Early Hearing Detection and Intervention in the Year 2000

1
Early Hearing Detection and Interventionin
theYear 2000
2
Number of Hospitals Doing Universal Newborn
Hearing Screening
Number of Programs
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Why is Early Identification of Hearing Loss so
Important?

• Congenital hearing loss interferes with the most
  basic human need to communicate with others

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"Blindness separates people from
things. Deafness separates people
from people."
--- Helen Keller
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Why is Early Identification of Hearing Loss so
Important?

• Congenital hearing loss interferes with the most
  basic human need to communicate with others
• Hearing loss is the most frequent birth defect

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Reported Prevalence Rates of Bilateral Permanent
Childhood
Hearing Loss (PCHL) in Population-based Studies
4.0
3.5
12
3.0
2.5
8
Prevalence per 1,000
9
2.0
3
4
1.5
5
7
2
1.0
11
10
.5
1
6
0
20
25
30
35
40
45
50
55
60
65
dB Threshold Level (loss criterion)
1. Barr (1980), n 65,000
7. Parving (1985), n 82,265
2. Downs (1978), n 10,726
8. Sehlin et al. (1990), n 63,463
3. Feinmesser et al. (1986), n 62,000
9. Sorri Rantakallio (1985), n 11,780
4. Fitzland (1985), n 30,890
10. Davis Wood (1992), n 29,317
5. Kankkunen (1982), n 31,280
11. Fortnum et al. (1996), n 552,558
6. Martin (1982), n 4,126,268
12. Watkin et al. (1990), n 51,250
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Percentage of Sensorineural Hearing
Losses Which Are Unilateral

of Hearing Impaired
Author (year) Children
in Sample Unilateral
1307

48
Kinney (1953)
1829

37
Brookhauser, Worthington
Kelly (1991)
171

35
Watkin, Baldwin, Laoide (1990)
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Incidence per 10,000 of Congenital
Defects/Diseases
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Why is Early Identification of Hearing Loss so
Important?

• Congenital hearing loss interferes with the most
  basic human need to communicate with others
• Hearing loss is the most frequent birth defect
• Undetected hearing loss has serious negative
  consequences

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Consequences of Hearing Loss
Severe/Profound PCHL Losses
2
Mild Bilateral and Unilateral PCHL Losses
2
Fluctuating Conductive Loss
2
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Reading Comprehension Scores of
Hearing and Deaf Students
10.0
'
9.0
Deaf
,
'
Hearing
'
8.0
'
7.0
'
6.0
'
Grade Equivalents
5.0
'
4.0
'
3.0
'
,
,
,
,
,
,
,
2.0
,
,
,
,
1.0
8
9
10
11
12
13
14
15
16
17
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Age in Years
Schildroth, A.N., Karchmer, M.A. (1986).
Deaf children in America
. San Diego College Hill Press.
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Effects of Unilateral Hearing Loss
Normal Hearing
Unilateral Hearing Loss
Math
Keller Bundy (1980)
(n 26 age 12 yrs)
Language
Math
Peterson (1981)
(n 48 age 7.5 yrs)
Language
Social
Bess Thorpe (1984)
(n 50 age 10 yrs)
Math
Blair, Peterson Viehweg (1985)
Language
(n 16 age 7.5 yrs)
Math
Culbertson Gilbert (1986)
Language
(n 50 age 10 yrs)
Social
Average Results
0th
10th
20th
30th
40th
50th
60th
Math 30th percentile
Percentile Rank
Language 25th percentile
Social 32nd percentile
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Effects of Mild Fluctuating Conductive Hearing
Loss
Teele, et al., 1990
194 children followed prospectively from 0-7
years.
)
Days child had otitis media between 0-3 years
assessed during normal visits to physician.
)
Data on intellectual ability, school achievement,
and language competency individually
)
measured at 7 years by "blind" diagnosticians.
Results for children with less than 30 days OME
were compared to children with more than
)
130 days adjusted for confounding variables.

