Transcript Should Newborn Hearing Screening be the Standard of Care

Early Hearing Detection and Intervention
in the
Year 2000
Number of Hospitals Doing Universal
Newborn Hearing Screening
1384
1200
934
1000
712
800
462
600
243
400
200
3
26
11
3
120
60
90
-0
0
ay
19
98
19
97
19
96
19
95
19
94
19
93
19
92
19
91
19
99
M
or
ea
rli
er
0
19
Number of Programs
1400
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 others
• Hearing loss is the most frequent
birth defect
Prevalence per 1,000
Reported Prevalence Rates of Bilateral Permanent Childhood
Hearing Loss (PCHL) in Population-based Studies
4.0
3.5
12
3.0
2.5
2.0
1.5
1.0
.5
0
20
1.
2.
3.
4.
5.
6.
8
9
3
4
2
7
5
11
1
25
10
6
30
35
40
45
50
55
dB Threshold Level (loss criterion)
Barr (1980), n = 65,000
Downs (1978), n = 10,726
Feinmesser et al. (1986), n = 62,000
Fitzland (1985), n = 30,890
Kankkunen (1982), n = 31,280
Martin (1982), n = 4,126,268
7.
8.
9.
10.
11.
12.
60
65
Parving (1985), n = 82,265
Sehlin et al. (1990), n = 63,463
Sorri & Rantakallio (1985), n = 11,780
Davis & Wood (1992), n = 29,317
Fortnum et al. (1996), n = 552,558
Watkin et al. (1990), n = 51,250
Percentage of Sensorineural Hearing
Losses Which Are Unilateral
Author (year)
# of Hearing Impaired
Children in Sample
% Unilateral
Kinney (1953)
1307
48%
Brookhauser, Worthington
& Kelly (1991)
1829
37%
171
35%
Watkin, Baldwin, & Laoide (1990)
Incidence per 10,000 of Congenital
Defects/Diseases
40
30
30
20
11
12
5
6
10
1
2
0
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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
Consequences of Hearing Loss
2 Severe/Profound PCHL Losses
2 Mild Bilateral and Unilateral PCHL Losses
2 Fluctuating Conductive Loss
Reading Comprehension Scores of
Hearing and Deaf Students
'
Grade Equivalents
10.0
9.0
,Deaf
8.0
' Hearing
'
'
'
7.0
'
6.0
'
5.0
'
4.0
3.0 '
2.0
,
,
8
9
,
,
,
,
,
,
,
,
,
1.0
10
11
12
13
14
15
16
Age in Years
Schildroth, A.N., & Karchmer, M.A. (1986). Deaf children in America. San Diego: College Hill Press.
17
18
Effects of Unilateral Hearing Loss
Normal Hearing
Keller & Bundy (1980)
(n = 26; age = 12 yrs)
Math
Language
Peterson (1981)
(n = 48; age = 7.5 yrs)
Math
Language
Bess & Thorpe (1984)
(n = 50; age = 10 yrs)
Social
Blair, Peterson & Viehweg (1985)
(n = 16; age = 7.5 yrs)
Math
Language
Culbertson & Gilbert (1986)
(n = 50; age = 10 yrs)
Math
Language
Social
Average Results
Math = 30th percentile
Language = 25th percentile
Social = 32nd percentile
0th
10th
20th
Unilateral Hearing Loss
30th
40th
Percentile Rank
50th
60th
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.
Outcome Measure
WISC-R Full Scale
Metropolitan Achievement Test
Math
Reading
Goldman Fristoe Articulation
Effect Size for
Less vs. More OME
.62
.48
.37
.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.
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
Yoshinaga-Itano, et al., 1996
6 Compared 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).
6 All children had bilateral hearing loss ranging from mild to profound,
and normally-hearing parents.
6 Language abilities measured by parent report using the Minnesota
Child Development Inventory (expressive and comprehension scales)
and the MacArthur Communicative Developmental Inventories
(vocabulary).
6 Cross-sectional assessment with children categorized in 4 different
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.
Language Age in Months
Expressive Language Scores for Hearing Impaired
Children Identified Before and After 6 Months of Age
35
30
25
20
15
10
Identified BEFORE 6 Months
Identified AFTER 6 Months
5
0
13-18 mos
(n = 15/8)
19-24 mos
(n = 12/16)
25-30 mos
(n = 11/20)
Chronological Age in Months
31-36 mos
(n = 8/19)
Vocabulary Size for Hearing Impaired Children
Identified Before and After 6 Months of Age
Vocabulary Size
300
250
200
150
100
Identified BEFORE 6 Months
Identified AFTER 6 Months
50
0
13-18 mos
(n = 15/8)
19-24 mos
(n = 12/16)
25-30 mos
(n = 11/20)
Chronological Age in Months
31-36 mos
(n = 8/19)
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.
Language Age (yrs)
6
Identified <6 mos (n = 25)
Identified >6 mos (n = 104)
5
4
3
2
1
0
0.8
1.2
1.8
2.2
2.8
3.2
3.8
Age (yrs)
Moeller, M.P. (1997).Personal communication
, [email protected]
4.2
4.8
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.
Status of Universal Newborn Hearing Screening
in the United States
.
.
Percentage of Births
Screened
90%+
51 - 90%
21 - 50%
1 - 20%
3
Tremendous Progress
During 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
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
Some babies are born listeners . . .
Others need your help!
www.infanthearing.org
1. There are resources available to help you
Screening is only the first part of an
Early Hearing Detection and
Intervention System
OAE Screening Prior
to Hospital
Discharge
Fail
ABR
Screening
Fail
Comprehensive Hearing
Evaluation Before 6
Months of Age
3. Just Do It!