Early Hearing Detection & Intervention

Every day, 33 babies are born in the United States with permanent hearing loss. With 3 of every 1,000 newborns having a hearing loss, it is the most frequently occurring birth defect. ^(1-8)

Each day infants are discharged from the hospital at birth without receiving an initial hearing screening. By missing these critical opportunities, infant hearing loss goes undetected for several years in nearly half of the cases. Consequently, these children miss out on early intervention to increase their language, cognitive, and social skills and their overall development is severely delayed. ^(1-8)

Less than 20% of the children born in the U.S. are born in hospitals that offer universal newborn hearing screening programs. The National Institute of Health, American Academy of Pediatrics, American Academy of Audiology, the Joint committee on Infant Hearing, and the Healthy People 2000 Report recommend that children with congenital hearing loss be identified before six months of age. ^(1-8)

Hearing loss among newborns is 20 times more prevalent than phenlyketonuria (PKU), a condition for which all newborns are screened.^(1-8)

Research has confirmed that treatment has the best results when infant hearing loss is identified and intervention is begins before the child reaches six months of age. Hearing loss among newborns is 20 times more prevalent than phenlyketonuria (PKU), a condition for which all newborns are screened.^(1-8)

The cost per child identified with congenital hearing loss is about 1/10^th the cost per child identified with PKU, hypothyroidism, or sickle cell anemia in metabolic disorder screening programs. Such metabolic disorder screening programs are required in all 50 states.^(1-8)

Research has compared children with hearing loss who receive early intervention and amplification before 6 months of age versus after 6 months of age. By the time they enter first grade, children identified earlier are 1-2 years ahead of their later-identified peers in language, cognitive, and social skills.^(1-8)

The average age that children with hearing loss are initially diagnosed, ranges from 12 to 25 months. Nearly 50% of newborns with hearing loss are not diagnosed until at least the second year of life. Studies have shown that when hearing loss is detected later, an important time frame for developing speech and language skills has passed. As a result, speech and language development is delayed and academic and social skills may be adversely affected.^(1-8)

A unilateral hearing loss that remains undetected will have negative consequences. Even children with a hearing loss in one ear are ten times as likely to be held back by a grade as compared to children with normal hearing in both ears. Infants identified with hearing loss may be fit with hearing amplification as young as four weeks of age. ^(1-8)
Appropriate and

comprehensive early intervention helps these children develop with better language, cognitive, and social skills. ^(1-8)

The evidence for the benefits, practicability, and cost-efficiency of Early Hearing Detection and Intervention is so compelling that 38 states have passed legislative mandates requiring hospitals to screen all newborns for hearing loss. Similar legislation is pending in several other states. ^(1-8)

The cost for hospital-based universal newborn hearing screening is very inexpensive and continues to decrease. Using current technology, the cost ranges from $10-$50 per baby depending on the protocol and technology used. ^(1-8)

The earlier hearing loss occurs in a child's life, the more serious the effects on the child's development. Similarly, the earlier the problem is identified and intervention begun, the less serious the ultimate impact. ^(1-8)

When early identification and intervention occurs, hearing impaired children make dramatic progress, are more successful in school, and become more productive members of society. ^(1-8)

The American Academy of Pediatrics, the American Academy of Audiology, the Joint Committee on Infant Hearing, and the National Association of the Deaf have recommended that all babies be screened for hearing loss before they leave the hospital. ^(1-8)

With screening, most cases of hearing loss can be detected prior to 3 to 4 months of age. With early identification, parents have the opportunity to communicate with their child beginning early in infancy. This improves language development for the child and strengthens the parent-child bonding. Research suggests that most preschool-age children with hearing loss will have language development within the normal range if intervention begins by 6 to12 months of age. It is widely believed that this will lead to improved school performance and occupational success. ^(1-8)

The cost-effectiveness of early detection depends on long-term outcomes. To the extent that improved language leads to lower special education costs and to improved learning potential, the monetary benefits of screening are likely to exceed the costs. The savings in special education costs are likely to exceed the costs of screening within 5 years. ^(1-8)

