League for the Hard of Hearing Early ID Fact Sheet

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Early Identification of Hearing Loss in Infants

FACT SHEET

1. Prevalence data suggest that 3-4 infants per 1000 will have a permanent hearing loss. The National Institute of Health (NIH), the American Academy of Pediatrics, the American Academy of Audiology, the Joint Committee on Infant Hearing, and the Healthy People 2000 Report have all recommended that children with congenital hearing loss be identified before six months of age. NIH recommended that universal newborn hearing screening programs be implemented, so that all babies would be screened before discharge from the hospital nursery. If a baby fails the screening, he or she is then referred for a complete audiological evaluation. If a hearing loss is diagnosed, appropriate amplification can be fit and the baby can be enrolled in an early intervention habilitation program. No child is too young to use amplification or to begin habilitation.
2. In the United States, the average age of identification of children with significant hearing loss is estimated between 18 and 30 months of age. This estimate is dependent on the degree of hearing loss. Severe to profound hearing loss is typically diagnosed between 11 and 17 months of age, but mild to moderate hearing loss is often not diagnosed until a child enters school. If hearing loss is not diagnosed early, it is difficult, if not impossible, for many children to acquire basic language, social, and cognitive skills.
3. A delay in diagnosis of hearing loss can have an irreversible effect on speech and language development. The presence of a severe to profound hearing loss precludes any access to speech without amplification and results in the lack of development of speech and oral language. Less severe hearing loss does not totally preclude access to speech, but depending on the degree of the loss, will have a significant impact and varied effect on speech and language development. There is considerable evidence to support the fact that regardless of the type of intervention strategy chosen (auditory/oral approach or total communication approach), overall communication skills are enhanced in children who have their hearing loss diagnosed and begin intervention within the first six months of life.
4. The technology exists to conduct universal newborn hearing screening programs and the number of hospitals with programs is growing. Currently, 28 states now mandate universal newborn hearing screening. Tests now exist that enable hearing screening to be conducted on all newborns, in a cost-effective manner: a) evoked otoacoustic emissions - a test that measures sounds that are generated in the cochlea (the organ of hearing in the inner ear) in response to stimuli presented to the ear. These sounds can be measured in the ear canal with a miniature microphone. The test is fast, non-invasive, and can be easily measured in well babies and also infants in the intensive care nursery; b) auditory brainstem response screening - a test that is a physiological measure of the auditory system to sounds presented to the ear. Three or four electrodes are pasted to the scalp to record brain activity in response to sound. This procedure has been used widely in programs that screen babies considered to be high risk for hearing loss. The clinical feasibility of this measure for universal hearing screening has not yet been published. In nationwide universal screening programs, more babies have been screened with evoked emissions than with brainstem response measures. Both tests are painless.
5. Universal newborn hearing screening programs are cost-effective. The total cost for hospital-based programs using current technology ranges from $10-60 per child depending on the protocol and technology used. The cost of identifying children with congenital hearing loss is about 1/10th the cost of identifying children with PKU, hypothyroidism, or sickle cell anemia, using metabolic disorder screening programs (which are required in all 50 states).
6. Not all early onset hearing loss is present at birth. Hearing loss can develop at any time. Hearing loss that develops after birth will not be diagnosed as part of a universal newborn hearing screening program. Therefore, pediatricians must be aware of the indicators of hearing loss, and refer an infant to a pediatric audiologist for a hearing test as soon as there is any suspicion of a problem. Parental concern alone should be considered enough of a reason for referring for a hearing test. Parents need to be educated regarding hearing development and what to do if they suspect their child is not hearing normally.

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