Effect Size for
Outcome Measure
Less vs. More OME
WISC-R Full Scale
.62
Metropolitan Achievement Test
Math
.48
Reading
.37
Goldman Fristoe Articulation
.43
Teele, D.W., Klein, J.O., Chase, C., Menyuk, P.,
Rosner, B.A., and the Greater Boston Otitis media
Study Group (1990).
Otitis media in infancy and intellectual
ability, school achievement, speech, and language
at age 7 years.
The Journal


of Infectious Diseases
,
162
, 685-694.
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Why is Early Identification of Hearing Loss so
Important?

• Hearing loss is the most frequent birth defect
• Undetected hearing loss has serious negative
  consequences
• There are dramatic benefits associated with early
  identification of hearing loss

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Yoshinaga-Itano, et al., 1996
Compared language abilities of hearing-impaired
children identified
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before 6 months of age (n 46) with similar
children identified after 6
months of age (n 63).
All children had bilateral hearing loss ranging
from mild to profound,
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and normally-hearing parents.
Language abilities measured by parent report
using the Minnesota
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Child Development Inventory (expressive and
comprehension scales)
and the MacArthur Communicative Developmental
Inventories
(vocabulary).
Cross-sectional assessment with children
categorized in 4 different
6
age groups.
Yoshinaga-Itano, C., Sedey, A., Apuzzo, M.,
Carey, A., Day, D., Coulter, D. (July 1996).
The effect of early


identification on the development of deaf and
hard-of-hearing infants and toddlers
. Paper presented at the
Joint Committee on Infant Hearing Meeting,
Austin, TX.
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Expressive Language Scores for Hearing Impaired
Children Identified Before and After 6 Months of
Age
35
30
25
Language Age in Months
20
15
10
Identified BEFORE 6 Months
5
Identified AFTER 6 Months
0
13-18 mos
19-24 mos
25-30 mos
31-36 mos
(n 15/8)
(n 12/16)
(n 11/20)
(n 8/19)
Chronological Age in Months
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Vocabulary Size for Hearing Impaired Children
Identified Before and After 6 Months of Age
300
250
200
Vocabulary Size
150
100
Identified BEFORE 6 Months
50
Identified AFTER 6 Months
0
13-18 mos
19-24 mos
25-30 mos
31-36 mos
(n 15/8)
(n 12/16)
(n 11/20)
(n 8/19)
Chronological Age in Months
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Boys Town National Research Hospital Study of
Earlier vs. Later
129 deaf and hard-of-hearing children assessed 2x
each year.
)
Assessments done by trained diagnostician as
normal part of early intervention program.
)
6
Identified lt6 mos (n 25)
5
Identified gt6 mos (n 104)
4
3
Language Age (yrs)
2
1
0
0.8
1.2
1.8
2.2
2.8
3.2
3.8
4.2
4.8
Age (yrs)
Moeller, M.P. (1997).
Personal communication
, moeller_at_boystown.org
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Implementing Effective EHDI Programs
out
Then a
miracle
occurs
Start
Good work,
but I think we might
need just a little
more detail right here.
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Status of Universal Newborn Hearing Screening in
the United States
.
Percentage of Births Screened
.
90
51 - 90
21 - 50
1 - 20
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Tremendous ProgressDuring the Last Decade

• Less than 30 with UNHS in 1993 compared with
  almost 1400 today
• Almost 2 million babies are screened every year
  prior to discharge
• 32 states have passed legislation related to
  newborn hearing screening

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The Other Side of the Coin . . . .

• 2,700 hospitals are not yet screening for hearing
  loss
• More than 2 million babies are NOT screened
  every year prior to discharge
• Most states who have passed legislation have not
  yet implemented it
• Only 9 states (accounting for 7 of the births)
  have implemented reasonable state wide programs

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Some babies are born listeners . . .
Others need your help!
www.infanthearing.org
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1. There are resources available to help you
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Screening is only the first part of an Early
Hearing Detection and Intervention System
OAE Screening Prior
ABR
Comprehensive Hearing Evaluation Before 6 Months
of Age
to Hospital
Screening
Fail
Fail
Discharge
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3. Just Do It!