years, according to
advocates for universal screening.
Seven years ago, a consensus panel
convened by the National Institutes of Health concluded that the "silent
epidemic" of severe hearing loss, warranted screening all newborns for hearing
disorders, which affect one to three of every 1,000 babies born in this country.
The panel also said that because as much as 30 percent of childhood hearing loss
developed after the newborn period, periodic hearing screening should take place
throughout childhood.
Though professional groups were at first skeptical
about these recommendations, in late 1994 universal newborn hearing
screening was endorsed by the Joint Committee on Infant Hearing, made
up of representatives of the American Academy of Pediatrics, the American
Speech-Language-Hearing Association and the American Academy of
Otolaryngology-Head and Neck Surgery.
Since then, many states have
passed laws establishing the circumstances and timetables for setting up
screening programs, and at least 400 hospitals now have screening programs. But
in many states, the laws exempt small hospitals and birthing centers or insist
only that a majority of infants be tested. Those loopholes allow many
hearing-impaired babies to fall through the cracks. The only way parents can
know for sure if their babies have been tested is to ask.
Although some
experts insist that newborn testing be limited to children at high risk for
hearing loss -- like those with family histories of the problem, low birth
weight or those born with herpes infections -- this stipulation means that half
of hearing-impaired babies will not be tested and will probably be missed.
How Newborns Are Tested
In recent years, several
easy-to-use and painless screening tools have been marketed. With the most
popular device, three electrodes placed on the baby's head automatically record
brain wave activity in the auditory brain stem when a sound is played through
earphones.
It can be used on a sleeping newborn without disturbing the
baby in any way. If an infant fails the test, it is repeated days or weeks later
and, if the test is failed again, the baby is referred to an audiologist for
more tests.
Unfortunately, Dr. Schuman wrote in Contemporary Pediatrics,
"not all infants referred for evaluation after screening show up." He noted that
in Colorado, "as many as 50 percent may fail to do so."
Another
screening device uses an ear probe to record "evoked otoacoustic emissions" --
tiny sounds made by cochlea hair cells when they are stimulated. One version
costs about $5,000, uses earplugs that cost $1 and can be administered by a
trained volunteer in a busy hospital nursery or doctor's office. Testing of both
ears takes less than five minutes, Dr. Schuman said.
Pediatricians with
a testing device in the office can use it periodically to evaluate the hearing
of patients who have repeated ear infections and fluid that remains lodged in
the middle ear. If significant hearing impairment is detected, ear tubes may be
recommended to unblock the ear canal until the child gets a little older.
Parents, too, have a role to play. In addition to following through on
recommended hearing checks, they should pay close attention to how the infant
responds to sound. From birth to 3 months, a baby who can hear will react to
loud sounds, be awakened by loud sounds, be soothed by a parent's voice, turn
toward a parent when spoken to, smile when spoken to and seem to know the
parents' voices.
But Dr. Schuman cautioned that the usual clues used by
parents and pediatricians to check a baby's hearing were unreliable. Even a baby
with a severe hearing impairment may blink or act startled in response to a loud
noise, like a loud clap. The baby reacts not to the noise itself but rather to
vibrations set off by the noise. A hearing test is the only way to be sure an
infant can hear normally.
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