Early Hearing Detection and Interventionin theYear 2000

Number of Hospitals Doing Universal Newborn Hearing ScreeningNumber of Programs

Why is Early Identification of Hearing Loss so Important?Congenital hearing loss interferes with the most basic human need to communicate with others

"Blindness separates people from things. Deafness separates people from people." --- Helen Keller

Why is Early Identification of Hearing Loss so Important?Congenital hearing loss interferes with the most basic human need to communicate with othersHearing loss is the most frequent birth defect

Reported Prevalence Rates of Bilateral Permanent Childhood Hearing Loss (PCHL) in Population-based Studies4.03.53.02.52.01.51.0.50 202530354045505560654298751610dB Threshold Level (loss criterion)Prevalence per 1,0001. Barr (1980), n = 65,000 7. Parving (1985), n = 82,2652. Downs (1978), n = 10,726 8. Sehlin et al. (1990), n = 63,4633. Feinmesser et al. (1986), n = 62,000 9. Sorri & Rantakallio (1985), n = 11,7804. Fitzland (1985), n = 30,89010. Davis & Wood (1992), n = 29,3175. Kankkunen (1982), n = 31,28011. Fortnum et al. (1996), n = 552,5586. Martin (1982), n = 4,126,26812. Watkin et al. (1990), n = 51,25012113

Percentage of Sensorineural Hearing Losses Which Are Unilateral # of Hearing ImpairedAuthor (year) Children in Sample % UnilateralKinney (1953)1307 48%Brookhauser, Worthington1829 37%& Kelly (1991)Watkin, Baldwin, & Laoide (1990)171 35%

Incidence per 10,000 of Congenital Defects/Diseases

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

Consequences of Hearing LossSevere/Profound PCHL LossesMild Bilateral and Unilateral PCHL LossesFluctuating Conductive Loss222

Reading Comprehension Scores of Hearing and Deaf Students'''''''',,,,,,,,,,,89101112131415161718Age in Years1.02.03.04.05.06.07.08.09.010.0Grade EquivalentsDeafHearing,'Schildroth, A.N., & Karchmer, M.A. (1986). Deaf children in America. San Diego: College Hill Press.

Effects of Unilateral Hearing LossMathLanguageMathLanguageSocialMathLanguageMathLanguageSocial0th10th20th30th40th50th60thPercentile RankNormal HearingUnilateral Hearing LossKeller & Bundy (1980)(n = 26; age = 12 yrs)Peterson (1981)(n = 48; age = 7.5 yrs)Bess & Thorpe (1984)(n = 50; age = 10 yrs)Blair, Peterson & Viehweg (1985) (n = 16; age = 7.5 yrs)Culbertson & Gilbert (1986)(n = 50; age = 10 yrs)Average ResultsMath = 30th percentileLanguage = 25th percentileSocial = 32nd percentile

Effects of Mild Fluctuating Conductive Hearing Loss Teele, et al., 1990194 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 OMEWISC-R Full Scale.62Metropolitan Achievement TestMath.48Reading.37Goldman Fristoe Articulation.43Teele, 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.

Why is Early Identification of Hearing Loss so Important?Hearing loss is the most frequent birth defectUndetected hearing loss has serious negative consequencesThere are dramatic benefits associated with early identification of hearing loss

Yoshinaga-Itano, et al., 1996Compared language abilities of hearing-impaired children identified 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, and normally-hearing parents.Language abilities measured by parent report using the Minnesota Child Development Inventory (expressive and comprehension scales) and the MacArthur Communicative Developmental Inventories (vocabulary).Cross-sectional assessment with children categorized in 4 different age groups.6666Yoshinaga-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.

13-18 mos(n = 15/8)19-24 mos(n = 12/16)25-30 mos(n = 11/20)31-36 mos(n = 8/19)05101520253035Identified BEFORE 6 MonthsIdentified AFTER 6 MonthsExpressive Language Scores for Hearing Impaired Children Identified Before and After 6 Months of AgeChronological Age in MonthsLanguage Age in Months

13-18 mos(n = 15/8)19-24 mos(n = 12/16)25-30 mos(n = 11/20)31-36 mos(n = 8/19)050100150200250300Identified BEFORE 6 MonthsIdentified AFTER 6 MonthsVocabulary Size for Hearing Impaired Children Identified Before and After 6 Months of AgeChronological Age in MonthsVocabulary Size

0.81.21.82.22.83.23.84.24.80123456Identified 6 mos (n = 104)Age (yrs)Language Age (yrs)Boys Town National Research Hospital Study of Earlier vs. LaterMoeller, M.P. (1997). Personal communication, moeller@boystown.org129 deaf and hard-of-hearing children assessed 2x each year.Assessments done by trained diagnostician as normal part of early intervention program.))

Good work,but I think we mightneed just a little more detail righthere.Implementing Effective EHDI Programs Then amiracleoccursoutStart

.Status of Universal Newborn Hearing Screeningin the United States.Percentage of Births Screened90%+21 - 50%1 - 20%351 - 90%

Tremendous ProgressDuring the Last DecadeLess 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

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

www.infanthearing.orgSome babies are born listeners . . .Others need your help!

1. There are resources available to help you

Screening is only the first part of an Early Hearing Detection and Intervention SystemOAE Screening Prior to Hospital DischargeABRScreeningFailFailComprehensive HearingEvaluation Before 6Months of Age

3. Just Do It!