If it remains undetected, even mild hearing loss or hearing loss in only one ear has substantial detrimental consequences. For example, research shows that children with hearing loss in one ear are ten times as likely to be held back at least one grade compared to a matched group of children with normal hearing. ^(1-8)

Research shows that by the time a child with hearing loss graduates from high school, more than $400,000 per child can be saved in special education costs if the child is identified early and given appropriate educational, medical, and audiological services. These savings in special education costs will pay for universal newborn hearing screening many times over. ^(1-8)

All babies should be screened for hearing loss in the birth hospital, and comprehensive, family-centered service should be available for identified children and families. Such statewide early hearing detection and intervention programs are now operational in most states. ^(1-8)

Infants with hearing loss can be fit with amplification before they are 1 month old. With appropriate family-centered intervention, normal language, cognitive, and social development for such infants is likely. ^(1-8)

The practicability and cost-efficiency of hospital-based universal newborn hearing screening is demonstrated by the fact that more than1,000 hospitals throughout the country are operating successful universal newborn hearing screening programs. ^(1-8)

In 1993, a Consensus Panel convened by the National lnstitutes of Health concluded "that all infants should be screened for hearing impairment. . . . This will be accomplished most efficiently by screening prior to discharge. . . . Infants who fail . . . should have a comprehensive hearing evaluation no later than 6 months of age" (www.nih.gov) ^(1-8)

There are four major ways in which hearing loss affects children--
1. It causes delay in the development of receptive and expressive communication skills (speech and language).
2. The language deficit causes learning problems that result in reduced academic achievement.
3. Communication difficulties often lead to social isolation and poor self-concept.
4. It may have an impact on vocational choices.

^(1-8)

References

The background and supporting information contained in this document is a compilation of research findings. All information presented here should be attributed to its referenced source and should not be considered a reflection of other organizations cited in the text. Additionally, multisource complilation is listed above, and idividual sources are listed below in the case that one would like to look at each individual document individually.

¹Centers for Disease Control and Prevention. Economic costs associated with mental retardation, cerebral palsy, hearing loss, and vision impairment --- United States, 2003. MMWR 2004;53:57-9.

²Honeycutt AA, Grosse SD, Dunlap LJ, Schendel DE, Chen H, Brann E, al Homsi G. Economic costs of mental retardation, cerebral palsy, hearing loss, and vision impairment. In: Altman BM, Barnartt SN, Hendershot GE, Larson SA, editors. Using survey data to study disability: results from the National Health Interview Survey on Disability. Research in social science and disability, volume 3. Amsterdam: Elsevier; 2003. p. 207-28.

³Luterman, D.M. (2002). When your child is deaf: A guide for parents (2nd ed.). Parkton, MD: York Press.

⁴Medwid, D.J., & Weston, D.C. (1995). Kid-friendly parenting with deaf and hard of hearing children: A treasury of fun activities toward better behavior. Washington, DC: Gallaudet University Press.

⁵Ogden, P.W. (1996). The silent garden: Raising your deaf child (Rev. ed.). Washington, DC: Gallaudet University Press.

⁶Schwartz, S. (Ed.). (1996). Choices in deafness: A parents' guide to communication options (2nd ed.). Bethesda, MD: Woodbine House.

⁷So your child has a hearing loss: Next steps for parents (n.d.). http://www.nichcy.org/pubs/factshe/fs3txt.htm#edimps. http://www.nlm.nih.gov/medlineplus/hearingproblemsinchildren.html Grosse S. Newborn hearing evidence-statement: screening. In: Campbell KP, Lanza A, Dixon R, Chattopadhyay S, Molinari N, Finch RA, editors. A Purchaser's Guide to Clinical Preventive Services: Moving Science into Coverage. Washington, DC: National Business Group on Health; 2006.

⁸The recommendations and supporting information contained in this document came from several sources, including the:
• American Academy of Audiology
• American Academy of Pediatrics (AAP)
• American Speech, Language, and Hearing Association
• Centers for Disease Control and Prevention (CDC)
• Directors of Speech and Hearing Programs in State Health and Welfare Agencies
• Joint Committee on Infant Hearing (JCIH)
• Health Resources and Services Administration (HRSA)
• National Center for Hearing Assessment and Management (NCHAM)
• National Institutes on Health (NIH)