The Effectiveness of Screening Programs Based on High-Risk Characteristics in Early Identification of Hearing Impairment

Abstract

Prompt identification of educationally significant hearing loss is yet an unattained goal. However, there is some evidence that the ability to identify and diagnose hearing loss at an early age has been significantly improved through the use of carefully designed screening protocols such as birth certificate-based high-risk registries. To evaluate the efficiency of birth certificate-based screening programs, 70 parents and guardians of 6-to 9-yr-old children with significant sensorineural losses were surveyed regarding their child's identification history. Each of these children was born in the state during the time a birth certificate-based screening program was in full operation. Results indicate that children with at least one risk factor for hearing impairment were identified an average of 7.7 mo earlier than children with no risk history. However, only 50% of the children with sensorineural hearing losses exhibited any of the risk factors and a significant number of children with risk factors were missed by the system. Had admission to a neonatal intensive care unit been considered a risk factor, 63% of the children would have exhibited at least one risk factor. More extensive implementation of high-risk registries in conjunction with more widespread education of parents and primary care providers regarding early behavioral indicators of hearing loss, procedures for referral, and appropriate intervention and management services needs to be considered (Ear Hear 12 5312-319).

Screening methods: Current status

“…Downs and Sterritt [1964] and Downs and Hemenway [1969] expanded these early nursery-based investigations to evaluate methodology and results of behavioral hearing screening in neonates. Based on behavioral screening of more than 17,000 newborns, Downs and Hemenway reported that 1) their behavioral technique permitted identification of infants with severe-to-profound hearing loss but failed to detect infants with milder forms of hearing impairment, 2) approximately one in 1,000 infants were born deaf, and 3) one-half of the identified infants exhibited risk factors for hearing loss, a finding remarkably similar to later reports [Pappas, 1983;Elssman et al, 1987;Mauk et al, 1991].…”

“…Based on this approach, an infant's hearing is screened only if s/he is identified "atrisk" on the basis of defined criteria such as bacterial meningitis, in utero infection, craniofacial anomaly, or other factors. [Pappas, 1983;Elssman et al, 1987;Mauk et al, 1991]. Second, despite wellknown recommendations for screening infants at-risk and decades of advocacy for early identification, the average age of identification for children with hearing loss in the United States stalled at about 12 to 18 months [Stein et al, 1983;Elssman et al, 1987;Stein et al, 1990;Harrison and Roush, 1996].…”

Community-based newborn hearing screening program in Taiwan

“…Therefore, screening protocols have focused only on infants at high risks for hearing loss. Since roughly 50% of children with congenital hearing loss do not have an established risk factor, neonates without any risk factors would be lost [9,10]. Ultimately, UNHS is very important and necessary.…”

The universal newborn hearing screening program at the University Hospital of Ferrara: Focus on costs and software solutions

“…The risk factor criteria, suggested by the Joint Committee on Infant Hearing (Table 1), are very useful for the recognition and classification of this category of subjects [22]. Regrettably, it has been reported that about 50% of the infantile cases identified with a hearing impairment, do not show none of the JCIH factors [23,24]. Therefore, a hearing screening program based only on the ''babies with JCIH risk factors'' could potentially miss a significant part of the cases presenting hearing impairment.…”