Copyright 1999 Gannett Company, Inc.
USA TODAY
May 24, 1999, Monday, FINAL EDITION
SECTION: LIFE; Pg. 10D
LENGTH: 1968 words
HEADLINE:
The cries grow louder: Check newborns' hearing High-tech test can save years of
therapy
BYLINE: Robert Davis
BODY:
Some deaf babies are lucky enough to be born
in a hospital where
inexpensive hearing tests are performed on all newborns.
Those
babies are leaving the hospital on a road toward hearing and
developing
normal language skills.
But because the tests are so
rarely administered, an estimated
30 U.S. newborns a day go home with
significant hearing impairment,
and it will take an average of 2 1/2 years
for their disability
to be discovered. By then, the children's brains will
have developed
largely without the influence of words.
This
disparity reflects the sporadic way in which new technologies
are being
introduced across the USA.
The technologies are simple tests that
expose an infant to clicking
noises and register the responses in either the
child's ear or
the brain. Both are used widely and cost less than $ 50 a
child.
Since the National Institutes of Health recommended in 1993
that
all babies undergo such testing within the first three months
of
life, about 20 states have passed laws encouraging the tests;
12 of those
demand that babies be tested. Federal legislation
is being considered that
would make it a national requirement.
But some hospitals and health
insurance systems have resisted
routine screening.
The U.S.
Preventive Services Task Force, a government-supported
committee that
advises on health screenings, studied the issue
in 1995 and found two major
problems.
First, there was not enough scientific evidence to
quantify the
benefits of early detection.
Second, there were too
many false positive readings. The committee
determined that between one and
three babies in every 1,000 births
would have serious hearing problems that
might benefit from the
testing. But more than 50 children in that group -- a
5% false
positive rate -- might fail the screening.
Mammograms
that screen women for breast cancer have the same false
positive rate.
Today, the false positive rate of infant hearing
screening
has improved and stands at 3% to 4%.
"This is an issue the task
force is revisiting now," says committee
staff director David Atkins. "It's
still not perfect. There are
still a fair amount of false positives. It's a
question of, is
it ready for prime time now?"
Committee
recommendations, which could lead to wider screening,
are expected next
year.
John Wheeler, president of the National Campaign for Hearing
Health,
says it's time to test all infants.
"This is a birth
defect that we can correct right after birth,
and these kids can grow up
self-identifying as healthy people,"
Wheeler says. "We have conquered a
major birth defect, and yet
we're not doing it."
The term "birth
defect" makes many in the deaf community cringe.
"The medical
community has a tendency to view deafness from a
pathological perspective,"
says Kathy Martin, a mental health
counselor at Spartanburg Area (S.C.)
Mental Health who works at
the School for the Deaf and Blind. "We do not see
ourselves as
having a 'pathology' or 'defect' needing to be fixed. We are
quite
happy the way we are."
19% of newborns tested
One of every 300 newborns has some hearing loss. Half of those
children have moderate to severe hearing loss in both ears.
Through traditional screening methods and limited mandatory testing
of all babies, only about 19% of newborns have their hearing checked,
but traditional screening methods have had major limitations.
A
complex brain scan that showed some hearing loss was expensive
and applied
only to babies known to be at high risk of hearing
loss -- some premature
babies and those born after problems during
pregnancy.
More
commonly, doctors could do little but expose babies to a
loud noise and try
to judge by the reaction whether the child
could hear.
But at
least half of all babies born with hearing loss are not
considered at high
risk.
"We knew by following that protocol we would miss 50% of the
babies with hearing loss," says Gilbert Herer, chairman of the
hearing
and speech department at Children's National Medical Center
in Silver
Spring, Md. "I never thought I would see the day when
I had the technology
to identify hearing loss during the newborn
period."
His program
now tests all babies born at Holy Cross Hospital using
otoacoustic emissions
testing. Since that testing began in 1997,
Holy Cross has diagnosed hearing
loss in 29 newborns.
Sometimes the problem is easy to fix. Some
babies are born with
"gunk" in the ear that is removed surgically. Other
times, the
hearing is permanently damaged because the tiny "hairs" deep
inside the ear that transmit sound signals to the brain don't
work
properly.
But today's high-tech hearing aids and cochlear implants
allow
babies whose hearing loss is identified early to grow up tuned
in
to the world around them. One hearing aid has a radio that
allows parents or
teachers to wear a microphone that transmits
their voices directly to the
ear. The mother washing dishes can
chatter as the child plays nearby,
teaching the baby language.
"The brain is developing so rapidly
during this time," Herer
says. "If you don't stimulate the auditory system,
these neural
tracks and neural clusters don't develop to support what we as
human beings use all the time."
Ringing the bell
Ten
years ago, Heather Young took her new baby, Jennifer, to the
pediatrician.
She suspected that the child was deaf. "She didn't
have a startle reflex,"
says Heather, now 31, of Lakewood, Colo.
"I said I didn't think she could
hear me."
Neither mother nor child fit the profile for being at high
risk
for hearing loss. The doctor rang a bell by Jennifer's ear, a
standard practice, and mistakenly determined that it was the mother
who
had a problem.
"He said I was a new mother and was uptight and that
I needed
to relax," she says.
Young had trouble following the
doctor's advice because nothing
seemed to bother Jennifer. The baby slept
through vacuum cleaning,
music and other noise.
At 18 months,
Jennifer still was not talking. She threw what her
mother calls "horrible
temper tantrums."
Doctors said it was probably too much TV, not
enough books and
a young mother's nervousness. "They just kept ringing that
bell,"
she says.
During a 1991 visit to another doctor with her
newborn sister,
Elise, Jennifer's silence was seen as a problem. Jennifer's
deafness
was finally diagnosed at age 3, and she was given hearing aids.
Because she had grown up in a world without noise, the racket
from the hearing aids was bothersome.
"She hated them," Young
says. "She buried them in the sandbox,
dunked them in Kool-Aid, flushed them
down the toilet, tried to
feed them to the dog and threw them out the car
window."
It took a year for her to want the hearing aids. The change
came
when, at age 4, she began to talk.
After six years and $
17,000 worth of speech and language therapy,
Jennifer is now about two years
behind her peers in school.
"She will never catch up," Young says.
"When you think of the
baby's development, there is a huge piece that
Jennifer just didn't
get. She's certainly not lazy. That's just the reality
of late
identification."
Hearing aids at 8 weeks
Before her son Ty was born in 1993, Young heard that Poudre Valley
Hospital in Fort Collins, Colo., was testing all newborns for
hearing
loss.
She decided to have her third child in that northern Colorado
town, and within 12 hours of his birth Ty was found to have a
hearing
loss.
"I didn't care who delivered the kid, I just wanted the test,"
she says. Ty had hearing aids at eight weeks, "before he knew
he had
hands," she says. "He babbled, and everything around
him was noisy, noisy.
He loved it. His language progressed typically."
Now 5 and in
kindergarten, "he's a mainstream kid," she says.
"He doesn't need special
services. He has really good articulation.
If you didn't see him with short
hair (revealing his hearing aids),
you would not know he is hearing
impaired."
Although there was no hearing loss in Young's family or
her husband's,
all three of their children have similar hearing loss.
Elise, the middle child, whose hearing loss was detected a year
after birth, was comfortable with her hearing aids by age 2 and
is about
a year and a half behind her peers in language development.
Space-age technology
The test that led to the NIH
recommendation, the otoacoustic emissions
test that helped Ty and others,
came from a blend of technologies
-- one used in space and one that began
underground.
David Kemp, a British physicist who listened to ground
echoes
to find oil deposits, decided to try to apply the technology to
human testing.
One common form of hearing loss involves damage
to the "hairs"
deep inside the cochlea in the ear. The hairs actually are
sensory
filaments that, when moved by sound waves, send signals to the
brain. When these hairs are damaged, they don't move, and the
person
gets no signal.
Kemp thought that if he could hear oil deposits in
the ground,
he could listen for the movement of the hairs. Moving hairs
would
imply, but not guarantee, the person could hear.
"People
said this guy was nuts," Herer says. "These echoes
are very soft."
To hear the sound of movement on a molecular level, Kemp had to
use space-age microphones.
"The technology of these microphones
being built today allowed
him to document what he suspected all the time,"
Herer says.
"The key is this technology. Before we had a reasonably
inexpensive
testing method, all we could say is we know there are infants
with hearing loss."
This test costs about $ 35 a child.
Silencing the bell
Young says the new technology has
helped absolve her feelings
of guilt over Jennifer's struggle. "It's been
very healing,"
she says. When Jennifer was born, the technology wasn't
there.
"There is no excuse now" for children not to be tested, she
says.
She travels across the country pushing legislation that would
make testing mandatory.
Combined, her daughters have run up $
27,000 worth of speech therapy
bills. Because her insurance would not pay
for it, she applied
for and received Colorado assistance for children with
disabilities.
"The taxpayers are paying for that," she says. Paying
for the
$ 35 test for every baby and then fitting the children with hearing
aids so they learn to communicate normally would be a better deal,
she
says.
Wheeler, of the Deafness Research Foundation, says that to
test
every newborn in the nation would cost less than $ 200 million,
which he calls "really tiny."
Young wants to see technology
silence the bell.
"Me and that stupid bell," she says. "If I ever do
anything
in my life, I want to ram that bell down somebody's throat. I
can't believe how many doctors have told me to relax."
Early signs of ear trouble
If your baby
doesn't have the following behavior, talk to your
doctor.
Birth
to 3 months
* Reacts to loud sounds
* Is soothed by your
voice
* Turns head to you when you speak
* Is awakened
by loud voices and sounds
* Smiles when spoken to
*
Seems to know your voice and quiets down if crying
3 to 6 months
* Looks upward or turns toward a new sound
* Responds to
"no" and to changes in tone of voice
* Imitates his/her own voice
* Enjoys rattles and other toys that make sound
* Begins
to repeat sounds (such as ooh, aah and ba-ba)
* Becomes scared by a
loud voice.
For a complete hearing checklist for children up to age
3, call
800-829-5934, or visit the National Campaign for Hearing Health
Web site: www.hearing health.net.
FOR TEXT WITHIN GRAPHIC
"Detecting hearing
loss" PLEASE SEE MICROFICHE
GRAPHIC: GRAPHIC, B/W, Grant Jerding, USA TODAY,
Source: University of Washington's VM Bloedel Hearing Research Center and USA
Today research; PHOTO, B/W, Tim Dillon, USA TODAY; PHOTO, B/W, Bill Clare; Sound
advice: Hearing screening technician Jacob Pimentel conducts a second-day check
of a newborn in April. The newborn had failed an initial test performed hours
after birth. Urging testing: Heather and Robert Young of Lakewood, Colo., with
children Ty, left, Elise and Jennifer w.
LOAD-DATE: May
24, 1999 
